Organizational Ethics Support for Health Care Lead-ers during the COVID-19 Pandemic and Beyond

Organizational ethics programs can help senior health care leaders align an institution's decision-making to its stated mission and values. The optimal ways organizational ethics can and should support senior leaders, however, are evolving. To inform that conversation, we discuss how organizational ethics has supported senior leaders in two tertiary hospitals during institutional responses to the COVID-19 pandemic. This real-time process of organizational ethics program development has helped characterize the types of support organizational ethics can provide to senior leaders and has identified how organizational ethics can be embedded in leadership processes to ensure the recognition and management of ethical challenges in health care.

COVID-19 Trial Enrollment for Those Who Cannot Consent: Ethical Challenges Posed by a Pandemic.

The current coronavirus disease 2019 (COVID-19) pandemic has triggered an intense global research effort to inform the life-saving work of frontline clinicians who need reliable information as soon as possible. Yet research done in pressured circumstances can lead to ethical dilemmas, especially for vulnerable research subjects. We present the case of a child with neurocognitive impairment who is diagnosed with COVID-19 infection after presenting with fever and a seizure. The child lives in a group home and is in the custody of the state; her parents lost parental rights many years ago. Some members of the health care team want to enroll her in a randomized clinical trial evaluating an experimental treatment of COVID-19. For minor patients to enroll in this clinical trial, the institutional review board requires assent of patients and consent of guardians. An ethics consult is called to help identify relevant concerns in enrollment. In the accompanying case discussion, we address historical perspectives on research involving people with disabilities; proper management of research participation for people with disabilities including consent by proxy, therapeutic misconception, and other threats to the ethical validity of clinical trials; and the potentially conflicting obligations of researchers and clinicians.