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We are living in very unusual times, with most countries globally affected by the Covid-19 pandemic. In the midst of politicisation, pointing fingers, blame-games and harsh statements from many circles, it is imperative that we clinicians must have a clear standpoint regarding the ethical aspects of this whole scenario.
In addition to ill-health (both physical and psychological) caused by this pandemic, there are multifarious major ethical concerns with respect to personal and social responsibilities, economic adversities and vulnerability of groups of individuals such as the elderly. The ethical dimensions broadly pertain to two major areas – healthcare and the societal settings. With respect to healthcare, resource allocation and rationing are one of the major issues. Throughout the world, it is common knowledge that public healthcare systems are underfunded and this pandemic has opened the eyes of many regarding the importance of strengthening primary and public healthcare allocating more resources to this area of medicine. Until vaccines and treatment drugs are developed, the primary method of preventing this disease is personal and public hygiene, in addition to isolation.
In countries where there is a raging spread of the disease and the healthcare settings are overwhelmed, there is already rationing of services based on ad hoc criteria. This includes denying testing, hospitalization, ICU care, ventilatory support, etc. We must have sound predetermined criteria decided by Ethics Committees and similar organizations.
With regards to healthcare providers, there have been situations where they need to attend to Covid-19 patients without appropriate personal protective equipment (PPE), which has introduced an ethical (and legal) dilemma of whether the providers can refuse to attend to patients in the absence of a proper PPE. Hoarding of drugs, PPE, and use of untested drugs are other major ethical concerns of note.
Health research is extremely crucial at this juncture; however, highest ethical standards must be adhered to, especially when new interventions and clinical trials are undertaken. With respect to societal settings, although fraught with controversies, when there is a national lockdown, it is everyone’s personal responsibility to abide by the rules, not only because it is illegal, but also because every single person may be an attributable cause for spreading the virus. This concern for others (beneficence) is one of the major personal ethical responsibilities, one should display at this point of time.
Another important social responsibility is avoiding the spread of fake news, unverified claims, sensational news, protected health information of patients in the social media. Price-gouging, hoarding essential amenities, distributing things on sectarian or other such discriminatory basis are all unethical behaviours reported during this time of pandemic.
CMJ wishes to reinforce the personal and social ethical responsibilities of every clinician as a global citizen, during these important times of our life in order to tide over this scourge collectively, adopting scientific and ethical strategies.
We wish you all a safe and healthy life ahead.