Usually, clinicians cannot withhold or withdraw medically necessary treatment without the patient's (or surrogate's) consent, but in pandemic crises, healthcare systems supersede autonomy to maximize public health through allocation and rationing of resources.


Syracuse University

Pepperdine University

The principles of medical ethics are:
- Autonomy
- Beneficence/non-maleficence
- Justice
- Fair innings
- Instrumental value

Medical Ethics in Healthcare Systems Response to COVID-19

In the context of research ethics, autonomy refers to an individual's fundamental right to make their own choices and take independent actions free from any coercion. Respecting a participant's autonomy is a core component of honoring their human dignity, and it is primarily upheld in research by ensuring they provide true informed consent before participating in any study.

Autonomy

Kirkpatrick, J. N., Hull, S. C., Fedson, S., Mullen, B., & Goodlin, S. J. (2020). Scarce-Resource Allocation and Patient Triage During the COVID-19 Pandemic. Journal of the American College of Cardiology, 76(1), 85-92. 
doi:10.1016/j.jacc.2020.05.006
https://www.sciencedirect.com/science/article/pii/S0735109720352232?via%3Dihub

Scarce-Resource Allocation and Patient Triage During the COVID-19 Pandemic

The principles that physicians act in the best interest of and avoid causing net harm to their patients. Since the scarcity of resources in a pandemic crisis raises conflict between clinicians’ commitment to individual patients and their duty to promote and protect public health, a triage team separate from the bedside physicians must triage patients.

Beneficence/non-maleficence and pandemic

The principle that a patient's access to scarce resources is determined by the urgency of the patient's need and their likelihood of benefiting from treatment, regardless of age, sex or gender identity, race or ethnicity, religion, socioeconomic status, religion, and assumed VIP status. During a pandemic, resource allocation may raise issues of discrimination based on age or pre-existing conditions.

Justice and pandemic

The principle that, when resources are limited, the young should be prioritized over the elderly because 1) all people have the right to experience all life stages and 2) advanced age is correlated with decreased physical resilience, so to achieve maximization of life-years saved, we must consider age in triage criteria. Some argue that fair innings leads to age discrimination.


Fair innings and pandemic

The notion that certain individuals, particularly healthcare workers, should receive priority access to limited resources because of 1) their instrumental value to society and 2) our urgent need to return them to the workforce so that they can continue treating patients. Prioritization also reduces voluntary absenteeism. Opponents argue this principle is difficult to implement and can devolve into discrimination.


Instrumental value and pandemic

With the pandemic occurring, medical necessities such as ventilators and medicine become very scarce. They are experiencing critical shortages of tools. The healthcare workers have to decide who to  administer the euqpiment and medication to. They have to decide who needs it most without risking the lives of other workers and patients. They also have to be ready if another wave occurs. 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1936949/

Can the Health-Care System Meet the Challenge of Pandemic Flu? Planning, Ethical, and Workforce Considerations

Infringement of medical autonomy in the COVID-19 pandemic

- Medical Autonomy or Patient Autonomy
- Bodily Integrity/Autonomy
- Institutional  Autonomy
- Political Self Governance  
- Adolecent  Autonomy (as a developmental milestone)
- Religious Autonomy


Types of Autonomy

Informed consent is the process of obtaining and documenting an individual's voluntary agreement to participate in a study after they have been fully informed of everything that might reasonably affect their decision. This practice is fundamentally important for respecting a person's autonomy, as it ensures they are aware of the study's true nature, risks, and procedures before agreeing to participate, preventing situations where they might be subjected to undisclosed harms.

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