Should neurosurgeons continue to work in the absence of personal protective equipment during the COVID-19 era?
COVID-19
Duty to work
Ethical
Neurosurgeons
PPE
Journal
Acta neurochirurgica
ISSN: 0942-0940
Titre abrégé: Acta Neurochir (Wien)
Pays: Austria
ID NLM: 0151000
Informations de publication
Date de publication:
03 2021
03 2021
Historique:
received:
30
06
2020
accepted:
01
12
2020
pubmed:
21
1
2021
medline:
27
2
2021
entrez:
20
1
2021
Statut:
ppublish
Résumé
The COVID-19 pandemic has resulted in a widespread shortage of personal protective equipment (PPE). Many healthcare workers, including neurosurgeons, have expressed concern about how to safely and adequately perform their medical responsibilities in these challenging circumstances. One of these concerns revolves around the pressing question: should providers continue to work in the absence of adequate PPE? Although the first peak of the COVID-19 crisis seems to have subsided and supply of PPE has increased, concerns about insufficient PPE availability remain. Inconsistent supply, limited efficacy, and continued high demand for PPE, combined with the continued threat of a second COVID-19 wave, mean that the issues surrounding PPE availability remain unresolved, including a duty to work. This paper offers an ethical investigation of whether neurosurgeons should perform their professional responsibilities with limited availability of PPE. We evaluate ethical considerations and conflicting duties and thereby hope to facilitate providers in making a well-considered personal and moral decision about this challenging issue.
Identifiants
pubmed: 33469692
doi: 10.1007/s00701-021-04703-8
pii: 10.1007/s00701-021-04703-8
pmc: PMC7815500
doi:
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
593-598Références
Anelli F, Leoni G, Monaco R et al (2020) Italian doctors call for protecting health care workers and boosting community surveillance during covid-19 outbreak. BMJ 368
Azkur AK, Akdis M, Azkur D et al (2020) Immune response to SARS-CoV-2 and mechanisms of immunopathological changes in COVID-19. Allergy. https://doi.org/10.1111/ALL.14364
British Medical Association (2020) COVID-19 refusing to treat where PPE is inadequate. https://www.bma.org.uk/advice-and-support/covid-19/ppe/covid-19-refusing-to-treat-where-ppe-is-inadequate . Accessed 19 May 2020
Brody H, Avery E (2009) Medicine’s duty to treat pandemic illness: solidarity and vulnerability. Hastings Cent Rep 39(1):40–48
doi: 10.1353/hcr.0.0104
Campbell D (2020) NHS doctors lacking PPE bullied into treating COVID-19 patients. The Guardian. https://www.theguardian.com/world/2020/apr/06/nhs-doctors-lacking-ppe-bullied-into-treating-covid-19-patients . Accessed 7 Apr 2020
Chang D, Xu H, Rebaza A et al (2020) Protecting health care workers from subclinical coronavirus infection. Lancet Respir Med 8(3):e1
doi: 10.1016/S2213-2600(20)30066-7
Cheung JC, Ho LT, Cheng JV et al (2020) Staff safety during emergency airway management for COVID-19 in Hong Kong. Lancet Respir Med 8(4):e19
doi: 10.1016/S2213-2600(20)30084-9
Clark C (2005) In harm’s way: AMA physicians and the duty to treat. J Med Philos 30(1):65–87
doi: 10.1080/03605310590907066
Cruess S, Cruess R (2004) Professionalism and medicine’s social contract with society. AMA J Ethics 6(4):185–188
Diamond M, Woskie L (2020) Covid-19 Protecting frontline healthcare workers –what lessons can we learn from Ebola? BMJ opinion https://blogsbmjcom/bmj/2020/03/25/healthcare-workforce-safety-and-ebola-in-the-context-of-covid-19/ . Accessed 28 May 2020
Fenton E (2020) Personal protective equipment for front-line health workers: an ethical imperative. https://blogs.bmj.com/medical-ethics/2020/03/31/personal-protective-equipment-for-front-line-health-workers-an-ethical-imperative/?int_source=trendmd&int_campaign=usage-042019&int_medium=cpc . Accessed 28 May 2020
Henegan C, Oke J, Jefferson T (2020) COVID-19 How many healthcare workers are infected? https://www.cebm.net/covid-19/covid-19-how-many-healthcare-workers-are-infected/ . Accessed 28 May 2020
Iverserson K (2018) Must I Respond if My Health is at Risk? J Emerg Med 55(2):288–293
doi: 10.1016/j.jemermed.2018.04.021
Ives J, Greenfield S, Parry JM et al (2009) Healthcare workers’ attitudes to working during pandemic influenza: a qualitative study. BMC Public Health 9(1):56–69
doi: 10.1186/1471-2458-9-56
Kleinman Z (2020) PPE ‘designed for women’ needed on the frontline. https://www.bbc.com/news/health-52454741 . Accessed 19 May 2020
Klompas M, Marris CA, Sinclair J, et al. (2020) Universal masking in hospitals in the Covid-19 era. NEJM: https://doi.org/10.1056/NEJMp2006372
Klopfenstein M (2008) Pandemic influenza and the duty to treat: the importance of solidarity and loyalty. Am J Bioeth 8(8):41–43
doi: 10.1080/15265160802318097
KNMG (2020) Zorgverlening zonder afdoende persoonlijke beschermingsmiddelen. https://www.knmg.nl/actualiteit-opinie/nieuws/nieuwsbericht-corona/zorgverlening-zonder-afdoende-persoonlijke-beschermingsmiddelen.htm . Accessed 19 May 2020
Leung N, Chu DKW, Chan KH et al (2020) Respiratory virus shedding in exhaled breath and efficacy of face masks. Nat Med 26:676–680
doi: 10.1038/s41591-020-0843-2
McConnell D (2020) Balancing the duty to treat with the duty to family in the context of the COVID-19 pandemic. J Med Ethics. https://doi.org/10.1136/medethics-2020-106250
Ng K, Poon BH, Kiat Puar TH et al (2020) COVID-19 and the risk to health care workers: a case report. Ann Intern Med. https://doi.org/10.7326/L20-0175
O’Mathúna D (2019) Health care workers’ obligations in CBRNE crises. In: Ethics and Law for Chemical, Biological, Radiological, Nuclear & Explosive Crises. Springer, Cham, pp 185–197
doi: 10.1007/978-3-030-11977-5_15
Provincial COVID-19 Task Force (2020)COVID-19 Ethics analysis: what is the ethical duty of health care workers to provide care during COVID-19 pandemic? https://www2.gov.bc.ca/assets/gov/health/about-bc-s-health-care-system/office-of-the-provincial-health-officer/covid-19/duty_to_care_during_covid_march_28_2020.pdf . Accessed 19 May 2020
Remuzzi A, Remuzzi G (2020) COVID-19 and Italy: what next? Lancet. https://doi.org/10.1016/S0140-6736(20)30627-9
Rutledge R (2020) Health care workers want hazard pay. Milwaukee Journal Sentinel, https://eu.jsonline.com/story/news/2020/04/24/wisconsin-health-care-workers-want-hazard-pay-some-have-coronavirus-masks-covid-19-ppe-shortage/3014511001/ . Accessed 25 April 2020
Schuklenk U (2020) What healthcare professionals owe us: why their duty to treat during a pandemic is contingent on personal protective equipment (PPE). J Med Ethics. https://doi.org/10.1136/medethics-2020-106278
Upshur R, Faith K, Gibson J, et al (2005) Stand on guard for thee. Ethical considerations in preparedness planning for pandemic influenza. A report of the University of Toronto Joint Centre for Bioethics Pandemic Influenza Working Group. http://www.jcb.utoronto.ca/people/documents/upshur_stand_guard.pdf . Accessed 19 May 2020
van der Weijden C, Bredenoord A, van Delden J (2010) The duty to treat in the context of an influenza pandemic. Vaccine 28(32):5260–5264
doi: 10.1016/j.vaccine.2010.05.059
WHO (2020) Shortage of personal protective equipment endangering health care workers https://www.who.int/news-room/detail/03-03-2020-shortage-of-personal-protective-equipment-endangering-health-workers-worldwide . Accessed 19 May 2020
WHO (2020) Ethical considerations in developing a public health response to pandemic influenza No. WHO/CDS/EPR/GIP/2007.2 https://www.who.int/csr/resources/publications/WHO_CDS_EPR_GIP_2007_2c.pdf 2007. Accessed 19 May 2020
WMA (2017) Declaration of Geneva, 1948 and as amended October 2017. https://www.wma.net/policies-post/wma-declaration-of-geneva/ . Accessed 25 May 2020
WMA (2017) Statement on epidemics and pandemics, as adopted in 2017. https://www.wma.net/policies-post/wma-declaration-of-geneva/ . Accessed 25 May 2020