HLSC220 Argumentative essay HD PDF

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Healthcare workers have a moral obligation to care for COVID19 patients and cannot object to caring for these patients Moral obligations are developed based on “society’s understanding of right and wrong” (Jeffrey, 2020). The current COVID-19 pandemic has raised multiple moral and ethical dilemmas within the healthcare industry, including whether it is a moral obligation to care for COVID-19 patients without objection. The term principlism refers to specific principles that pave moral and ethical actions (Kerridge, Lowe & McPhee, 2013). As proposed by Beauchamp and Childress (2013) autonomy, beneficence, justice and non-maleficence are the primary universal principles. In healthcare settings, these principles can be shown through the duty of care that workers abide by. However, during the instance of an outbreak like COVID-19, what is considered right and wrong regarding patient care? Throughout this paper, the key ideas of principlism will be discussed regarding the moral obligation that healthcare workers must care for COVID-19 patients. The themes of self-preservation and duty of care will be commented on in pertain to morality. The ethical theories and legal consequences to consider in this scenario will be explored. Healthcare workers have a duty of care to uphold when caring for patients. Autonomy (n.d) is the idea of shared decision making and independence of choice. It does not directly apply to this scenario regarding the patient as the patient does not get to decide whether healthcare workers abide by their moral obligation of treating all patients, this being a personal decision of the worker. Following this, autonomy should always be upheld when healthcare workers are caring for COVID-19 patients to meet ethical standards, which is done by allowing the patient to make decisions about their treatment. Beneficence is an ethical notion that focuses on actively promoting a person’s health and reducing harm (Lulé et al., 2019). Beneficence is clearly underlined within the International Council of Nurses (ICN) Code of Ethics. The statements within the code highlight the importance of nurses caring for all people and promoting quality health and well-being (International Council of Nurses, 2012). Principle based codes like the ICN’s are found throughout all healthcare workplaces

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and hold similar key ideas. These codes act as a guide as to how healthcare workers should practise in order to meet moral and ethical requirements. These codes also support other ideas in principlism. Justice in this case would be providing necessary care to COVID-19 patients. The use of necessary in this instance refers to the need of a patient and if that care is not available to them, further harm can incur (Summers & Morrison, n.d.). Likewise, the principle of non-maleficence is the “duty to refrain from harming” (Cohen et al., 2020). Both these principles are important in reducing the harm that comes to patients, especially in cases like this, when conditions can worsen without treatment. In this scenario, the refusal of treatment to COVID-19 patients would be against the moral obligation healthcare workers have to provide optimal patient care. By not caring for COVID-19 patients, healthcare workers are not promoting health, nor are they reducing harm to the patient. However, a question being raised is what about the healthcare workers duty of care to themselves?

Healthcare professionals are told during training to access the dangers to yourself before entering a situation. According to the Paramedicine Board of Australia, it is important for paramedics, which extends to all healthcare workers, to “ensure their own person safety” (Paramedicine Board of Australia, 2018). Furthermore, the Nursing and Midwifery Council (NMC) questioned where to draw the line when it comes to duty of care for patients and the duty healthcare professionals have to themselves and their families (Trueland, 2020). While autonomy did not apply to patient in this scenario, it can apply to healthcare workers who should be able to make their own choices concerning their health. If a healthcare worker feels like they are at risk, as per autonomy, they should be able to object to caring for COVID-19 patients. The main worry for healthcare workers is being exposed to COVID-19 and that is why self-preservation in this scenario is being talked about, as well as, the rights that healthcare professionals in denying care for COVID-19 patients based on personal risk (British Medical Association, 2020). With that said, the healthcare industry has adapted to minimise risks to healthcare professionals and the wider community by creating extra precautions, such as, social distancing and providing personal 2

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protect equipment (PPE). The Director of Louisiana’s Biosecurity Institute, Terri Rebmann, stated that the biggest risk to healthcare workers when treating COVID-19 patients is the mistakes made when removing or putting on PPE (Wetsman, 2020). Continuing with that notion, healthcare workers are provided with training for infection and prevention control. Since COVID-19, further training has been provided to help workers adapt and minimise risk by the Australian Commission on Safety and Quality in Health Care (Department of Health, 2020). The risk to healthcare worker themselves must be significantly higher than the risk that will occur to the patient without proper care for a work to even consider not providing care (Trueland, 2020). With all these precautions being put in place and the duty of care healthcare workers have, it would be ethically and legally wrong for them to deny care for COVID-19 patients.

There is a legal obligation that healthcare workers must provide adequate duty of care. As previously stated, legal consequences can occur from the refusal of treating a patient. These legal obligations are also often guided by the common moral standards perceived by the greater community. The lack of care for a patient is disregarding the ideas of principlism. Non-maleficence is breached when denial of helping the COVID-19 patients will potentially cause them harm in the long run (British Medical Association, 2020). By refusing to treat the patient, healthcare workers are not abiding by their moral obligation for sound duty of care, and hence can face legal consequences without a highly justifiable reason (Joseph, 2020). The Royal College of Nursing reiterates that refusing care to COVID-19 patients must be the last resort (Joseph, 2020).

In this scenario, ethical theories like deontology and utilitarianism are severely questioned. Do we focus on rules or outcomes? Deontology is about using certain rules to decide what is right and wrong (The University of Texas at Austin, 2020). In this case, with how new the epidemic is, it is difficult to abide by a certain set of rules when the conditions are so new-found and drastically

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changing. While we have the common principlism keys, there is a lot of question as to how these work in a pandemic situation. Utilitarianism is the idea of the right action being the one with most pleasurable outcome (Ozolins & Grainger, 2015). In this situation, how do we know what the best outcome will be if the risks are too high? Elaine Maxwell, clinical advisor at the National Institute for Health Research, questions how do we know what rules to follow and if there are new ones based on how new COVID-19 is? (Trueland, 2020). It is being doubted whether healthcare professionals should undergo their moral obligation to care for patients or take care of themselves. In this instance, preference utilitarianism and the principle of equal consideration of interest would be the best ethical ideas to adopt as it creates beneficial consequences for all parties involved (Ozolins & Grainger, 2015). By following protective measures and maintaining PPE, healthcare workers will have minimised risk to themselves and will still be able to care for COVID-19 patients, therefore, gaining more pleasure from being able to meet their moral obligation of duty of care and keeping themselves protected. Healthcare workers are ‘assumed to adopt a view that their duty to care overrides self-preservation” (Jeffrey, 2020). With that said, health workers would adopt ethical theories like altruism due to their empathetic nature to act in their patient’s best interest. In this paper, it was discussed how healthcare workers objecting to treating COVID-19 patients does not fulfill their moral obligation. Principlism is essential in a healthcare worker’s moral and ethical decisions based on their duty of care to all patients. It was made apparent that breaching such principles can lead to legal implications for healthcare workers without justifiable reason. In such scenarios like this one, the ideas of acting based on the most pleasurable outcome and following the rules expressed within deontology and utilitarianism are challenging the healthcare industry. It raises questions as to whom the outcome should be pleasurable for, the patient or the healthcare worker, and if there should be new rules made?

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Autonomy (n.d.). In Cambridge Advanced Learner's Dictionary & Thesaurus. Retrieved August 8th, 2020, from https://dictionary.cambridge.org/dictionary/english/autonomy Beauchamp, T., & Childress, J. (2013). Principles of biomedical ethics (7th ed.). New York, NY: Oxford University Press. British Medical Association. (2020). COVID-19 – ethical issues. A guidance note [Ebook]. Retrieved 12 August 2020, from https://www.bma.org.uk/media/2226/bma-covid-19-ethics-guidance.pdf. Cohen, D., Kurkowski, M., Wilson, R., Jonke, G., Patel, O., & Pappas, R. et al. (2020). Ethical practice during the COVID-19 pandemic. The Journal Of The American Dental Association, 151(5), 377378. https://doi.org/10.1016/j.adaj.2020.03.038 Department of Health (2020). COVID-19 infection control training. https://www.health.gov.au/resources/apps-and-tools/covid-19-infection-control-training International Council of Nurses (2012). THE ICN Code of Ethics for nurses https://www.icn.ch/sites/default/files/inline-files/2012_ICN_Codeofethicsfornurses_%20eng.pdf (newest code as of 2020) Jeffrey, D. (2020). Relational ethical approaches to the COVID-19 pandemic. Journal Of Medical Ethics, 46, 495-498. https://doi.org/http://dx.doi.org/10.1136/medethics-2020-106264 Joseph, Paul (2020, May 21). Coronavirus: can nurses refuse to work if they do not have adequate PPE? The Conversation. https://theconversation.com/coronavirus-can-nurses-refuse-to-work-ifthey-dont-have-adequate-ppe-138545 Kerridge, I., Lowe, M., & McPhee, J. (2013). Ethics and law for the health professions (4th ed.). Annandale, N.S.W.: The Federation Press

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Lulé, D., Kübler, A., & Ludolph, A. (2019). Ethical Principles in Patient-Centered Medical Care to Support Quality of Life in Amyotrophic Lateral Sclerosis. Frontiers In Neurology, 10, 259. https://doi.org/10.3389/fneur.2019.00259 Ozolins, J., & Grainger, J. (2015). Foundations of health care ethics: Theory to practice. Port Melbourne, Vic.: Cambridge University Press Paramedicine Board of Australia. (2018). CODE OF CONDUCT (interim) (p. 17). Paramedicine Board of Australia. Summers, J., & Morrison, E. Principles of healthcare ethics (2nd ed., pp. 41-52). Jones and Bartlett Publishers. The University of Texas at Austin. (2020). Deontology. Ethics Unwrapped. Retrieved 30 August 2020, from https://ethicsunwrapped.utexas.edu/glossary/deontology. Trueland, J. (2020). Nurses’ right to refuse to treat: when is it justified?. Nursing Standard, 35(7), 3941. https://doi.org/10.7748/ns.35.7.39.s17 Wetsman, Nicole (2020, March 6). Health care workers are at high risk of catching COVID-19. The Verge. https://www.theverge.com/2020/3/5/21166088/coronavirus-covid-19-protectiondoctors-nurses-health-workers-risk

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