Surgery in COVID-19 Crisis Conditions: Can We Protect Our Ethical Integrity Against the Odds?

By J Macleod, S Mezher and R Hasan

Since the dawn of the COVID-19 crisis, drastic changes have swept across many organisations. Healthcare providers are particularly affected by this; which we have experienced first-hand working in cardiac surgery. Working in this constantly evolving situation inevitably leads to uncertainty, inconsistency and even fear despite the best of efforts. For us, this sparked heated discussions on some of the most important topics ranging from consent to optimal management. The feeling was that these issues needed more formal exploration to help keep our practise as best as it can be for patients. Our backgrounds helped us to see that to achieve this, the new processes and structure must be justified, clear and consistent.

Throughout his career J Macleod has been involved in organisation and management, from the Bute Medical Society to the Brazilian Paralympic Rowing Team. He understands the importance of building a team in which each member brings their unique perspective to solve a complex problem.  S Mezher, leadership author and founder of, is particularly interested in creating optimal organisational structures to maximally benefit the end user. R Hasan, Lead Cardiothoracic Surgeon, has extensive experience in leading and managing a tertiary care centre department. With our shared background we felt that together we may create the necessary justification to guide clinical management. To do this we needed to interrogate the ethical literature and then apply that to the issues we are being faced in everyday clinical practise. This gave birth to our paper: “Surgery in COVID-19 Crisis Conditions: Can We Protect Our Ethical Integrity Against the Odds?”.

Our paper draws on many sources including Kantian ethics and Beauchamp and Childress’s landmark textbook “Principles of Biomedical Ethics”. It was very interesting how taking such generalised pieces of ethical guidance and applying them to the current clinical challenges could produce real clinical practise recommendations. An identical process could be used, in theory, to evaluate any problem to identify the key deciding factors requiring consideration. Historically there has been criticism of the practical utility of ethical theory. Cookson and Dolan attributed this to reluctance of philosophers to over-include themselves into complex details of healthcare delivery. They described how the philosopher states to himself “I am not very well versed in the details of these problems, and have had to content myself with giving what I think is the best philosophical basis for their solution, leaving it to others to apply it to the various difficulties that all who seek to provide an adequate health service are faced with”. Although this may not be true for all philosophers, it follows that the clinician must bridge the gap between ethical theory and its real-world application. We argue that is only through this continued teamwork that a united effort towards a more just and beneficial healthcare environment can be created for the patient. This is especially important in these uncertain times.


Paper title: Surgery in COVID-19 Crisis Conditions: Can We Protect Our Ethical Integrity Against the Odds?

Author(s): J Macleod, S Mezher, R Hasan

Affiliations: Department of Cardiothoracic Surgery, Manchester Royal Infirmary, Oxford Road, M13 9WL

Competing interests: The authors declare no competing interests.

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Sermed Mezher – Facebook 

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