Kenneth V. Iserson, MD, MBA


Western J Emerg Med. 2020;21(3):477-483. 

In This Article

Abstract and Introduction


As clinicians and support personnel struggle with their responsibilities to treat during the current COVID-19 pandemic, several ethical issues have emerged. Will healthcare workers and support staff fulfill their duty to treat in the face of high risks? Will institutional and government leaders at all levels do the right things to help alleviate healthcare workers risks and fears? Will physicians be willing to make hard, resource-allocation decisions if they cannot first husband or improvise alternatives?

With our healthcare facilities and governments unprepared for this inevitable disaster, front-line doctors, advanced providers, nurses, EMS, and support personnel struggle with acute shortages of equipment—both to treat patients and protect themselves. With their personal and possibly their family's lives and health at risk, they must weigh the option of continuing to work or retreat to safety. This decision, made daily, is based on professional and personal values, how they perceive existing risks—including available protective measures, and their perception of the level and transparency of information they receive. Often, while clinicians get this information, support personnel do not, leading to absenteeism and deteriorating healthcare services. Leadership can use good risk communication (complete, widely transmitted, and transparent) to align healthcare workers' risk perceptions with reality. They also can address the common problems healthcare workers must overcome to continue working (ie, risk mitigation techniques). Physicians, if they cannot sufficiently husband or improvise lifesaving resources, will have to face difficult triage decisions. Ideally, they will use a predetermined plan, probably based on the principles of Utilitarianism (maximizing the greatest good) and derived from professional and community input. Unfortunately, none of these plans is optimal.


Disasters recur on a regular basis. In any disaster, and especially in those caused by disease, the public expects healthcare professionals to be on the front lines. Indeed, most healthcare professionals expect that of themselves and their colleagues. In most disasters, and certainly during the current COVID-19 pandemic, frontline healthcare professionals face two key ethical issues: (1) whether to respond despite the risks involved; and (2) how to distribute scarce, lifesaving medical resources. In this paper, I discuss how healthcare professionals weigh risk factors related to their response and the actions the healthcare community can take, including proper communication and mitigating responder concerns, to maximize and maintain our caregiver workforce. I then very briefly discuss the ethics of scarce resources and suggest options, such as recalling retired clinicians to service, improvisation, and husbanding available resources to mitigate rationing.