Ethical considerations

Editor – Thank you for publishing the article ‘Evaluating the national PPE guidance for NHS healthcare workers during the COVID-19 pandemic’ which gives an evidence-based summary of current PPE guidelines.¹

The authors' discussion of ethical considerations mentions avoiding harm to the public, the moral duty of government leaders to be open and honest if there is insufficient quality or quantity of personal protective equipment (PPE) and that healthcare workers (HCWs) should be duly informed of their own personal risks when caring for COVID-19 patients. It does not mention two further issues that I wish to highlight here: autonomy of HCWs to ensure their own safety and indemnity.

The first step in assessing unwell patients is always to ensure that it is safe to approach. Given that some HCWs working in high-risk COVID settings are still unable to access PPE and the rising death toll among HCWs, the importance of this cannot be overstated. HCWs can be tempted to accept poor quality or availability of PPE out of a duty of care and fear of indemnity while putting themselves at risk. They are not encouraged to exercise autonomy in the event that they deem the risk to themselves greater than potential benefit to the patient.

As of April 2020, the Medical Protection Society has stated its position that ‘If a doctor decides they cannot safely see a COVID-19 patient because they do not have adequate PPE and a patient subsequently comes to harm, they should not be held personally accountable by their employer or the regulator.’² It is calling for ‘urgent reassurance’ from the general medical council and employers on this issue. Government MPs are also asking for emergency laws to protect doctors forced to make difficult decisions during the pandemic.

In view of this, I would suggest that HCWs should not only be ‘informed’ of their own personal risks but be encouraged and empowered to make valid autonomous decisions considering their own safety without fear of indemnity. To make this a reality, we need employers and regulating bodies to make changes in policy that reflect how much we as a society value the lives and diligence of HCWs in these difficult times.