AMA / Ethics guidance during a pandemic: an overview

American Medical Association. Updated June 9, 2020

This series of articles offers foundational guidance in medical ethics for health care professionals and institutions responding to the COVID-19 pandemic.

https://www.ama-assn.org/delivering-care/ethics/ethics-guidance-during-pandemic-overview

As members of the medical profession, physicians’ first and primary obligation is to provide care to those in need, even in the face of greater than usual risk to their own safety, health or life (Opinion 8.3: Physicians’ responsibilities in disaster response & preparedness).

These articles draw on the ethics guidance of the AMA Code of Medical Ethics to help physicians meet the challenges of providing care under conditions of urgent need, limited resources and rapidly changing scientific knowledge. They map the opinions of the Code, which of necessity are framed broadly as policy statements, to the contours of the evolving COVID-19 pandemic.

Articles are being added as further questions surface and understanding of the pandemic expands. In addition, the AMA Journal of Ethics podcasts and videocasts explore a variety of topics related to COVID-19. For regularly updated content, please visit the journal’s COVID-19 ethics resource center.

1. AMA Code of Medical Ethics: Guidance in a pandemic

   1. This overview links overarching questions about wise stewardship of professional skills and material resources to guidance in opinions on allocating limited health care resources, leadership of health care teams, and the obligation to balance the needs of individuals with the needs of the community at large.

2. Access and health equity during a pandemic

   1. What is the responsibility of physicians to support fair access to care for patients, particularly during a pandemic?

3. Caring for patients at the end of life

   1. Every patient reaching the end of life must receive appropriate supportive care.

4. Clinical research versus patient care: Access experimental treatment

   1. Guidance about the quality of decision making and consent for use of unproven, experimental therapies in patient care.

5. Clinical research versus patient care: Conducting clinical trials

   1. The urgent need to effective treatments does not permit relaxing the obligation ensure that research is ethically sound, and that participants understand the differences between clinical research and patient care.

6. Crisis standards of care: Guidance from the AMA Code of Medical Ethics

   1. What are the essential features ethically sound crisis standards of care?.

7. DNR orders in a public health crisis

   1. During a public health crisis do not attempt resuscitation (DNAR or DNR) orders require special ethical consideration.

8. Ethical practice in isolation, quarantine & contact tracing

   1. How should physicians strike the balance between individual rights and privacy when dealing with contact tracing, isolation or quarantine that aim to protect the community?

9. Fair access to limited critical care resources

   1. Physicians must balance competing responsibilities simultaneously, notably in decisions about how and when to draw on limited, critically needed resources.

10. Graduating early to join the physician workforce

    1. How should institutions protect young professionals as they enter the workforce in a health care crisis?

11. Obligations to protect health care professionals

    1. Physicians have a well-recognized duty to provide care during a public health emergency. But what are the obligations to to protect them as they fulfill that responsibility?

12. Physicians in the media: Responsibilities to the public and the profession

    1. The public need for accurate information during a pandemic underscores physicians’ obligation to be truthful, accurate spokespersons for science and the profession.

13. Prescribing medications responsibly in a pandemic

    1. How best to prescribe medications responsibly when the decision can be clinically and ethically challenging.

14. Prioritizing the rest of health care in a public health crisis

    1. Short term, it may be essential to restrict delivery of “routine” care in the interest of reducing immediate risk, but that strategy is not medically or ethically sustainable in the longer term.

15. Protecting public health & vulnerable populations in a pandemic

    1. Physicians have a responsibility to advocate for and protect the most vulnerable patients and populations.

16. Providing patient care remotely in a pandemic

    1. The professional commitment to support access to care informs the ethical use of telemedicine to provide health care services, while lowering the risk of transmitting infectious disease.

17. Research ethics in a public health crisis

    1. Well-designed, ethically sound research to generate the scientifically grounded knowledge essential for responding to a pandemic when the lives of so many are at stake.

18. Restrictive covenants and patient care in a pandemic

    1. Should physicians be able to provide care outside of a non-compete agreement or restrictive covenant during a pandemic?

19. Speaking out on issues adversely affecting patient safety in a pandemic

    1. Physicians have an ethical obligation to address conditions that adversely affect quality patient care.

20. Use of patient registries during public health emergencies

    1. Datasets of patient information can be extremely useful during a pandemic, allowing public health officials to track outbreaks of disease, but protecting patient confidentiality remains fundamental.

21. Vaccine trials & healthy volunteers

    1. Developing vaccines during the urgency of a pandemic highlight the ethical significance of trial design and informed consent.

22. AMA Declaration of Professional Responsibility

    1. The AMA Declaration of Professional Responsibility reaffirms physicians’ commitment to combat natural and man-made assaults on the health and well-being of humankind.