Subject(s)
Family/psychology , Health Services Accessibility/ethics , Maternal Health Services/ethics , Patient Acceptance of Health Care/psychology , Pregnant Women/psychology , Women's Rights/ethics , COVID-19/prevention & control , Europe , Female , Humans , Infection Control , Maternal Health Services/organization & administration , Parturition/psychology , Pregnancy , Quality of Health Care/ethics , SARS-CoV-2ABSTRACT
Healthcare policies developed during the COVID-19 pandemic to safeguard community health have the potential to disadvantage women in three areas. First, protocols for deferral of elective surgery may assign a lower priority to important reproductive outcomes. Second, policies regarding the prevention and treatment of COVID-19 may not capture the complexity of the considerations related to pregnancy. Third, policies formulated to reduce infectious exposure inadvertently may increase disparities in maternal health outcomes and rates of violence towards women. In this commentary, we outline these challenges unique to women's healthcare in a pandemic, provide preliminary recommendations and identify areas for further exploration and refinement of policy.
Subject(s)
COVID-19 , Delivery of Health Care/ethics , Health Policy , Pandemics , Social Justice , Women's Health/ethics , Women's Rights/ethics , COVID-19/prevention & control , Ethics, Clinical , Female , Gender-Based Violence , Health Status Disparities , Humans , Maternal Health Services/ethics , Pregnancy , Pregnancy Complications/prevention & control , Public Health , SARS-CoV-2ABSTRACT
The current COVID-19 pandemic places maternity staff at risk of engaging in clinical practice that may be in direct contravention with evidence; professional recommendations; or, more profoundly, deeply held ethical or moral beliefs and values, as services attempt to control the risk of cross-infection. Practice changes in some settings include reduction in personal contacts for tests, treatments and antenatal and postnatal care, exclusion of birth partners for labor and birth, separation of mother and baby in the immediate postnatal period, restrictions on breastfeeding, and reduced capacity for hands-on professional labor support through social distancing and use of personal protective equipment. These enforced changes may result in increasing levels of occupational moral injury that need to be addressed at both an organizational and a personal level. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
Subject(s)
Coronavirus Infections/prevention & control , Maternal Health Services , Medical Staff , Nursing Staff , Occupational Diseases , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Psychological Trauma , Adult , COVID-19 , Humans , Maternal Health Services/ethics , Maternal Health Services/organization & administration , Medical Staff/ethics , Medical Staff/psychology , Morals , Nursing Staff/ethics , Nursing Staff/psychology , Occupational Diseases/etiology , Occupational Diseases/psychology , Psychological Trauma/etiology , Psychological Trauma/psychologyABSTRACT
The coronavirus disease 2019 (COVID-19) pandemic has placed great demands on many hospitals to maximize their capacity to care for affected patients. The requirement to reassign space has created challenges for obstetric services. We describe the nature of that challenge for an obstetric service in New York City. This experience raised an ethical challenge: whether it would be consistent with professional integrity to respond to a public health emergency with a plan for obstetric services that would create an increased risk of rare maternal mortality. We answered this question using the conceptual tools of professional ethics in obstetrics, especially the professional virtue of integrity. A public health emergency requires frameshifting from an individual-patient perspective to a population-based perspective. We show that an individual-patient-based, beneficence-based deliberative clinical judgment is not an adequate basis for organizational policy in response to a public health emergency. Instead, physicians, especially those in leadership positions, must frameshift to population-based clinical ethical judgment that focuses on reduction of mortality as much as possible in the entire population of patients served by a healthcare organization.