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COVID-19 and beyond: the ethical challenges of resetting health services during and after public health emergencies
  1. Paul Baines1,
  2. Heather Draper1,
  3. Anna Chiumento2,
  4. Sara Fovargue3,
  5. Lucy Frith4
  1. 1Division of Health Science, Warwick Medical School, University of Warwick, Coventry, UK
  2. 2Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
  3. 3Law School, Lancaster University, Lancaster, UK
  4. 4Institute of Population Health, University of Liverpool, Liverpool, UK
  1. Correspondence to Dr Lucy Frith, Institute of Population Health, University of Liverpool, Liverpool L69 3BX, UK; L.J.Frith{at}liverpool.ac.uk

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COVID-19 continues to dominate 2020 and is likely to be a feature of our lives for some time to come. Given this, how should health systems respond ethically to the persistent challenges of responding to the ongoing impact of the pandemic? Relatedly, what ethical values should underpin the resetting of health services after the initial wave, knowing that local spikes and further waves now seem inevitable? In this editorial, we outline some of the ethical challenges confronting those running health services as they try to resume non-COVID-related services, and the downstream ethical implications these have for healthcare professionals’ day-to-day decision making. This is a phase of recovery, resumption and renewal; a form of reset for health services.1 This reset phase will define the ‘new normal' for healthcare delivery, and it offers an opportunity to reimagine and change services for the better. There are difficulties, however, healthcare systems are already weakened by austerity and the first wave of COVID-19 and remain under stress as the pandemic continues. The reset period is operating alongside, rather than at the end, of the pandemic and this creates difficult ethical choices.

Ethical challenges of reset

Balancing the greater good with individual care

Pandemics—and public health emergencies more generally—reinforce approaches to ethics that emphasise or derive from the interests of communities, rather than those grounded in the claims of the autonomous individual. The response has been to draw on more public health focused ethics, ‘if demand outstrips the ability to deliver to existing standards, more strictly utilitarian considerations will have to be applied, and decisions about how to meet the individual's need will give way to decisions about how to maximise overall benefit’.2 Alongside this, effective …

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