By Stephen Trevick, MD
Medical care during the COVID-19 pandemic has seen greater change over a shorter period of time than once believed possible. As physicians and associated medical providers, our institutions, case profiles and even day-to-day workflows have undergone incredible shifts.
The Neurocritical Care Society has released a bundle of the book "Law and Ethics in Neurocritical Care" by Drs. James E. Szalados, Wendy Wright and Wade Smith alongside "The Ethics Curriculum for Neurocritical Care Fellowships," edited by myself and written by the NCS Ethics Committee. As we navigate the pandemic and operate within new or unfamiliar contexts, ethical and legal considerations have necessarily taken on incredible significance.
And yet, the principles by which we practice are still the same. The basic principles of beneficence, nonmaleficence, autonomy and justice remain the guiding pillars of modern medical ethics. They remain instrumental in helping to inform care in response to the current pandemic.
How do we provide beneficial care in light of ever-shifting scientific uncertainty? How do we maintain the decision-making power of surrogates when they are no longer present at the bedside? By what standard can we apply unilateral do-not-resuscitate orders or rationing of care? Many concerns that until recently seemed theoretical have become stark and immediate in their impact.
The law serves as a framework within which we can provide ethical care. As medical challenges evolve and systems necessarily change, the law ideally provides stability to practitioners, preventing overly rapid or fringe changes, as well as continuity of service. However, the law is not always as transparent or instructive as we might hope. It encompasses regional differences, case precedents and statutes written in language not always reflective of medical realities.
The recent changes to medical care stemming from COVID-19 have forced us to ask ourselves what type of providers we are and what type we wish to be. Medical practice requires robust scientific knowledge, but in order to address patients' needs and values amidst medical uncertainty, we must draw on a much wider range of competencies. The law and ethics products like those offered by NCS help instill an awareness for the subtleties of ethical practice in our trainees, and they also further educate veteran practitioners.
Understanding of medical ethics is necessary to not simply intuit but to affirmatively develop our own moral stances toward the worthy goal of efficacious and defensible decision making.