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Ethical guidance published for frontline staff dealing with pandemic

The Royal College of Physicians has published ethical guidance for frontline staff dealing with the COVID-19 pandemic, supported by more than a dozen other health organisations.

Members of the RCP’s Committee on Ethical Issues in Medicine, chaired by Dr Alexis Paton, developed the guidance, which is supported by nine other Royal Colleges and five medical faculties. It takes into consideration joint statements from the General Medical Council (GMC), the NHS and the UK’s four Chief Medical Officers.

The guidance reminds frontline staff that while so much has changed during the pandemic, they still need to ensure that care is provided in a fair and equitable way.

Beds – including Intensive Therapy Unit (ITU) beds – should still be allocated according to continual assessment so that patients in most need are prioritised.

The presence or absence of COVID-19 should not be a limiting factor in treatment decisions. Where care between a COVID-19 patient and another patient in need of care is in question, care should be prioritised based on national guidance. Decisions made, regardless of whether they are COVID-19 related, should be done according to protocol, as per good clinical practice; ideally by more than one clinician and, in ITU, involving the entire multidisciplinary team. Accountability remains unchanged and such decisions should be robustly documented.

The RCP’s guidance reminds doctors of the importance of discussing with individual patients and their carers their wishes regarding ongoing care, and, again, these decisions should be clearly recorded.

As well as having a duty to protect the public from harm, doctors have a right to protect themselves so that they can continue to care effectively, and it would be ethical for those who would be harmed by contracting COVID-19, including doctors aged over 70 or with underlying health conditions – as per the government’s guidance – to refrain from treating patients with (or suspected to have) the virus. They should instead take on duties away from high-risk areas.

Clinicians should receive support from government and their employing trusts or health boards. Those working outside of their usual remit must get appropriate training and all frontline staff must have access to Personal Protective Equipment (PPE) during the pandemic. They should immediately report any instance of being asked to care for patients without PPE to their clinical director or here.

The RCP’s guidance is supported by the Royal College of Anaesthetists, Royal College of Emergency Medicine, Royal College of General Practitioners, Royal College of Radiologists, Royal College of Ophthalmologists, Royal College of Nursing, Royal College of Physicians of Edinburgh, Royal College of Physicians and Surgeons of Glasgow and Royal College of Psychiatrists, the Faculty of Pharmaceutical Medicine, Faculty of Occupational Medicine, Faculty of Sexual and Reproductive Healthcare, Faculty of Intensive Care Medicine, Faculty of Sports and Exercise Medicine, Faculty of Pre-Hospital Care and the Faculty of Public Health.

Appendix 1 - Receiving the COVID-19 vaccine
When deciding whether to accept a COVID-19 vaccine, healthcare staff should consider the ethical and professional obligations to their practice, their patients and themselves. Staff have a duty of care towards their patients which they must balance with a duty of care to themselves. Based upon the available evidence, there is potential net benefit to an individual receiving the vaccine. This benefit is likely to extend to the community of people with whom they come into contact, including family, friends and patients. It may extend to society at large, by reducing the ability of the virus to spread. More generally, there must be transparency around prioritisation and rollout of vaccine and the RCP advocates that ethical principles of accountability, transparency, inclusivity, reasonableness and responsiveness, as set out in this guidance, are followed.
Appendix 2 - Ethical dilemma scenarios for ambulance-based clinical assessments during COVID-19
An appendix has been added to reflect the fact that, with the NHS weathering the second, considerably larger wave of COVID-19, patients are unfortunately needing clinical assessment by hospital staff in waiting ambulances. To help clarify the best, most ethical course of action in such circumstances, the RCP has based additional guidance around some common scenarios. This is not intended to normalise clinical assessment by acute medical teams of patients in waiting ambulances. The RCP also understands that such a situation will often be difficult for families and patients. But when all other measures to prevent this have been exhausted, healthcare staff can make valid and appropriate decisions in such circumstances.


Ethical dimensions of COVID-19 for frontline staff 1.25 MB Uploaded: 5 February 2021