Forced Choices: Ethical Challenges in Cardiology During the COVID-19 Pandemic

• Type of Material: Article
• Authors: Prateeti Khazanie, University of Colorado; Matthew K. Wynia, University of Colorado; Neal Dickert, Emory University
• Language: English
• Date: 2020-07-21
• Publisher: American Heart Association
• Publication Version: Final Published Version
• Copyright Statement: © 2020 American Heart Association, Inc.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1161/CIRCULATIONAHA.120.047681
• Title of Journal or Parent Work: CIRCULATION
• Volume: 142
• Issue: 3
• Start Page: 194
• End Page: 196
• Grant/Funding Information: Dr Khazanie has institutional research grant support from the US National Institutes of Health (grant no. K23 HL145122). Dr Dickert receives research funding from the Agency for Healthcare Research and Quality (grant no. R01HS026081).
• Keywords: social justice; resources; healthcare landscape; COVID-19; personal protective equipment; optimizing care; pandemic; ethical commitments; staff; autonomy
• Research Categories: Health Sciences, Health Care Management

Abstract

The coronavirus disease 2019 (COVID-19) pandemic has dramatically changed the healthcare landscape. The influx of patients threatens to exhaust resources, from ventilators and critical care beds to personal protective equipment (PPE) and staff. Clinicians’ core ethical commitments to patients remain, but we must make difficult choices. As acknowledged in a National Academies of Sciences, Engineering, and Medicine crisis care statement, “Clinicians are ethically justified—and, indeed, are ethically obligated—to use the available resources to sustain life and wellbeing to the greatest extent possible.”1 Thus, during crises, we must shift from optimizing care for every individual to care that “saves the most lives.” This shift is not a denial of the importance of patients’ autonomy but is an attempt to maximize social justice in resource-limited settings. Communities must preemptively come together to address the forced choices health professionals must make. The cardiology community is no exception.