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) 

In This Article

Ethical Reflection

The COVID-19 pandemic puts two ethical frameworks in direct tension with each other. In standard practice, nurses embrace a principle- or virtue-based framework that focuses on respect for patient autonomy. We strive to help patients in front of us navigate their illness or injury and minimize suffering; our patients, in a normal state, guide our work. However, when resources are severely limited, we're asked to participate in a shift that means some patients may not have access to the treatment they desire. This utilitarian framework asks organizations to work together to achieve the greatest good for the greatest number of people in their shared communities. Crisis standards of care are designed to provide fairness through the equitable allocation of scarce resources.

However, a fair process during a disaster may not feel fair, and doing our best may not feel like enough when individual patient needs outpace our ability to meet them. We should strive for our best and be forgiving when it doesn't feel good enough. We can minimize harm by speaking up, seeking support inside and outside of our organizations, and leading the way to forge creative paths forward. We don't know how long the COVID-19 pandemic will last, but as the surge of patients fluctuates, we must act to minimize the strain of looming cumulative distress now. Work must continue to outline methods of support during this acute phase until we reach a place to rebuild.

The declaration of a public health emergency has shifted some elements of the standards of care already. We must prevent further spread of the disease, which can't be achieved without protecting healthcare providers so we can safely care for patients. That means we must preserve scarce PPE for those at the bedside by limiting visitation and postponing elective surgeries as able. How we demonstrate compassion in a crisis will, by necessity, look and feel different. It may not feel good to not have access to the choices we're used to, but this doesn't mean individual providers are doing anything wrong. The PPE shortage has exposed gaps in our health system, but the pandemic requires that we put our trust in a flawed system. We must act together to promote solidarity and work to provide equitable care to our community and patients.

These are uncertain times. Sadly, no perfect options exist during a pandemic, but moral distress can be mitigated when we listen to all perspectives, identify sources of conflict, and, when presented with limited choices, seek to identify options that minimize moral harm. Nurses must continue to speak up and reach out. We can bring calm to our patients, our community, and our profession during this challenging time. We're in this together.