Article Text
Abstract
COVID-19 is reducing the ability to perform surgical procedures worldwide, giving rise to a multitude of ethical, practical and medical dilemmas. Adapting to crisis conditions requires a rethink of traditional best practices in surgical management, delving into an area of unknown risk profiles. Key challenging areas include cancelling elective operations, modifying procedures to adapt local services and updating the consenting process. We aim to provide an ethical rationale to support change in practice and guide future decision-making. Using the four principles approach as a structure, Medline was searched for existing ethical frameworks aimed at resolving conflicting moral duties. Where insufficient data were available, best guidance was sought from educational institutions: National Health Service England and The Royal College of Surgeons. Multiple papers presenting high-quality, reasoned, ethical theory and practice guidance were collected. Using this as a basis to assess current practice, multiple requirements were generated to ensure preservation of ethical integrity when making management decisions. Careful consideration of ethical principles must guide production of local guidance ensuring consistent patient selection thus preserving equality as well as quality of clinical services. A critical issue is balancing the benefit of surgery against the unknown risk of developing COVID-19 and its associated complications. As such, the need for surgery must be sufficiently pressing to proceed with conventional or non-conventional operative management; otherwise, delaying intervention is justified. For delayed operations, it is our duty to quantify the long-term impact on patients’ outcome within the constraints of pandemic management and its long-term outlook.
- surgery
- ethics
- public health ethics
- right to healthcare
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Footnotes
JM and SM are joint first authors.
Contributors JM and SM contributed equally to this paper. RH provided a supervisory role in editing and finalising the manuscript. They have extensive expertise in arranging cardiac surgery, specifically with patient interaction forming a crucial portion of daily workload. It was initially drafted after COVID-19 drastically cut down our departments operating capacity raising a variety of ethical issues to be addressed. The lack of clear guidance lead to discussion in regards to how we treat urgent cardiac surgery patients to the best of our department’s ability. JM and SM wrote, edited and reviewed the manuscript and approved the final draft. Sources were found via analysing key ethical texts, found via Medline. JM is the guarantor of the article.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; internally peer reviewed.
Data availability statement There are no data in this work.