Author: Sharon Kaur, Faculty of Law, University of Malaya, Malaysia
Healthcare professionals working in clinical settings are likely to face complex and difficult issues during the Covid-19 pandemic. For example, grappling with how to balance their duties to Covid-19 patients as well as to the wider community; how to respond to the unmet needs of non-Covid-19 patients; and in some cases, how to equitably distribute scarce resources. It is therefore unsurprising that many healthcare professionals have experienced and continue to experience distress and confusion in the time of Covid-19. Clinical ethics support is valuable in these situations to provide advice and recommendations in challenging cases by clarifying values and facilitating the use of context appropriate ethical frameworks and guidelines. It is an important part of the response to the unique ethical challenges faced by doctors during the pandemic.
However, institutionalised, well-established clinical ethics support may not be readily available in many countries. This is likely to be true of many lower- and middle-income countries (LMIC) such as Malaysia. Recognising the need and importance of providing timely, context appropriate and ethically sound support to local healthcare professionals, the idea of a virtual clinical ethics consultation service for Covid-19 was mooted. A virtual service would have the benefit of providing healthcare professionals across the country with quick and easy access to ethics experts who were primarily based in the capital. Significantly, by using free platforms such as Google Docs, WhatsApp and Zoom calls, the service could be run without the need for a budget.
With this in mind and in the spirit of solidarity, a team of experts from diverse backgrounds including clinical ethics, from different institutions of healthcare and higher learning in Malaysia, launched the Clinical Ethics Malaysia (CEM) COVID-19 Consultation Service; a platform to provide clinical ethics advice to healthcare professionals due to the COVID-19 pandemic. Everyone on the team volunteers their time and expertise.
Two key observations can be made from an initial analysis of the cases submitted. First, local doctors are primarily struggling to deal with issues relating to the tensions between public health and individual interests. In designing policies and interventions that maximise the common good (public health interests), it is vital that policymakers keep in mind the need for approaches and methods that minimise harm to individual interests, particularly the interests of vulnerable populations. While many of the restrictions imposed by the State and healthcare institutions were recognised as scientifically and ethically appropriate to contain the spread of the disease, some healthcare professionals raised concerns that non COVID-19 patients (particularly vulnerable patients, such as the elderly and cancer patients), were bearing a disproportionate burden of the risk. Rigid policy positions of healthcare institutions that failed to adapt nimbly to falling infection rates created a significant amount of moral distress.
Second, building public trust and solidarity by way of effective and positive communication strategies is essential. Clinical management of patients during the initial stages of the second wave of the outbreak in Malaysia was made more difficult by the stigma and discrimination experienced by certain groups. This led to among other things, a number of instances where patients lied to healthcare professionals about their risk levels, resulting in unit closures and quarantine of healthcare workers.
Solidarity lies at the heart of this initiative. We all have a common interest and objective in that we want to support healthcare professionals in the delivery of ethically sound healthcare services. We are united in supporting innovative measures to achieve this goal given our limited resources and pool of experts. We act in the common interest even if this means that we might have to make some sacrifices in order to achieve this. Meetings may have to be held after work or during the weekends, and free time might be spent in research and reading lengthy articles. It is important to remember that we should explore ways in which we can work around our limitations and explore new ways to engage as ethicists to meet the needs of our colleagues and society in general during these difficult times.