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Sophie's Choice: The Moral and Ethical Dilemmas of COVID-19

Updated: Apr 19, 2020

In all of my thirty years of medical practice I have never encountered the degree of moral and ethical dilemmas as those created by COVID-19. None of us have experienced anything like this. At no time in our history has all of humanity been at risk for contracting the same potentially deadly disease. And never in my entire career could I have imagined that we would be so woefully unequipped and unprepared. The greatest nation in the world with one of the best pandemic response systems, brought to our knees by dysfunction and corruption.

Physicians are faced with unprecedented moral and ethical demands. Everywhere we look, we are presented with “Sophie’s Choice” decisions.

The oncologist must decide if their patient’s cancer treatment outweighs their risk of contracting this virus.

Internists will be faced with an onslaught of chronic diseases gone haywire, because patients are not risking an office visit.

Surgeons are performing emergency surgeries without the certainty of their patient’s COVID-19 status.

OB GYNs are exposing themselves to this virus due to lack of adequate PPE and hesitation on the part of patients and their partners to truthfully relay their symptoms.

And, of course, with the lack of PPE, everyone on the front line—ED physicians, hospitalists, ID, anesthesiologists—are risking their lives every single day. Not to mention a multitude of others—first responders, hospital staff, and more.

For none are these decisions as excruciating as for physician moms, who are risking not only their own well-being but that of their children, their partners, and potentially, that of their elderly parents. They are having to make the impossible decision of potentially exposing their families vs. isolating themselves for weeks to months. And in many cases, this decision is being made for them, leaving them with no choice at all.

Is our loyalty to our families or to our patients? To our colleagues or to ourselves?

Who are we responsible to and what are we responsible for?

Newborns are being separated from their mothers at birth.

Dying patients are being isolated from their families.

We are all being torn apart from those we love. And we are failing one of our primary duties to our loved ones, to protect them.

Everywhere we look, we witness massive inequities—inequities of race, inequities of gender, inequities of age, inequities of sexual orientation—all magnified by this one microscopic destructive virus. Blacks are dying from COVID-19 at much higher rates than whites. Women make up the majority of frontline workers and are more likely to be caretakers of both children and elderly adults. Gay men who have recovered from this virus are not being allowed to contribute their plasma toward a potential treatment. Mothers are being separated from their babies. The elderly are dying at much higher rates everywhere, are being isolated from family and visitors, and are being abandoned in LTC facilities. Domestic abuse has skyrocketed. The homeless and imprisoned are facing unimaginable horrors.

I have only questions. No answers yet.

However, the answers surround us.

All of the failings of our present healthcare systems are on display in technicolor. All of our failings as a people are in plain view—racism, sexism, misogyny, bigotry, elder-abuse, domestic violence.

And all of the solutions are present too. Unprecedented selfless giving on a massive scale, countless acts of compassion and gratitude, the outpouring of support from colleagues, family, the public. The meeting of minds and countless think tanks coming up with protocols and solutions. The entire global scientific community working together toward one cause. Multiple industries innovating to create solutions—whether to supply PPE or create “pop-up” self-contained units to house patients and healthcare staff.

We are being shown the way of the future, what needs to change, and what is possible if we truly work together.

So, through all of these moral and ethical dilemmas, all of the fear and grief and tragedy, there are rays of hope that we will get through this, and that we will be ready to move forward in creating a safer and more equitable future together.

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This post originally appeared on on April 13, 2020

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