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J Am Acad Orthop Surg ; 29(2): e72-e78, 2021 Jan 15.
Article in English | MEDLINE | ID: covidwho-914687


The question about how to resume typical orthopaedic care during a pandemic, such as coronavirus disease 2019, should be framed not only as a logistic or safety question but also as an ethical question. The current published guidelines from surgical societies do not explicitly address ethical dilemmas, such as why public health ethics requires a cessation of nonemergency surgery or how to fairly allocate limited resources for delayed surgical care. We propose ethical guidance for the resumption of care on the basis of public health ethics with a focus on clinical equipoise, triage tiers, and flexibility. We then provide orthopaedic surgery examples to guide physicians in the ethical resumption of care.

COVID-19 , Orthopedic Procedures/ethics , Public Health Administration/ethics , Adolescent , Aged , Arthroplasty, Replacement, Hip , Arthroplasty, Replacement, Knee , COVID-19/epidemiology , Clavicle/injuries , Clavicle/surgery , Clinical Decision-Making , Female , Femoral Neoplasms/surgery , Fractures, Bone/surgery , Giant Cell Tumors/surgery , Humans , Male , Middle Aged , Orthopedics , Pandemics , Practice Guidelines as Topic , Rotator Cuff Injuries/surgery , SARS-CoV-2 , Therapeutic Equipoise , Triage
J Am Acad Orthop Surg ; 28(11): 471-476, 2020 Jun 01.
Article in English | MEDLINE | ID: covidwho-56807


The Coronavirus disease 2019 pandemic has been an unprecedented challenge to healthcare systems and clinicians around the globe. As the virus has spread, critical questions arose about how to best deliver health care in emergency situations where material and personnel resources become scarce. Clinicians who excel at caring for the individual patient at the bedside are now being reoriented into a system where they are being asked to see the collective public as their responsibility. As such, the clinical ethics that clinicians are accustomed to practicing are being modified by a framework of public health ethics defined by the presence of a global pandemic. There are many unknowns about Coronavirus disease 2019, which makes it difficult to provide consistent recommendations and guidelines that uniformly apply to all situations. This lack of consensus leads to the clinicians' confusion and distress. Real-life dilemmas about how to allocate resources and provide care in hotspot cities make explicit the need for careful ethical analysis, but the need runs far deeper than that; even when not trading some lives against others, the responsibilities of both individual clinicians and the broader healthcare system are changing in the face of this crisis.

Betacoronavirus , Coronavirus Infections , Delivery of Health Care/ethics , Orthopedic Procedures/ethics , Pandemics/ethics , Pneumonia, Viral , Bioethical Issues , COVID-19 , Female , Humans , Male , Outcome Assessment, Health Care , Pandemics/prevention & control , SARS-CoV-2 , United States