Hear today's radio diary on an ER doctor's ethical dilemma amid the pandemic.
The pandemic has been rife with ethical dilemmas: from patient care to vaccine distribution nationwide. We discuss how to think through the ethical implications of COVID-19.
Amal Mattu, emergency physician and professor of emergency medicine at the University of Maryland School of Medicine. (@AmalMattu)
What is bioethics in the context of American medicine?
Akilah Jefferson Shah: “Bioethics is what we do. … Historically, people think of bioethics as a grand idea that is in the background, kind of in the clouds, that's not something that we are actionable about on a day-to-day basis. And I always try to think of it as what we do every day. So how do we think about patients, not just their pathophysiology, but how do we think about their lives in general? Which are much more than just what's happening in the body.
"How is it impacting themselves? How is it impacting their family? How do all of these outside experiences and things really impact the way that people's health evolves throughout their lifetime? And so thinking about things like social determinants of health, about racism, all of those things matter and they are inclusive in bioethics. And so I think that's the best way to think about it.”
On the bioethics of the pandemic
Akilah Jefferson Shah: “One of the big issues that has come up in this pandemic is inequality throughout the health care system. And in bioethics, we think about many, many things. But fairness and justice is a big thing that we think about every single day. And so this pandemic and the inequitable ways in which people have been impacted, whether it's from particular communities, urban places, rural places, whether it's based on race and ethnicity. So, brown and black people being disproportionately impacted, indigenous communities being disproportionately impacted.
"Whether it is from, some people would say a socioeconomic status place, where people who have more access to things like treatments, and testing and all of that tend to do better than those who have a harder time getting to testing centers, a harder time getting to hospitals, more exposures based on where they work and where they live. And so, you know, all of that comes together in the day-to-day impacts of COVID-19 in this pandemic. And so thinking about all of that, and how we can make differences in how we make decisions to specifically address all of those issues, I think has been important.”
On the importance of being ‘expansive’ in how we talk about vaccine distribution
Yolonda Wilson: “We’ve had a lot of conversation about health care workers receiving the vaccine first, and I certainly think that that is a right path to take. However, I want to be sure that we are intentional about being expansive and being inclusive in who gets counted as health care workers. A lot of the popular conversation tends to focus on, for instance, physicians and nurses. And while I certainly think that they are important, I think it's also important to remember that the people who make health care happen aren't all physicians and nurses.
“We have people who work in cafeterias. We have people who work in what is now called, in many places, environmental services. So, orderlies, housekeeping staff. And often, at the height of the pandemic, they did not receive the same amount of PPE and they didn't have the same access to PPE, and yet they were still vulnerable. And so when we think about people like health care workers having access to the vaccine, I want us to be intentional and be expansive about that.”
On inequities of the health care system
Akilah Jefferson Shah: “The health care system is inequitable. So, we have to work within that to make things better. I think for a very long time bioethicists have ... taken that for granted and assumed a reasonable level of equality here. And now, I think there's a new wave of bioethics that's happening that really pushes that point that we are truly living in an inequitable society and that we cannot ignore that. And when I say that one point, you know, for a lot of ethical decision-making, many things are what we call colorblind or race-neutral decisions.
"And that's something I found during the pandemic that we have been pushing back on a whole lot. How can we — if we know that things like racism are making a big impact on the way that people's health outcomes are — how can we make ethical decisions that are race neutral? We have to take that into account somehow. And I think the same thing for other issues that come up in a baseline, inequitable society, we have to take that into consideration when we are making these decisions from an ethical lens.”
What would you like to see changed?
Yolonda Wilson: “Part of what's going to determine what gets taken advantage of and how much is going to just be, you know, public will … federal, and state and local will to make these things happen. So a conversation that I've been having a lot in recent months have been with educational institutions and thinking about curricular changes and development to really incorporate not just thinking about ethics, but thinking about ethics in the context of structural injustice.
"And so I think when you're talking about training the coming generation of providers and clinicians, I think that this is going to be an important opportunity here. Now, when you think about the kind of federal funding for hospitals or government funding, I think there's a space for ethics to be built into those frameworks and resources. That having a bioethicist nearby or directly on staff isn't just a luxury for research institutions, but that it is the kind of thing that is as necessary as having some of the other positions to staff one's hospital.”
From The Reading List
The Atlantic: "What the Chaos in Hospitals Is Doing to Doctors" — "The original 'God Committee' had seven members: a surgeon, a minister, a banker, a labor leader, a housewife, a government worker, and a lawyer."
CNN: "Covid-recovering Trump promised top drugs for all — he's mainly just helped his friends" — "When President Donald Trump emerged from a three-night hospital stay for his coronavirus infection, he made a vow in a videotaped on the White House South Lawn."
Axios: "The coronavirus vaccine distribution plan raises ethical questions" — "The first vaccination sites are expected to receive coronavirus vaccines today, the next step of an extraordinary endeavor that's brought us to the beginning of the end of the pandemic."
The Conversation: "COVID-19 makes clear that bioethics must confront health disparities" — "With some reluctance, I’ve come to the sad realization the COVID-19 pandemic has been a stress test for bioethics, a field of study that intersects medicine, law, the humanities and the social sciences."
This program aired on December 15, 2020.