Ethical guidance for frontline staff dealing with the COVID-19 pandemic has been published, supported by the Royal College of Physicians of Edinburgh ('the College') and over a dozen other health organisations.
The guidance takes into consideration recent joint statements from the General Medical Council (GMC), the NHS and the UK’s four Chief Medical Officers. It reminds frontline staff that while so much has changed during the pandemic, they still require to ensure that care is provided in a fair and equitable way.
According to the guidance, beds – including Intensive Therapy Unit (ITU) beds – should still be allocated according to continual assessment so that patients in most need are prioritised.
The presence or absence of COVID-19 should not be a limiting factor in treatment decisions. Where care between a COVID-19 patient and another patient in need of care is in question, care should be prioritised based on national guidance. Decisions made, regardless of whether they are COVID-19 related, should be done according to protocol, as per good clinical practice; ideally by more than one clinician and, in ITU, involving the entire multidisciplinary team. Accountability remains unchanged and such decisions should be robustly documented.
In addition, the guidance reminds doctors of the importance of discussing with individual patients and their carers their wishes regarding ongoing care, and these decisions should be clearly recorded.
As well as having a duty to protect the public from harm, doctors have a right to protect themselves so that they can continue to care effectively, and it would be ethical for those who would be harmed by contracting COVID-19, including doctors aged over 70 or with underlying health conditions – as per the government’s guidance – to refrain from treating patients with (or suspected to have) the virus. They should instead take on duties away from high risk areas.
Clinicians should receive support from government and their employing trusts or health boards. Those working outside of their usual remit must get appropriate training and all frontline staff must have access to Personal Protective Equipment (PPE) during the pandemic. The advice for clinicians is to immediately report any instance of being asked to care for patients without PPE to their clinical director.
