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
This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.
https://bmj.com/coronavirus/usageStatistics from Altmetric.com
Read the full text or download the PDF:
Other content recommended for you
- The role of CABG in the era of drug-eluting stents: a surgeon's viewpoint
- Coronary artery disease in patients hospitalised with Coronavirus disease 2019 (COVID-19) infection
- Multi-vessel coronary disease and percutaneous coronary intervention
- Coronary bypass surgery versus stenting in multivessel disease involving the proximal left anterior descending coronary artery
- Is surgery still the preferred option for coronary revascularisation in diabetics with multivessel coronary disease?
- Incidence and outcome of myocardial infarction treated with percutaneous coronary intervention during COVID-19 pandemic
- National health system cuts and triage decisions during the COVID-19 pandemic in Italy and Spain: ethical implications
- Clinical outcomes and costs of cardiac revascularisation in England and New York state
- Challenges in the management of older patients with acute coronary syndromes in the COVID-19 pandemic
- Racial differences in management and outcomes of acute myocardial infarction during COVID-19 pandemic