key: cord-306652-e9zvyftn
authors: Eng, Oliver S.; Tseng, Jennifer; Ejaz, Aslam; Pawlik, Timothy M.; Angelos, Peter
title: Apples to Oranges: Ethical Considerations in COVID-19 Surgical Recovery
date: 2020-05-20
journal: Ann Surg
DOI: 10.1097/sla.0000000000004082
sha: 
doc_id: 306652
cord_uid: e9zvyftn

nan

Phone: +1 (773) 702-4897

Fax: +1 (773) 702-6120

As the COVID-19 pandemic approaches peak incidence in many areas, recovery and emergence plans including the re-initiation of surgical cases are underway. As the manifestations of the pandemic persist, we are pushed away from familiar algorithms into uncharted waters where multiple ethical challenges exist due to a paucity of data.

Keywords: COVID-19, recovery, surgical ethics As the COVID-19 pandemic approaches peak incidence in many areas, recovery and emergence plans including the re-initiation of surgical cases are underway. The first challenge for hospitals and health care systems involves scheduling the hundreds of postponed surgical procedures. Presuming all of the previously scheduled operations are medically necessary, the difficulty lies in deciding which procedures are most time-sensitive and deserve priority. 1 The cornerstone of case risk stratification has been based on datadriven medical decision-making coupled with surgeon judgment. 2 However, as the manifestations of the pandemic persist, we are pushed away from familiar algorithms into uncharted waters where multiple ethical challenges exist due to a paucity of data.

It is clear that dichotomizing surgical cases ("elective" versus "non-elective", "essential" versus "non-essential") is an oversimplification. The prime example of this false dichotomy is cancer surgery, which does not fall squarely into one particular category. Several surgical societies have made recommendations regarding postponing some cancer surgeries by extrapolating from existing guidelines and best evidence. 3 However, surgical delay has its consequences. In many cases, patients with aggressive disease biology have been initiated or the illness or disease on an individual patient if a hospital is seeing stable or declining numbers of new COVID-19 infections without immediate resource availability concerns. At the beginning of the COVID pandemic, physicians were forced to move from individualized patient-centered to public health ethics, which is, by its nature, more paternalistic. 4 This shift was not easy, but was necessary to weigh the risks to the community in the face of scarce resources. As surgeons shift back to patient-centered ethics, they should refocus on balancing non-maleficence, beneficence, and patient autonomy against institutional constraints. Last but not least, we need to share with patients the possible uncertainty of long-term operative outcomes during the COVID-19 era to engage them in shared decision making, weighing the risks of infection against the benefits of surgery and adding in consideration of consumption of resources beyond the individual surgeon in this unprecedented time of public health stress.

Medically-Necessary, Time-Sensitive Procedures: A Scoring System to Ethically and Efficiently Manage Resource Scarcity and Provider Risk During the COVID-19 Pandemic

Are we harming cancer patients by delaying their cancer surgery during the COVID-19 pandemic? Ann Surg

Management of Cancer Surgery Cases During the COVID-19 Pandemic : Considerations

Ethics, and COVID-19: Early Lessons Learned

Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited