12. COVID Ethics

Question 1

Is it reasonable to ask retired doctors and nurses to return to duty?

Answer 1

• I think its not unreasonable to ask or put out a public plea, but it would be unreasonable to impose this obligation over doctors
• Doctors ordinarily are sworn to a duty of care to their patients, which they give effect to in their day today life. This said, this commitment is voluntary, borne from a doctor’s own will. To ask a doctor to serve against his or her will would contravene freedom of choice, protected by Article 8 ECHR and may do more harm than good to patients [PRIVATE LIFE, FAMILY, HOME AND CORRESPONDENCE]
• Retirement is ordinarily correlative with age, and increased age means increased susceptibility to illness. Combined with the initial inaccessibility or scarcity of PPE, it would be ethically unsound to require doctors to return to work

–>CONSEQUENTIALIST: perform their clinical duties competently and safely; 40,000 retired staff last month

–> DEONTOLOGICAL: self-determination and personal freedom

Question 2

Should doctors be required to wear PPE when treating patients?

Answer 2

• PRAGMATIC: the principle of scene safety acknowledges that healthcare workers cannot effectively contribute to patient care if the workforce is injured during the provision of care
• UNIVERSALISABILITY STANCE (KANTIAN ETHICS): for an act to be moral, it would be moral if everyone acted the same. If healthcare workers refused PPE, the whole workforce would become immobilise
• UTILITARIAN: omitting PPE to save one patient may infect a larger number of patients/workforce

Question 3

Should vaccines be made mandatory?

Answer 3

Question reveals tension between autonomy on the one hand and public safety on the other.
Personally, I would say no, speaking from a perspective of political pragmatism

IN FAVOUR:
+Prevent unjust; duty to neighbours;
+100k death toll, top down approaches that curtail freedom justified as in the public interest
+Evidence Based Science: empirically can reduce reproductive value of virus and safe lives

AGAINST

(1) Autonomy pillar of doctor patient relationships
(2) Consequentialist perspective: medicine contingent on public trust in the profession. Paternalistic Medicine public to lose trust of the medical profession -> climate fake news this is even more precarious

CONCLUSION

• Strongly and proactively recommended
• Supported by a public education campaign that stamps down on misinformation
• -> Integrity medical profession
• -> most uninformed are in most need of education and patience.

Question 4

Is it right to delay the second jab to vaccinate more people?

Utilitarian

(1) SAFETY RESEARCH ETHICS
(2) AUTONOMY AND CONSENT
(3) PUBLIC TRUST

Answer 4

Utilitarian perspective: vaccinating greater number of people with a dingle dose will be more effective than vaccinating a small number of people with two doses  54% protection, minimising hospitalisations

1) SAFETY AND RESEACH ETHICS: Pfizer vaccine’s safety and efficacy was evaluated on 21 day dosing schedule. no data to demonstrate protection is sustained after the first dose after 21 days; leaves people vulnerable to the virus; tampers with Evidence-Based medicine and “following the science” (Doctors’ Association UK) –> beneficence and non-maleficence
2) AUTONOMY AND CONSENT: those who had the 1st dose consented to a vaccination regime of 2 doses 3 weeks apart in accordance with the clinical trials conducted by Pfizer
3) PUBLIC TRUST: patients must have faith in the vaccine programme, so concentration must be on evidence based medicine and optimising supply and delivery –> tampered with by mixed messages, u-turns, and compromising patient consent

Question 5

Should we lower standards of research in an emergency?

Answer 5

No.

• Clinical trials should be subject to same rigorous testing
• National research guidelines should be adhered to
• Validation from regulatory bodies

Research expediated

(1) Collaboration with international communities –> data bases; 3/4 scientific COVID research published with public access
(2) Funding and resourcing –> £850M Europe
(3) Expediated regulatory authorisation –> WHO guidelines on COVID research states that internationally accepted ethical standards must be met, whilst some standards may be adapted depending on context and circumstance

o Scientific validity
o Social value
o Risk-benefit ratio
o Fair, voluntary participation 
o  Equal moral respect for participants

Question 6

Patient presents to you with disinformation about the COVID vaccine or lack of trust in it. What do you do

Answer 6

(1) Beneficence and non-maleficence
(2) Ask patient why they have a suspicion
(3) Empathetic to concerns

Question 7

How would you ethically prioritise access to the vaccine?

Answer 7

(1) Justice

Question 8

Is it acceptable for doctors to give spare doses of vaccines to family and friends, despite not being clinically extremely vulnerable or not being an essential worker?

Answer 8

(1) All reasonable and practicable steps; beneficence; non-maleficence; utilitarianism
(2) If nobody else; justice; maximising resources; consequentialist

Question 9

Young, transplant patient requests early access to the vaccine. What do you do?

Answer 9

(1) Justice

(2) Empathetic