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 royal colleges and health organisations.
The guidance reminds staff that the principles they need to observe during the pandemic are the same as they would normally be - including ensuring that care is provided in a fair and equitable way, that beds are allocated according to continual assessment and that decisions made, whether COVID-19 related or not, should be done according to protocol, in line with good clinical practice.
Accountability remains unchanged and clinical decisions, ideally made by more than one clinician, must be robustly documented.
The guidance reminds doctors of the importance of discussing with individual patients and their carers their wishes regarding ongoing care, and, again, that 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, so the guidance underlines that 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.
Professor Andrew Goddard, president of the Royal College of Physicians, said:
'These are extraordinary times and NHS frontline staff are going to have to make some very difficult decisions in the most challenging of circumstances in the days and weeks ahead. Many royal colleges and health organisations have worked together to produce this guidance and such collaboration is needed now more than ever before. The principles in the guidance are the same we would use in more ordinary times, and patients and families need to know that we will always strive to do the best for them, however trying the situation.'
Dr Alexis Paton, Chair of the RCP’s Committee on Ethical Issues in Medicine, who wrote the guidance, said:
‘Consistency and accountability nationwide are key to ethical decision-making during the pandemic, for the reassurance and protection of patients and health professionals alike. This guidance provides much needed clarity and consistency to all frontline staff during this crisis.’
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 and Faculty of Sports and Exercise Medicine.