Ethics in a Pandemic

Laura Webster, DBE, RN, HEC-C, CEN; Lucia D. Wocial, PhD, RN, FAAN, HEC-C

Am Nurs Journal. 2020;15(9)

Abstract and Introduction

Introduction

Nurses need to engage in self-care to reduce moral distress.

Takeaways:

The COVID-19 pandemic brings many ethical dilemmas for nurses and their patients.
The ethical framework used during a crisis remains significantly different than in a normal state.
This article provides an overview of the ethical framework used in crisis standards of care and begins to explore methods to support identifying and addressing moral distress at the bedside.

Disasters, including global pandemics such as COVID-19, disrupt standard care and present ethical challenges. Planning helps us prepare for disasters, but it can't eliminate the ethical dilemmas and moral distress that clinicians will face. Staffing and supply shortages and patient surges require nurses and other healthcare providers to make decisions that may not align with standard care but are necessary under the circumstances. Familiarity with the ethical foundations for shifting standards of care will help nurses navigate moral distress and achieve some degree of resilience during challenging times.

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Sidebar 1

Scarce Resource Allocation

This table illustrates how a resource (in this case, masks) is allocated during patient surges in conventional, contingency, and crisis states of a pandemic. Masks are the indicator, and percent reduction in supply is the trigger. Multiple strategies are applied as supplies diminish. (The % values are for illustration purposes only.)

Mask allocation during patient surges
	Conventional (surplus)	Contingency (20%)	Crisis (50%)
Prepare	• Review current supply. • Evaluate consumption rate for surge stockpile.
Conserve	• Limit nonessential personnel/students. • Reuse patient masks.	• Limit elective procedures. • Limit visitors. • Group patients with similar conditions.
Substitute*	• Seek new sources.	• Use N95 as a substitute for powered air-purifying respirator*. • Request supplies from national stockpile.
Adapt*		• Use surgical masks with face shield. • Use fabric masks.
Refuse*		• Clean and resterilize masks. • Allow prolonged use.
Allocate**			• Prioritize highest-risk clinicians. • Limit use (e.g., a patient with a fever may not wear a mask, but the clinician should).
Reallocate**			• Limit treatment interventions when masks aren't available.
Per Centers for Disease Control and Prevention, U.S. Occupational Safety and Health Administration, and public health guidance *Per regional, state, and/or federal guidance