{"id":3908,"date":"2020-07-06T21:14:28","date_gmt":"2020-07-06T20:14:28","guid":{"rendered":"https:\/\/blogs.bmj.com\/medical-ethics\/?p=3908"},"modified":"2020-07-06T21:14:28","modified_gmt":"2020-07-06T20:14:28","slug":"finding-the-space-for-ethics-during-a-global-crisis","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/medical-ethics\/2020\/07\/06\/finding-the-space-for-ethics-during-a-global-crisis\/","title":{"rendered":"Finding the space for ethics during a global crisis"},"content":{"rendered":"<p>By Mary Hall, Deborah Mbofana, Merryn Ekberg, and Mitch Harper<\/p>\n<p>The concept of emergency preparedness is based on the need to act rather than plan, to be able to pick up and run with a ready prepared, detailed plan.\u00a0 In the UK, the <a href=\"https:\/\/www.gov.uk\/government\/publications\/emergency-preparedness\">Emergency Preparedness<\/a> and <a href=\"https:\/\/www.gov.uk\/guidance\/emergency-response-and-recovery\">Emergency Response and Recovery<\/a> sections of The Civil Contingencies Act (2004) provide a framework for preparing and responding to civil emergencies.\u00a0 Pandemic flu has been regarded as one of the most \u2018severe natural challenges likely to affect the UK\u2019 and its detailed <a href=\"https:\/\/www.gov.uk\/guidance\/pandemic-flu\">emergency plans<\/a> have formed the basis for the UK\u2019s response to the Covid-19 pandemic.<\/p>\n<p>The coordinated response to Covid-19 has seen emergency plans kick in and a dependence on command and control structures of quick, responsive decision making down the chain of command.\u00a0 However this is an unprecedented situation; plans have had to be changed or adapted on an almost daily basis as new scientific evidence becomes available.\u00a0 Regular changes in guidance have created a scramble of local activity with little or no time to think, plan or reflect on critical decisions being made.\u00a0 The opportunity for robust ethical decision making becomes at risk of redundancy, a casualty of the emergency response.<\/p>\n<p>This is particularly true for those working in the health sector.\u00a0 Professional bodies have recognised the potential impact on staff and developed supporting documents for <a href=\"https:\/\/www.bma.org.uk\/bma-media-centre\/bma-publishes-ethics-guidance-for-doctors-making-difficult-covid-19-decisions-on-the-front-line\">medics<\/a>, <a href=\"https:\/\/www.nmc.org.uk\/news\/coronavirus\/\">nurses<\/a> and <a href=\"https:\/\/www.ahpnw.nhs.uk\/covid-19-ahps\">allied health professionals<\/a> but these still require local adaptation and adoption that incorporates a reflective, reasonable and justifiable approach.<\/p>\n<p>In Northamptonshire we set up an Ethics Advisory Group to provide key decision makers an opportunity to incorporate ethical considerations into their decision-making process.\u00a0 Rather than being viewed as a luxury, there was acceptance of the need for a structured, reasoned and ethically informed approach to the critical decisions needing to be made.\u00a0 Not least, there was recognition of the exceptional demands being placed on key staff and the need for reassurance and backing regarding individual daily decisions.<\/p>\n<p>The group was set up by the Public Health team of Northamptonshire County Council.\u00a0 Senior level support was apparent from the start with representation at a Director, Chief Executive or senior decision maker level from the local acute trusts, community trust, district and borough councils, adult services, HealthWatch and the University of Northampton.<\/p>\n<p>The group has been very clear that it is not a decision making body.\u00a0 It uses an ethical framework to provide advice and ethical consideration on issues or questions that have been raised by organisations across the social care, health and local government system within Northamptonshire.\u00a0 It does not consider individual ethical issues or complaints but has provided advice on ethical considerations of, for example, allowing hospital or care home visiting or re-deploying staff.\u00a0 National guidance is used as a starting point for discussions, but often local issues need further consideration and nuance than that available in guidelines.\u00a0 The ethical framework successfully enables this to happen.<\/p>\n<p>The group meets weekly, dependent on issues raised, and despite the immense workload of all members, there has always been a regular and high attendance level.\u00a0 This is not seen as a burden, but, rather as an opportunity to contribute to a local and global emergency.\u00a0 There is reassurance in the fact that local decision making can be supported by considered, ethical advice even at a time of crisis.\u00a0 The multi-disciplinary nature of participants means that issues are considered from all angles including that of the resident, their relatives, staff and the community from different organisational perspectives.\u00a0 This is important when disseminating advice and conclusions.<\/p>\n<p>Emergency preparedness enables us to react and respond to emergencies quickly and with minimal need to develop new plans.\u00a0 Ethics and the time for ethical consideration could be a casualty of this emergency response.\u00a0 Yet this is a time when ethics is critical: we need to be able to say, in the coming months and years, that the decisions we\u2019ve taken and the actions we\u2019ve done are ones based on sound reasoning and judgement that benefit most and harm fewest whilst maintaining respect for autonomy.\u00a0 Ethical decision making is not a luxury but a necessity.\u00a0 In setting up, and making space for an Ethics Advisory Group, we have accepted our professional responsibilities and obligations.<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Authors and affiliations:<\/strong><\/p>\n<p>Mary Hall, Consultant in Public Health, Northamptonshire County Council<\/p>\n<p>Deborah Mbofana, Public Health Practitioner, Northamptonshire County Council<\/p>\n<p>Dr Merryn Ekberg, Senior Lecturer in Bioethics, University of Northampton<\/p>\n<p>Mitch Harper, Public Health Officer, Northamptonshire County Council<\/p>\n<p><strong>\u00a0Competing interests: <\/strong>None<\/p>\n<p>&nbsp;<!--TrendMD v2.4.8--><\/p>\n","protected":false},"excerpt":{"rendered":"<p>By Mary Hall, Deborah Mbofana, Merryn Ekberg, and Mitch Harper The concept of emergency preparedness is based on the need to act rather than plan, to be able to pick up and run with a ready prepared, detailed plan.\u00a0 In the UK, the Emergency Preparedness and Emergency Response and Recovery sections of The Civil Contingencies [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/medical-ethics\/2020\/07\/06\/finding-the-space-for-ethics-during-a-global-crisis\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":353,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[8070],"tags":[304],"class_list":["post-3908","post","type-post","status-publish","format-standard","hentry","category-pandemic","tag-public-health"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Finding the space for ethics during a global crisis - Journal of Medical Ethics blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/medical-ethics\/2020\/07\/06\/finding-the-space-for-ethics-during-a-global-crisis\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" 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