The Council on Ethical and Judicial Affairs shall Investigate general or specific professional conditions and matters relating to the relations of physicians to one another, arbitrate matters between physicians and the public, resolve disputes between members of the Medical Society, direct and supervise activities of the Medical Society which pertain to educational programs and questions of medical ethics.

Chair

Kleper de Almeida, MD      

Stuart J. Bagatell, MD            

Peter L Cruise                         

George Luck, MD                   

Marnie Poncy                         

Brent Schillinger, MD            

Mark A. Rubenstein, MD       

Emanuel Newmark, MD        

Michael S. Zeide, MD             

 

ETHICS GUIDELINES FOR CRISIS STANDARDS
OF CARE IN PUBLIC HEALTH EMERGENCIES

  

Establishing an ethical response to the COVID-19 pandemic: An emerging need for collaboration, consensus and action 

 

 

Palm Beach County Medical Society and Florida Bioethics Network

 

Advocate for a Crisis Plan for Providers  

 

(West Palm Beach, Florida) – The COVID-19 pandemic has threatened to overwhelm healthcare systems and created a need to evaluate ethical guidelines for allocation and triage of resources. Leaders of the Palm Beach County Medical Society (PBCMS) and the Florida Bioethics Network (FBN) are calling for providers to proactively adopt a clear ethical framework.  

 

Kenneth W. Goodman, PhD, Director, University of Miami Miller School of Medicine Institute for Bioethics and Health Policy and Founder of FBN, helped to draft the guidelines that can serve as recommended strategies and a template to guide hospitals facing dire circumstances.  

 

He worked with other volunteer members of the FBN, including nurses, physicians, social workers, clergy and lawyers. According to Dr. Goodman, the document is NOT legal advice. Instead it “provides what are regarded as ethically optimized guidelines for ventilator rationing and triage, cardiopulmonary resuscitation and other challenges faced in an emergency,” he writes in the document’s executive summary. 

 

Other states, including Maryland, Arizona and Utah, have adopted similar guidelines, but the vast majority of the U.S, including Florida, have no guidelines in place.  A 2019 article published by critical care physicians describes Maryland’s efforts to build an allocation framework. Maryland set out to understand community values relating to the allocation of scarce lifesaving resources through a “community engagement effort using a Deliberative Democracy methodology. Members of the general public, healthcare professionals and disaster professionals participated. A framework was developed over a two-year process which is intended to assist hospitals and public health agencies in their independent and coordinated response to scarce resource allocation procedures (Chest:2019; 155 (4): 848-854).

 

As the physician authors of “Fair Allocation of Scarce Medical Resources in the Time of COVID-19” wrote in a recent issue of the New England Journal of Medicine: “public health mitigation efforts do not obviate the need to adequately prepare for the allocation of scarce resources before it becomes necessary.” 

 

“Uncertainty around this pandemic continues and it is imperative to establish ethical criteria and processes to fairly implement allocation decisions for serious situations,” stated Brent M. Schillinger, MD, who is active with both organizations, serves as a member of the PBCMS Council on Ethics and is a past president of the Society. 

 

Dr. Schillinger stresses that public health emergencies have the potential to stress clinicians and healthcare systems.  Proactive preparation will help guide care aimed at producing optimal outcomes because detailed discussions and thoughtful decision making will be difficult in a crisis.  

 

According to Kleper de Almeida, MD, the current situation sheds light on the need to address surge capacity.  Critical health care workers, medications needed to treat COVID-19 such as Remdesivir, convalescent plasma, hospital beds, and supplies need to be addressed in the plan. Mental health support for physicians and care givers must also be included. He emphasizes that ideally, we will never need to pull a document like this off the shelf, but in an emergency, guidelines will provide physician decision makers a standardized roadmap to follow.  

 

As we continue to deal with the current pandemic, PBCMS, along with the Healthcare Emergency Response Coalition of Palm Beach County (HERC), reminds the public to follow the COVID-19 safety guidelines. 

 

  • Wear a mask
  • Avoid touching your face
  • Maintain social distancing
  • Frequent Hand washing