The SMC asked experts to comment on the ethical concerns and questions raised during the pandemic.
Dr Ben Gray, Senior Lecturer of Primary Health Care and General Practice, University of Otago, Wellington, comments:
“The first point I would make is that in my view ‘ethics’ is culture bound, that what one group of people think is ‘right’ may not align with what another group think. This is well illustrated by the variation in which different countries have responded; China with enforced lock down, America with its limited ability to mount a public health response because of embedded ‘rights’ of personal autonomy, Singapore with an authoritarian government, very dense and largely compliant population.
“I think the central issue to be aware of is that existing disparities will be amplified by the lockdown. Iona Holsted (my old boss and Secretary for Education) made this point clearly when discussing online education and the students who did not have access to a device or broadband. So we all need to be aware of ways in which we can mitigate those risks.
“Despite the roll-out of the 24/7 interpreting service last year, many clinicians still use family members to interpret for patients with limited English proficiency (LEP). If clinicians use professional telephone interpreters, then they can easily patch a three-way conversation together. If using family members at the very least, clinicians need to know how to use available technology to ‘conference call’.
“Requirements of health facilities for patients not to have support people make a lot of sense from a public health point of view, but it is much more onerous for those with LEP wanting for example to have family members with more English fluency present.
“Transport is a problem. Many poorer people rely on either public transport (which is either much less or not available) to get around. For example, I am aware of a school in Cannons Creek that is providing food bags for solo parents (mums) who cannot get to the supermarket.
“Manage My Health (the online patient portal in primary care) has come into its own in this time…for those who are able to use it, which requires English proficiency, technological capability, and device and data access. This will further widen health outcome disparities.
“We have long-standing disparities of care based on rurality. Those living in cities have better access to intensive care than those living rurally. Given the problems of logistics and fear of spreading the virus it is very unlikely that in the event of a significant outbreak that we will be transporting any patients around the country. So patients cared for by smaller DHBs are likely to be disadvantaged. As noted above, this is an existing problem that is likely to be more obvious if we get a significant outbreak.
“Commentary from the Race Relations Commissioner and the Disability Commissioner has been welcome in pointing out ways in which these communities have been disadvantaged.”Conflict of interest statement: I am employed by the University of Otago and Newtown Union Health Service. I have no conflicts of interest.
Dr Elizabeth Fenton, Lecturer, Bioethics Centre, University of Otago, comments:
“Public health infrastructure is undervalued except in times of crisis. Many of the benefits of investing in public health are realised in the future, sometimes long into the future, making it an unattractive investment politically.
“When a crisis occurs, we see the holes created by lack of investment. We also see how much health means to people: when it is threatened, we will go to enormous lengths to protect it.
“Concerns from frontline health workers about lack of personal protective equipment (PPE) reflect one example of underinvestment. During a crisis we depend on our health services being available and well resourced. We expect frontline health staff to come to work. But our expectation that these services will be there when we need them depends on hospitals and the institutions that govern them meeting their responsibility to protect frontline workers. This responsibility is grounded in the ethical value of reciprocity.
“Reciprocity underpins our individual responsibilities to help one another during a public health emergency, and to meet our professional responsibilities to society. Some workers might feel conflicted about meeting these professional responsibilities if it means risking their own or their family’s health. When healthcare bodies meet their reciprocal responsibility to ensure that the risks for these workers are minimised, it can help to resolve that conflict.
“A public health crisis like COVID-19 makes the importance of health obvious. A moral commitment to protecting health demands that we continuously invest in a robust and well-resourced health system for the long-term, not just in the context of an immediate health crisis.”
No conflict of interest.