Affiliation:
1. Division of Trauma, Acute, and Critical Care Surgery, Department of Surgery, Duke University Medical Center , Durham, North Carolina , USA
2. Department of Surgery, Texas Christian University , Fort Worth, Texas , USA
Abstract
Abstract
During pandemics, healthcare providers struggle with balancing obligations to self, family, and patients. While HIV/AIDS seemed to settle this issue, coronavirus disease 2019 (COVID-19) rekindled debates regarding treatment refusal. We searched MEDLINE, Embase, CINAHL Complete, and Web of Science using terms including obligation, refusal, HIV/AIDS, COVID-19, and pandemics. After duplicate removal and dual, independent screening, we analyzed 156 articles for quality, ethical position, reasons, and concepts. Diseases in our sample included HIV/AIDS (72.2%), severe acute respiratory syndrome (SARS) (10.2%), COVID-19 (10.2%), Ebola (7.0%), and influenza (7.0%). Most articles (81.9%, n = 128) indicated an obligation to treat. COVID-19 had the highest number of papers indicating ethical acceptability of refusal (60%, P < .001), while HIV had the least (13.3%, P = .026). Several reason domains were significantly different during COVID-19, including unreasonable risks to self/family (26.7%, P < .001) and labor rights/workers' protection (40%, P < .001). A surge in ethics literature during COVID-19 has advocated for permissibility of treatment refusal. Balancing healthcare provision with workforce protection is crucial in effectively responding to a global pandemic.
Publisher
Oxford University Press (OUP)
Reference58 articles.
1. Health care workers' experiences of workplace incidents that posed a risk of patient and worker injury: a critical incident technique analysis;Strid;BMC Health Serv Res,2021
2. Interventions to support the resilience and mental health of frontline health and social care professionals during and after a disease outbreak, epidemic or pandemic: a mixed methods systematic review;Pollock;Cochrane Database Syst Rev,2020
3. Your country needs you”: the ethics of allocating staff to high-risk clinical roles in the management of patients with COVID-19;Dunn;J Med Ethics,2020
4. Professionalism: COVID-19 made me do it!;Karuppiah;Curr Opin Anaesthesiol,2022
5. Beyond duty: medical “heroes” and the COVID-19 pandemic;Lipworth;J Bioeth Inq,2020