Ethical decision-making is contextual; previous tools may cause harm if used out of context. (Tuohey J. A Matrix for ethical decision making in a pandemic, Health Progress, Nov-Dec 2007, 20-25 [Link]).
 
We recommend: 

  1. That the ethical framework adopted by ED physicians is underpinned by the fundamental premises:
    • Every person matters, and every person deserves respect.
    • We never abandon a patient: care is never futile; treatment may be. 
  2. That prior to making decisions clinicians check for their own forms of personal bias. All humans have them and they impede good ethical decision making. Stereotypes regarding race, socioeconomics, age and address should not influence clinical decision making.
  3. Emergency clinicians apply well-known and ethically rigorous principles to guide decision making (Beauchamp, T. L.,  Childress, J. F. (1979). Principles of biomedical ethics. New York: Oxford University Press). These are applicable to the patient, our colleagues and the broader community:
    • Autonomy: the ability to choose but not in detriment to others. For example; patients may still choose to reject treatment and alternatively patients cannot demand treatment that does not have any capacity to benefit or that limits treatments of others.
    • Beneficence: obligation to provide care that is for the good of the patient and others including staff. This includes being truthful to patients and communicating with relevant stakeholders, where feasible.
    • Non-maleficence: options of care offered must avoid harm. Examples include: futile treatment and exposing staff to risk without availability of personal protective equipment.
    • Justice: allocating medical resources fairly, according to medical need and each patient’s capacity to benefit. This allocation should not be influenced by the race, culture, wealth or address of the person being treated.
  4. That emergency clinicians supplement the above principles with use of an objective, evidence-based threshold test to guide decision making in times of resource scarcity. The use of such tools will ensure that there is consistency of decision making that is less liable to latent biases and emotional valence. See figure below for an example of a standardized, evidence-based decision-making approach. 

Further advice for emergency clinicians can be found at:

  • Alberta Health, Ethical Framework for Responding to Pandemic Influenza [Link]

An example of standardised evidence-based decision-making guide is provided in Figure 15 below:

Figure 15. Example of a standardised evidence-based decision-making guide

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