Rules of Engagement: Ethics in the Age of COVID-19

With all the buzz about COVID-19 and it’s variants in health care environments, as well as comments in social media spheres and varying news outlets, a discussion about COVID-19 and ethics is warranted.

COVID-19 is ubiquitous now. One can’t go anywhere or do anything without a reminder about COVID-19. From signs on business doors saying “Masks highly recommended” to traffic signs displaying COVID-19 statistics or stating the number of vaccinated people in the state, to online discussions about the most recent CDC guidance, the COVID-19 pandemic remains an omnipresent force in daily life.

Ethics are not quite that visible. For healthcare workers, it may be a term used to discuss regulations or protocols during formal training or health care educational programs. There are policies and procedures in workplaces to address ethical issues. Companies may have designated ethics committees or an annual in-service on the topic. Generally speaking, however, ethics isn’t a part of most people’s daily dialogue.

For most, ethics are a personal concept—a part of one’s being that provides direction for behaviors—as opposed to guidelines or data on a public sign. The case could be made that if one works in certain settings, such as home health or hospice organizations, an exception could be made as to the role and application of ethical considerations.

Am I Ethical?

COVID-19 has made us aware of what is going on in our bodies in a way that most of us have never been before. Symptoms that would be ignored or passed off before the pandemic now have the propensity to mean something different.

Should I be worried about this cough? I have a headache… is that still an early sign of COVID-19? Is my runny nose a sign of seasonal allergies or do I have COVID-19? I was near someone who tested positive… do I feel sick today? Luckily, there are readily available COVID-19 testing sites and/or home kits to help us answer these questions.

COVID-19 has also made us more aware of what is going on with others. People are more mindful of people around them and if they are doing such things as coughing, sneezing, or wearing a mask. They strive to maintain social distancing and other science-based COVID-19 mitigation behaviors.

In considering one’s awareness of ethics, however, such questions are less common—and the answers less definitive. In environments in which life or death risk is particularly high, this can be deeply problematic.

For example, when evaluating the care of home health patients, a healthcare provider is likely to say they did their job. This evaluation might include considerations for how the quality of care could be improved. However, the question as to whether or not care was provided in an ethical manner regarding COVID-19 may be less unlikely. There are no testing sites and/or home kits to determine if we have “a case of COVID-19 ethics.” It is up to us to decide.

What Factors Determine Ethical Conduct?

People have the freedom to make decisions about their vaccination status, where they receive their information about COVID-19, and who they believe. Notwithstanding, fact-based science and information is just that. Licensing boards set standards that focus on behaviors (e.g. breach of confidentiality, standards of practice, etc.) but don’t establish rules about enacting those behaviors in an ethical manner.

Care providers can practice at the very edges of ethical practice boundaries, especially in the privacy of a person’s home, while still remaining compliant. Even before the COVID-19 pandemic, providers have been cautioned about familiarity gained with long-term home care clients blurring personal and professional boundaries.

Incorporating Ethics Into Standard Care

As health care providers, we have choices to make. What impact do we want COVID-19 to have on our practice? Will we get vaccinated, boosted, or work on “naturally obtained” immunity? How seriously do we take COVID-19 in comparison to other diseases and conditions for which people seek health care?

Health care providers may have to choose where and how they wish to be employed. What outcomes might occur when health care providers exercise their individual rights without fully considering how those choices impact the rights of others, including at-risk patients and co-workers?

Do we want to work from an ethical foundation? Where do we obtain our information about ethical practice? What does ethical practice mean? Which ethical principle tends to guide our practice? How do—and how should—ethics drive the decision-making where we work? What difficulties might technological or other advances bring to the ethical foundation of our practice?

These important questions must be explored by healthcare providers at all levels of care, but they are particularly significant in life or death settings such as home health and hospice workplaces.

My MedBridge course “Ethical Considerations for Home Care Personnel in the Digital Age” guides viewers through selected ethical considerations essential to the foundation of home care and hospice practice. In addition, scenarios concerning common practice issues are presented, including decision points where one can look at how to best respond to the scenario, with the hope that this will prepare providers for similar situations in their practice. Potential impacts of known and futuristic technology, i.e., the digital age, on ethics, both personal and organization driven, are presented for the viewers’ practice considerations.