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Christine Mitchell, Ethical Dilemmas in Mask and Equipment Shortages: Health care during the COVID-19 pandemic

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Christine Mitchell, Ethical Dilemmas in Mask and Equipment Shortages: Health care during the COVID-19 pandemic

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Personal protective equipment or PPE has been a major topic of discussion across the nation. The COVID-19 pandemic has exposed major shortages of PPE and health care workers are being asked take care of patients with what some would argue is inadequate protection. The guidelines set by the CDC have changed and recommendations have even gone so far as to approve bandannas as a means for respiratory protection. Some have argued that it is unethical for health care workers to not have adequate protection, while others think it's their duty, protected or not. Adding to this debate has been theft, hoarding and disparate distribution of these critical supplies. During this panel discussion moderator Carmel Shachar, Stephen P. Wood, Christine Mitchell and Dr. Michael Mina explored the ethics of PPE in the COVID-19 pandemic.

Personal protective equipment or PPE has been a major topic of discussion across the nation. The COVID-19 pandemic has exposed major shortages of PPE and health care workers are being asked take care of patients with what some would argue is inadequate protection. The guidelines set by the CDC have changed and recommendations have even gone so far as to approve bandannas as a means for respiratory protection. Some have argued that it is unethical for health care workers to not have adequate protection, while others think it's their duty, protected or not. Adding to this debate has been theft, hoarding and disparate distribution of these critical supplies. During this panel discussion moderator Carmel Shachar, Stephen P. Wood, Christine Mitchell and Dr. Michael Mina explored the ethics of PPE in the COVID-19 pandemic.

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Christine Mitchell, Ethical Dilemmas in Mask and Equipment Shortages: Health care during the COVID-19 pandemic

  1. 1. Ethical Dilemmas in Mask and Equipment Shortages: Health care during the COVID-19 pandemic
  2. 2. 2 Personal Protective Equipment • Masks and respirators • Gloves • Gowns and aprons • Goggles/Face shields • Booties • Sanitizers
  3. 3. 3 All U.S. healthcare facilities should begin using PPE contingency strategies now (CDC*) “U.S. healthcare facilities experiencing PPE shortages may need to consider crisis capacity strategies, which must be carefully planned before implementation. The effectiveness of crisis strategies is uncertain and may pose a risk for transmission between HCP and patients.” https://www.cdc.gov/hai/pdfs/ppe/PPE-Sequence.pdf
  4. 4. 4 Masks Need: ~3.5 - 7.3B N95 masks/year Cloth face coverings are not considered PPE because their capability to protect healthcare personnel (HCP) is unknown. Facemasks, if available, should be reserved for HCP. [CDC 4-13-2020]
  5. 5. 5 Individual HCP: Duty to care EMS personnel, RTs, RNs, MDs: Codes of ethics “Because of their commitment to care for the sick and injured, individual physicians have an obligation to provide urgent medical care during disasters. This ethical obligation holds even in the face of greater than usual risks to their own safety, health or life.” [AMA Code of Ethics’ Opinion on Physician Duty to Treat] The nurse provides services…unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems. [ANA]
  6. 6. 6 Duty to care • What is my ethical duty to care for patients in the absence of proper PPE? • Am I obligated to care for CoVID19 patients if I am in a high risk group? • Do I have to care for infected patients if I live with family members in a high risk group? • How do I weigh the duty to care against risks to myself and my family? • Do professional duties have limits?
  7. 7. 7 Organizational duties to protect • Standards • Protection • Information • Re-assignment • Equity • Support
  8. 8. Civilian Action in Pandemic Rachel Popkin, #findthemasks Founder | Harvard class of ‘08 “I majored in psych/minored in CS & am now am a Senior Product Manager at Google. My freshman roommate is a pulmonologist in the Bay Area & told me how terrified she was for her team without PPE supply 4100+ locations requesting PPE ”
  9. 9. Civilian Action in Pandemic Linda Yang, 3D-printer & #findthemasks Canada | MBE class of ‘20 ” I was the oddball in undergrad who did biochemistry & became a scientist. The majority of my friends went onto medical school. 14 years later, they are on the frontlines & who I think about in the pandemic. Mask Straps & Ear Savers “
  10. 10. Come study and work with us Twitter.com/HMSbioethics Facebook.com/HMSbioethics Bioethics.hms.harvard.edu Harvard Medical School Bioethics Journal Pandemics call for new attention to the common good, social justice and global health

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