Improving Patient Care Delivery

As a newly established independent physician in a healthcare environment that is still dealing with the COVID-19 pandemic, you may have questions about resources available to you and your patients and how you should handle certain sensitive topics. Here are some helpful tips for dealing with questions of ethics and COVID treatment options.

Why did ethics become such an issue during the pandemic?

In the early months of the COVID-19 pandemic, ethical questions arose about prioritizing treatment, personal protective equipment (PPE) availability and use, testing requirements, and even resuscitation decisions, as discussed by researchers publishing in medical journals in 2020. As the outbreak continues, and even resurges, the ethical challenges continue.

For independent physicians, those questions include prioritizing patients for medical care. As the researchers point out, healthcare providers face a major burden in the number of patients that need their care, even as resources may still be limited. They emphasize that the relationship between ethics and medicine is unequivocal. As the ethical challenges emerging from the pandemic are identified and resolved, physicians can make better decisions in maintaining the highest quality of care for their patients.

Do you have to disclose your own health information to your patients?

The ethical question of disclosing a physician’s health status to patients is not unique to the COVID-19 pandemic. During the early days of the AIDS epidemic, physicians struggled with whether to disclose their HIV status. In 1988, the Council on Ethical and Judicial Affairs (CEJA) acknowledged that “the rights to privacy and to confidentiality of the AIDS victim . . . are absolute until they infringe in a material way on the safety of another person or persons.”

The American Medical Association (AMA) states that “physicians themselves have the right to have the confidentiality of their personal health information respected, including information about what conditions they have or have not been vaccinated for.” However, the AMA also states that physicians may wish to voluntarily disclose their vaccination status and, in fact, by doing so may be able to encourage patients to do the same. The organization emphasizes that if patients ask about their status, physicians should answer truthfully.

Do you have an ethical duty to treat an infected patient?

The decision to decline to treat an infected or unvaccinated patient is a question of ethics faced by many independent physicians during the pandemic. To address this issue, the AMA Code of Medical Ethics has been revised to reflect the need for the provider and the clinical staff to remain safe and available to treat all patients:

The duty to treat is foundational to the profession of medicine but is not absolute. The health care workforce is not an unlimited resource and must be preserved to ensure that care is available in the future. For their part, physicians have a responsibility to protect themselves, as well as a duty of solidarity to colleagues to share risks and burdens in a public health crisis. So too, health care institutions have responsibilities to support and protect health care professionals and to apportion the risks and benefits of providing care as equitably as possible.

What is the role of ethics for providers in moving beyond the pandemic?

Given the proliferation of information, and misinformation, on social media and other platforms throughout the pandemic, independent physicians may now also face the need to restore trust with their patients. That can be best done through transparency and open communication, as well as a willingness to educate patients on the facts of the virus, vaccines, and treatment options.

As experts point out, ethics should be meaningfully positioned to inform decisions at the practice level, in the community, and even globally. They emphasize that during a public health emergency, epidemiologists are expected to contribute their expertise and experience, but ethicists should also be called on to inform a coherent ethical response to the challenges healthcare providers will face during a crisis such as the pandemic.