Carol Taylor is a senior clinical scholar at Georgetown’s Kennedy Institute for Ethics and a professor in the School of Nursing & Health Studies (NHS) whose research interests include health-care decision-making. She and her graduate student, Abigail Regan (G’22), a nurse in the online family nurse practitioner program at NHS who works at a hospital in Denver, talk about the ethical concerns surrounding distribution of Personal Protective Equipment (PPE).
What happens when we start running low on masks and other PPE equipment? How should these items be ethically distributed?
Taylor: Many are questioning how the wealthiest country in the world, knowing this pandemic was coming, failed to ensure an adequate supply of PPE. It is a critical responsibility of a moral country, government at all levels and health care leadership to ensure adequate supplies of needed equipment. So when supplies run low, those at the highest risk of contracting COVID-19 should receive the highest priority for receiving scarce PPE. Clinicians doing procedures in settings where the possibility of exposure is greatest, such as resuscitative measures, should also have priority for PPEs.
Regan: In the Neonatal ICU at my hospital, we are currently allotted one surgical mask per 12-hour shift. But we’ve also been told it’s only a matter of time before we have a NICU baby who tests positive for COVID-19. When this happens, I believe the nurse and care team should be allotted the use of respirator masks. But we are being told that only the physician or advanced care provider intubating patients will get N95 masks. This scares me.
Is rationing protective equipment being talked about? Is that ethical?
Taylor: Any nurse working on a short-staffed unit makes rationing decisions every shift about how much time and care each patient receives. Because the United States didn’t adequately heed early warnings, we were not adequately prepared for the current crisis, so we find ourselves needing to ration PPE until we can increase supply. It is critical that this is done using ethical criteria. The CDC, for example, rightly recommends prioritizing PPE for care activities in which splashes and sprays are anticipated.
Regan: Having my institution tell me that I am not worth more than one mask a shift makes me feel expendable. We are constantly being bombarded by emails at work stating, “Be mindful of how much Purell you’re using! Be conscious of how many disinfectant wipes you’re going through during a shift!” While I know these “reminders” are not intentionally unfair, it feels like they’re asking us to make sacrifices to help prevent the spreading of a pandemic that could have been contained much earlier.
Are some facilities “punishing” health care professionals for what they believe are appropriate self-care measures?
Taylor: A recent MedScape article reported that health care workers are facing everything from ridicule to firing for taking matters into their own hands to protect themselves. Upper management is patrolling hospital halls and telling staff who have access to masks not to wear them. Non-clinicians such as receptionists are forbidden to wear masks even when they have their own supply. These practices raise excellent ethical questions. Should “charity begin at home,” to keep us well enough to do our jobs, or should our prior commitment be to ensuring a level playing field where all share risk equally?
Regan: While I have not encountered this problem in my hospital, I have many friends who say they would resign if their hospital management confronts them for using their own masks. My current thinking is, “if you won’t protect me, I have to protect myself.” My closest friend works in an ICU in New York. Nurses there are being told not to discard N95’s at the end of their shift. She’s fortunate to have family friends who have donated respirator masks for her personal use. But she says she feels guilty and nurses amongst her unit have nicknamed this “contraband” as “black market masks.” This is an issue that needs to be resolved sooner rather than later.