Article

Putting health workers first for some treatments amid pandemic is justifiable, ethicists say

April – May, 2020

By LISA EISENHAUER
April 28, 2020

Giving health care workers priority for vaccines and some treatment during the COVID-19 pandemic could be an ethically defensible decision, according to Catholic ethicists who took part in a recent webinar.

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Miller

David Miller, associate director for academic programs and administrator for the Edmund D. Pellegrino Center for Clinical Bioethics at the Georgetown University Medical Center, said the spread of COVID-19, if it worsens, could put the nation's entire health care system at risk. "Depending on how the current situation develops, privileging health care workers for vaccination and possibly for treatments when illness incapacitates them may be necessary to advance the common good," Miller said.

Miller said the common good includes the central public or social goods and services that are needed to sustain society, such as public education, sanitation and policing. During a pandemic, the health care network is "foundational to allow all of those other functions to go on," he said.

Miller was one of three ethicists who took park in a webinar panel discussion on the ethics of giving preferential treatment to medical personnel and first responders amid the pandemic. The April 23 broadcast was the second of a series titled "Catholic Ethics and the challenge of COVID-19." The series is being presented on consecutive Thursdays through May by CHA and Georgetown University with participation from the Pellegrino Center for Clinical Bioethics.

Who merits privilege?
The ethicists noted that just the idea of giving anyone priority for limited health care resources is fraught with moral considerations. If health care workers were to receive priority access to scarce treatments, defining who is an essential health care worker presents its own challenges. The definition, they noted, could be narrowed to individuals who are involved in the direct medical care of patients or broadened to include maintenance and food service workers in hospitals.

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Sotomayer

Panelist Dr. Claudia Sotomayor, a clinical ethicist at the Pellegrino Center for Clinical Bioethics and an adjunct assistant professor of internal medicine at Georgetown University Medical Center, shared infection data from the Centers for Disease Control and Prevention. The report defined essential health care workers as those "who have the potential for direct or indirect exposure to patients or infectious materials." That data showed that of the people who had tested positive for COVID-19 up to April 4 and whose professions were known, 20% fit the definition of essential health care workers.

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Hibner

Sotomayor and Miller were joined by Nathaniel Blanton Hibner, CHA's director of ethics, as they discussed the various levels of care that might be needed for victims of COVID-19 and for which of those levels it might be ethical to give preferential status for treatment to health care workers and first responders. Those levels were vaccines, antiviral drugs that could potentially cure victims, and life-sustaining measures, such as the use of ventilators.

Front of the line
The ethicists agreed that giving health care workers the first vaccines was reasonable in that they would not only be protected as they provide potentially lifesaving care but so would potentially many other people with whom they come in contact.

Miller maintained that health care workers should also be considered for preferential access to drugs that could shorten the duration and intensity of the illness. "It's a recognition of the fact that their specialized training makes them difficult to replace and an essential support for the system," he said.

Sotomayor expressed reservations with that reasoning because it risked putting a person's value as a "social utility" above their value as a human being. "We're reducing that physician, that nurse, that health care provider to whatever they know to do, right? It's like, you're useful to me, so I'm kind of using you." she said.

She said she thinks it is important for health care systems, especially Catholic ones, to protect the human dignity of workers regardless of their professional roles.

She conceded, however, that it might be ethically allowable to move more quickly to restore the health of doctors and nurses if it means they will be able to use their skills to stem an illness that threatens the whole of society.

Hibner, who also moderated the discussion, said, "So, it sounds as if there are some very good reasons why we many want to prefer treatment for health care workers. Some include, as I said, that they can treat others, that they will continue to maintain our health care system."

None of the ethicists went so far as to say that health workers should be considered for preferential treatment if potentially life-saving care such as access to ventilators grew scarce.

Ethics and ventilator rationing
In the first half of the webinar Dr. Daniel Sulmasy discussed the ethical considerations involved in setting rationing criteria for ventilators. Sulmasy is the André Hellegers professor of biomedical ethics in the departments of medicine and philosophy at Georgetown University. He is acting director of the Kennedy Institute of Ethics at Georgetown and he is on the staff of the Pellegrino Center for Clinical Bioethics.

Dan Sulmasy
Sulmasy

He said a fundamental message he's been giving everyone he talks to about ethics amid the pandemic is that circumstances don't dictate ethical principles. "I'm sort of getting very disturbed by all that I hear about this pandemic changing everything, as if we have to throw our ethics out and start all over again," he said. "That's not the message. We need our ethics and our principles now more than ever."

Sulmasy said the most important principal for care providers is to benefit patients and, conversely, to not do what does not benefit them. Secondly, providers should respect the inherent dignity of every patient.

Determining worth
Applying those and other basic ethical principles, such as common good and justice to the current crisis, he said, means doing everything possible to avoid rationing or in any way denying beneficial care to patients. However, care providers should also determine how much care patients want. "This is partly because of our respect for them as persons, which includes beginning to talk to people as we would under normal circumstances when they come into the hospital and asking about whether they wish to forgo life-sustaining treatments in a general way, not just in a pandemic," he said.

For patients who want every reasonable step possible taken to keep them alive, he said efforts should be made to increase or stretch the supply of materials or to encourage the use of alternatives that work just as well. He said this could include sharing ventilators or using 3-D printers to make more.

If supplies grow so scarce that rationing is unavoidable, Sulmasy said the distribution of the treatment or medication should be based on three fundamental criteria: the patient's need, the patient's prognosis and the potential for the treatment to be effective. Criteria such as race and social class have no place in ethical decisions about health care, Sulmasy said.

"What we should be deciding, if we need to ration, is whether the treatment is worthwhile, not whether the person is worthy of treatment," he said.

The next one-hour webinar in the series will be at 1 p.m. (Eastern time) on Thursday. The topics will be "Organizational Ethics: Response to Crisis Standards and Allocation of Resources" and "Ethical Issues in Labor and Delivery, and Neonates."

View the recorded webinar
Download the presentation

Prior coverage of webinar series:
Resuscitation considerations go beyond patients amid pandemic, Catholic ethicists say

 

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