Incorporating ethics into infectious disease clinical practice guidelines

Incorporating ethics into clinical practice guidelines (CPGs) can be challenging. This is particularly evident for infectious diseases (ID) CPGs because of the complexity of ID ethics (IDE) and the multiplicity of populations at risk for infections.

The OPENING project (IncOrPorating Ethics iN ClINical Guidelines: Practical Indications) was initiated by the European Society of Clinical Microbiology and Infectious Diseases Ethics Advisory Committee in collaboration with the European Society of Clinical Microbiology and Infectious Diseases Guidelines Subcommittee to generate guidelines for the systematic inclusion of ethics principles into ID CPGs.

The first part of the project, presented here, aimed at: (a) performing a scoping review of articles published in PubMed and Google Scholar between 1990 and 2024 discussing ethics inclusion in CPGs; (b) reviewing guidance documents for ethics incorporation in documents from international societies; (c) outlining how the main ethics principles could be included in ID CPGs according to the results retrieved.

We retrieved 21 articles written between 1994 and 2024. None of these specifically focused on IDE. The main topic discussed in articles and societies' guidance was the inclusion of equity principles at different stages of CPGs development. Multiple authors also addressed how specific subgroups and disadvantaged populations should be considered in the preparation of CPGs. Involvement of patients and their representatives in CPGs was also advocated. A structured framework for the systematic inclusion of IDE principles in CPGs was suggested to summarize these points.

There is a lack of recommendations for incorporating ethics in ID CPGs. Efforts should be made by scientific societies to include ethics guidelines in ID CPGs to fill this gap.