Ethical principles and a practical approach to support policy making through the next phases of the COVID-19 pandemic and beyond

Why it matters

During the height of the COVID-19 pandemic, there were rapid changes in clinical practice, with healthcare organisations and individuals trying new approaches to the delivery of care that would, previously, have involved multiple steps. These changes all have important ethical implications.

The pandemic required healthcare organisations to think more carefully about balancing and prioritising the legal and ethical interests of different groups of patients and staff. Learning from this period presents an opportunity to improve ways of working and not lose positive changes seen during the pandemic.

Approach

We have set out building on work done by Fritz and Cox, who in turn draw on Rawls and Scanlon, from which a practical and consistent approach can be developed to help healthcare organisations respond logically and ethically to the challenges they face. We suggest commitments to:

1. Articulating the needs, rights and interests of different stakeholders affected by any policy, including specific patient groups and staff.
2. Being accountable and transparent: keeping people as informed as possible, giving them the chance to express their views, and taking reasoned and open decisions.
3. Considering the impact actions will have on future generations; ensuring decisions are sustainable, that there is adequate training and support for staff, and national investment in infrastructure.
4. Treating everybody equitably, with all deserving of consideration and care; any decisions to treat people differently should be justified on ethically and legally defensible grounds.

Recommendations

Implementing these commitments requires specific actions:

• Put in place frameworks to enable clear advocacy for each competing objective. Where decisions are being made, conflicting demands (for example among different patient or staffing groups, or across care settings) should be identified and considered.
• Communicate policy and practice effectively to the public, for example by producing accessible summaries and updates on key policy decisions, information, and changes to practice. This may provoke some short-term anxiety but will reduce the spread of disinformation and strengthen trust, and it may improve health outcomes.
• Promote integration of decision-making among social, primary, secondary, and tertiary care, and reduce or stop unnecessary interventions. This is essential to ensure inequalities are addressed and inefficiencies diminished. The post-pandemic period should be used as a ‘reset’ opportunity to ensure that we do the activities that are most worth doing.
• Minimise health inequalities. As services are restarted, it is imperative that the opportunity is taken to reduce existing health inequalities, rather than allowing them to worsen. Services for more disadvantaged areas and groups should be prioritised when restarting.
• Build spare capacity into the system. To maintain a sustainable health service, implementing policies that ensure there is some ‘crisis resilience’ may not only help to prepare for medical crises but also improve the sustainability of the workforce in other ways. This might be by improving training, protecting mental health, creating the ability to work across sectors, or fostering greater understanding of competing needs.