a crowd of people shuffling through a sidewalk

Reopening the Country During COVID-19: Legal and Policy Issues 

By Mark A. Hall and David M. Studdert

Every public health crisis poses unique legal and ethical challenges, but none more so in modern times than the novel coronavirus pandemic. Urgent responses to the pandemic have halted movement and work and dramatically changed daily routines for most of our population in ways entirely unprecedented. As we wrote recently, this sweeping response challenges a host of civil liberties that state and federal statutes and constitutions protect. It should come as no surprise, then, that we are starting to hear widespread grumbling. There are even reports of some initial “protest” lawsuits. But even without overt legal challenges, public health officials are well attuned to the need to respect civil liberties in setting appropriate policies. And, if those officials are not well-attuned, politicians, who are concerned about widespread economic fallout, will forcefully remind them.

It follows that there is a pressing need for a set of principles to guide not just the imposing of COVID-type restrictions, but also relaxing or lifting them.

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A doctor holding a paper that reads "stay at home"

Ethical Duties of Health Care Providers and the Public in the Time of COVID-19

By Jonathan M. Marron, Louise P. King, and Paul C. McLean

In medical ethics, we often speak of duties, such as the duty one has to patients, to society, to our families, to ourselves. In fact, deontology is a moral theory often cited in medical ethics based primarily on the consideration and application of such duties.

But we typically speak of duties under “normal” circumstances, and normal certainly does not describe the current COVID-19 pandemic. It is unclear whether and how our typical conceptualization of duties – the duty of clinicians, of health care institutions, and of the public – apply under these unprecedented conditions. These questions are being considered in our hospitals, living rooms, the lay press, and on social media.

What follows is an edited version of a Twitter dialogue between surgeon Louise P. King and pediatric oncologist Jonathan Marron, both faculty members at the Harvard Medical School Center for Bioethics. Drs. King and Marron were responding to a tweet by Paul McLean, social media editor at the Center for Bioethics, on his personal account.

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empty hospital bed

Disability and Rationing of Care amid COVID-19

By Katrina N. Jirik, PhD

As health care resources grow increasingly scarce amid the COVID-19 pandemic, states, hospitals, and individuals are forced to make tough decisions about the rationing of care. These decisions are often framed in terms of medical and/or legal criteria. However, many people, especially the physicians who make the difficult decisions, realize they have a huge moral component related to perceptions of the value of an individual’s life.

Various states have triage guidelines in place, which differ somewhat, but primarily reflect a utilitarian goal of saving the most people with the least expenditure of finite resources. This is where the societal issue of the value of the life of a person with a disability comes into play.

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hospital equipment

How Triage During COVID-19 Can be Fair to Patients with Disabilities

By Govind Persad

On March 28, 2020, the Department of Health and Human Services issued guidance regarding the application of antidiscrimination law to triage policies — that is, policies for fairly allocating scarce medical treatments, like ventilators, in the COVID-19 pandemic.

Many news outlets incorrectly portrayed HHS as prohibiting triage guidelines from considering disability. But the guidance is more nuanced.

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Researcher works at a lab bench

Human Subjects Research in Emergencies: An Ethical and Legal Guide (Part I)

By Jennifer S. Bard

This post is the first in a series about conducting human subjects research in emergencies. These posts are being written in response to a rapidly evolving situation and will reflect the state of knowledge at the time of writing.

The world is facing a medical emergency in the form of the rapid spread of a new virus, COVID-19, for which there is no known effective treatment and no preventive vaccine.

Without minimizing the need for haste or the significance of the threat, it is still important to remain aware of the risks inherent in rushing to treat patients with anything that might work and simultaneously conducting the research necessary to identify safety and effective interventions.

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alcatraz, san francisco

The COVID-19 Pandemic and Efforts to Release People in Custody

By Phebe Hong

The first death of a federal inmate from COVID-19 occurred on March 28, at a prison in Oakdale, Louisiana. The inmate had been incarcerated for 13 years for a nonviolent drug charge. At least four other infected inmates have died at the same institution.

The COVID-19 pandemic is wreaking havoc on prisons and jails, where proper social distancing is nearly impossible to maintain.

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woman with iv in her hand in hospital. Labor and delivery preparation. Intravenious therapy infusion. shallow depth of field. selective focus

The Ethical Argument Against Allowing Birth Partners in All New York Hospitals

By Louise P. King and Neel Shah

Among pregnant people and those who love them, the past few weeks have been especially confusing and anxiety-provoking.

As the new epicenter of the COVID-19 pandemic, New York City hospitals temporarily restricted pregnant people from having a birth partner present during labor, a move that stoked international outcry and a vocal community response. Following a Change.org petition that rapidly amassed more than 600,000 protesting signatures, Governor Cuomo responded with an executive order, stating via a spokesperson, “[i]n no hospital in New York will a woman be forced to be alone when she gives birth. Not now, not ever.”

Both of us are obstetrician/gynecologists who have dedicated our careers to supporting the reproductive health and rights of those we are entrusted to care for. We are trained in health law policy and bioethics. And while we support the strong show of support for laboring women and their rights, we believe the Governor’s decision to mandate all New York hospitals allow birth partners — irrespective of the local case rate of COVID-19 or hospital capacity to test for infection or protect health care workers — is uninformed and unethical.

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hospital equipment, including heart rate monitor and oxygen monitor functioning at bedside.

Why COVID-19 is a Chronic Health Concern for the US

By Daniel Aaron

The U.S. government has ratified a record-breaking $2 trillion stimulus package just as it has soared past 100,000 coronavirus cases and 1,500 deaths (as of March 27). The U.S. now has the most cases of any country—this despite undercounting due to continuing problems in testing Americans on account of various scientific and policy failures.

Coronavirus has scared Americans. Public health officials and physicians are urging people to stay at home because this disease kills. Many have invoked the language of war, implying a temporary battle against a foreign foe. This framing, though it may galvanize quick support, disregards our own systematic policy failures to prevent, test, and trace coronavirus, and the more general need to solve important policy problems.

Coronavirus is an acute problem at the individual level, but nationally it represents a chronic concern. No doubt, developing innovative ways to increase the number of ventilators, recruit health care workers, and improve hospital capacity will save lives in the short-term — despite mixed messages from the federal government. But a long-term perspective is needed to address the serious problems underlying our country’s systemic failures across public health.

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basketball on court

The Long-Term Harm of Favoritism in COVID-19 Testing

By Jonathan M. Marron and Paul C. McLean

One of us is a sports fan, childhood cancer doctor, and bioethicist. The other is a former sportswriter drawn to medical ethics since the cure of his only child. If sports and ethics have something in common, it’s the value of a level playing field. Fairness matters. There’s a coin toss: heads or tails. Fairness, not favoritism.

We view the doctor-patient relationship through slightly different lenses, but it’s precious either way. It’s a relationship — above all else — built on trust. And that relationship, a cornerstone of healthcare, is suddenly like an already vulnerable person facing an uncertain prognosis. If the doctor-patient relationship is to survive the novel coronavirus (COVID-19) pandemic, it will require a unified team, trust, and a level playing field, regardless of how much money or influence you have.

What does sports have to do with this?

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corridor with hospital beds

3 Human Rights Imperatives for Rationing Care in the Time of Coronavirus

By Alicia Ely Yamin and Ole F. Norheim

Scholarly and official statements and publications regarding human rights during the current pandemic have largely reiterated the important lessons learned from HIV/AIDS, Zika and Ebola, such as: engagement with affected communities; combatting stigma and discrimination; ensuring access for the most vulnerable; accounting for gendered effects; and limiting rights restrictions in the name of public health.

But there is a notable silence as to one of the most critical decisions that almost every society will face during the COVID-19 pandemic: rationing scarce health care resources and access to care.

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