COVID-19 and the orthopaedic surgeon: who gets redeployed?
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Published on: January 6, 2023
Rachel S Bronheim1, Casey Jo Humbyrd2,3,4
1Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland, USA.
Insights
Physician redeployment during COVID-19 requires balancing patient care, societal needs, and physician well-being. A framework for surgical specialists ensures ethical and equitable participation in public health crises.
Area of Science:
- Medical Ethics
- Public Health Policy
- Surgical Specialties
Background:
- The COVID-19 pandemic necessitated redeploying physicians, including specialists, to address increased healthcare demands.
- This redeployment raises ethical questions regarding physicians' competing obligations to patients, self, and society.
Purpose of the Study:
- To analyze the ethical considerations of redeploying specialty physicians during a public health crisis.
- To develop a framework for the ethical and equitable redeployment of surgical specialists, using orthopaedic surgery as a model.
Main Methods:
- Analysis of a clinical scenario involving an orthopaedic sports surgeon redeployed for COVID-19 care.
- Development of a redeployment framework based on ethical principles and practical considerations.
Main Results:
- Physicians have a moral obligation to participate in redeployment, but this obligation is conditional.
- Conditions include high local COVID-19 rates, fulfilled patient care obligations, and the pandemic's impact on specialist value.
Conclusions:
- Redeployment should prioritize voluntary participation over compulsory measures.
- The framework ensures redeployment is ethically permissible, equitable, and minimizes unreasonable risk to physicians.
Abstract:
The COVID-19 pandemic has increased demand for physicians, leading to widespread redeployment of specialty physicians to care for patients with COVID-19. These redeployments highlight an important question: How do physicians balance competing obligations to their own health, their own patients, and society during a public health crisis? How can physicians, specifically subspecialists, navigate this tension? In this article, we analyse a clinical scenario in which an orthopaedic sports surgeon is redeployed to care for patients with COVID-19. This case raises questions about physicians' obligations to their own patients compared with society at large, the relative value of specialty physicians during a global pandemic, and the ethical permissibility of compulsory redeployment. Using the orthopaedic surgery specialty as a model, we build a redeployment framework for surgical specialists that is both ethical and equitable. We argue that although orthopaedic surgeons have a moral obligation to participate in physician redeployment schemes, the scope of this obligation is limited and contingent on the following conditions: (1) the number of local COVID-19 cases is high; (2) obligations to their own patients or orthopaedic patients requiring urgent or emergency care have been fulfilled; (3) their value as physicians exceeds their value as specialists because of the pandemic climate; (4) voluntary redeployments are exhausted before compulsory redeployments are implemented; and (5) redeployment would not put the physicians at unreasonable risk of harm.
