COVID-19 | Ethics

Introduction

The ongoing COVID-19 pandemic raises a number of important ethical questions, which may also emerge in the work of military health care personnel (HCP) as they are often part of the response to the pandemic. Therefore, the ICMM and its Center of Reference for Education on IHL and Ethics (RefC) in cooperation with the ZH Center for Military Medical Ethics (CMME) have decided to provide some guidance and resources on how to deal with the ethical issues.

On this page, we want to provide and continuously update a list of resources such as national ethics guidelines, important research, and other relevant documents that may inform and support HCP in their difficult decisions.

This page will be updated regularly. You can help us to keep this collection up to date by sending your input via email to This email address is being protected from spambots. You need JavaScript enabled to view it.

National and international medical ethics guidelines (alphabetical order)

Selected readings in the ethics of triage

Not all listed items are with specific attention to COVID-19, but also more generally on triage.

• Berlinger, N., Wynia, M., Powell, T., Hester, D., M., Milliken, and A., Fabi, R. 2020. Ethical Framework for Health Care Institutions Responding to Novel Coronavirus SARS-CoV-2 (COVID-19) Guidelines for Institutional Ethics Services Responding to COVID-19: Managing Uncertainty, Safeguarding Communities, Guiding Practice. The Hastings Center. https://www.thehastingscenter.org/wp-content/uploads/HastingsCenterCovidFramework2020.pdf
• Christian, Michael D., Laura Hawryluck, Randy S. Wax, Tim Cook, Neil M. Lazar, Margaret S. Herridge, Matthew P. Muller, Douglas R. Gowans, Wendy Fortier, and Frederick M. Burkle. 2006.
  Development of a triage protocol for critical care during an influenza pandemic. Canadian Medical Association Journal 175: 1377. https://doi.org/10.1503/cmaj.060911
• Emanuel, Ezekiel J., Govind Persad, Ross Upshur, Beatriz Thome, Michael Parker, Aaron Glickman, Cathy Zhang, Connor Boyle, Maxwell Smith, and James P. Phillips. 2020.
  Fair Allocation of Scarce Medical Resources in the Time of Covid-19. New England Journal of Medicine: NEJMsb2005114. https://doi.org/10.1056/NEJMsb2005114
• Gostin, Lawrence O., Eric A. Friedman, and Sarah A. Wetter. 2020.
  Responding to COVID-19: How to Navigate a Public Health Emergency Legally and Ethically. Hastings Center Report. https://doi.org/10.1002/hast.1090
• Howe, Edmund G. 2014. Medical Ethics in Disasters. In Conflict and Catastrophe Medicine: A Practical Guide, ed. James M. Ryan, Adriaan P. C. C. Hopperus Buma, Charles W. Beadling, Aroop Mozumder, David M. Nott, Norman M. Rich, Walter Henny, and David MacGarty, 91–110. London: Springer London. https://doi.org/10.1007/978-1-4471-2927-1_6
• Iserson, Kenneth V., and John C. Moskop. 2007. Triage in medicine, part I: Concept, history, and types. Annals of emergency medicine 49: 275–281. https://doi.org/10.1016/j.annemergmed.2006.05.019
  Moskop, John C., and Kenneth V. Iserson. 2007. Triage in Medicine, Part II: Underlying Values and Principles. Annals of Emergency Medicine 49: 282–287. https://doi.org/10.1016/j.annemergmed.2006.07.012
• Iserson, Kenneth. 2020. Healthcare Ethics During a Pandemic. Western Journal of Emergency Medicine 21. https://doi.org/10.5811/westjem.2020.4.47549.
• Kramer, Jessica B., Douglas E. Brown, and Piroska K. Kopar. 2020. Ethics in the Time of Coronavirus: Recommendations in the COVID-19 Pandemic. Journal of the American College of Surgeons 230: 1114–1118. https://doi.org/10.1016/j.jamcollsurg.2020.04.004.
• Levin, D., R. O. Cadigan, P. D. Biddinger, S. Condon, H. K. Koh, and Joint Massachusetts Dept Public Hl. 2009.
  Altered Standards of Care During an Influenza Pandemic: Identifying Ethical, Legal, and Practical Principles to Guide Decision Making. Disaster Medicine and Public Health Preparedness 3: S132–S140. https://dx.doi.org/10.1097%2FDmp.0b013e3181ac3dd2
• Mannelli, Chiara. 2020. Whose life to save? Scarce resources allocation in the COVID-19 outbreak. Journal of Medical Ethics 46: 364–366. https://doi.org/10.1136/medethics-2020-106227.
• Newdick C, Sheehan M, Dunn M. Tragic choices in intensive care during the COVID-19 pandemic: on fairness, consistency and community. Journal of Medical Ethics 2020; 46:646-651. https://jme.bmj.com/content/46/10/646
• Persad, Govind, Alan Wertheimer, and Ezekiel J Emanuel. 2009. Principles for allocation of scarce medical interventions. The Lancet 373: 423–431. https://doi.org/10.1016/S0140-6736(09)60137-9
• Winslow, G. R. 2003. Triage. Encyclopedia of Bioethics 5: 2520–2523.
• Winsor, Shawn, Cécile Bensimon, Robert Sibbald, Kyle Anstey, Paula Chidwick, Kevin Coughlin, Peter Cox, et al. 2014. Identifying Prioritization Criteria to Supplement Critical Care Triage Protocols for the Allocation of Ventilators during a Pandemic Influenza. Healthcare Quarterly 17: 44–51. https://doi.org/10.12927/hcq.2014.23833

Research in ethics – collections

• AMA Journal of Ethics, Resources on COVID-19
  https://journalofethics.ama-assn.org/covid-19-ethics-resource-center
• The Hastings Center – Ethics Resources on the Coronavirus (COVID-19)
  https://www.thehastingscenter.org/ethics-resources-on-the-coronavirus/
• Johns Hopkins University – Coronavirus Resource Center.
  https://coronavirus.jhu.edu/
• A Philosophy & COVID-19 Bibliography
  http://dailynous.com/2020/04/16/philosophy-covid-19-bibliography/

Research in medicine – collections

• NEJM – https://www.nejm.org/coronavirus
• NIH – https://www.nih.gov/health-information/coronavirus

Other pages that may be helpful

• The ICMM's COVID-19 page – http://www.cimm-icmm.org/covid-19/
• The COVID-19 Humanitarian site by a number of organizations – https://www.covid19humanitarian.com/
• COVID 19 Resources by the Humanitarian Health Ethics Network – https://humanitarianhealthethics.net/home/hheat/hhe-covid-19-resources/

Reports

• Public Health England: Disparities in the risk and outcomes of COVID-19. – https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/908434/Disparities_in_the_risk_and_outcomes_of_COVID_August_2020_update.pdf
• Amnesty International: Exposed, silenced, attacked: failures to protect health and essential workers during the COVID-19 pandemic. – https://www.amnesty.org/en/documents/pol40/2572/2020/en/

Podcasts etc

• The Global Philospher (BBC) – Pandemic Ethics
  https://www.bbc.co.uk/sounds/play/m000h63r
• ICRC Humanitarian Las & Policy Blog – From the ‘Spanish Flu’ to COVID-19: lessons from the 1918 pandemic and First World War
  https://blogs.icrc.org/law-and-policy/2020/04/23/spanish-flu-covid-19-1918-pandemic-first-world-war/

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