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Even in the best of times there may be a tension between a physician’s ethical obligations to the individual patient and to the broader public. During a global pandemic such as COVID-19, that tension has been heightened and may come into play in many clinical scenarios, according to Rebecca Brendel, M.D., J.D., chair of the APA Committee on Ethics. She is director of the master’s degree program at the Harvard Medical School Center for Bioethics and a member of the AMA Council on Ethical and Judicial Affairs.
“For most of us, in our practices, what we are most commonly thinking about is the single patient before us. Now we are in the midst of an enormous public health crisis, and as physicians we have an ethical obligation to think as well about the greater good.”
She outlined two specific clinical scenarios that are liable to be common and in which competing ethical obligations to patient or public health will be at play:
Prescriptions and hoarding of medicines: Patients are bound to be anxious about having an adequate supply of their medications during a period when pharmacies are being deluged and may be experiencing shortages. These patients may be inclined to request an extra supply of medications. Psychiatrists should be certain their patients have an adequate supply of their medications (taking into account whether the risk of suicide exists), but Brendel advised that psychiatrists avoid prescribing refills that could lead a patient to hoard medications. “One way we can be absolutely sure there will be shortages of medications is by not thinking cautiously about how we prescribe.”
(Reimbursement for multiple months of prescriptions varies with health plans; many plans cover a maximum of a 60- or 90-day supply, but physicians could theoretically write scripts for even longer, and mail-order pharmacies could auto-fill them; moreover, some patients might be willing to pay out of pocket for extra supplies.)
Brendel said psychiatrists can help allay patients’ fears and should talk to them about planning ahead and not waiting until they are about to run out of a medication to request a refill.
Social distancing and scheduling appointments: Psychiatrists and mental health professionals are likely to have patients who prefer, expect, and may even insist upon face-to-face visits. “In normal times, psychiatrists have an obligation to put their patients’ needs and wants first and to accommodate them within established clinical boundaries to the best of their ability,” Brendel said. “We are not in normal times. Data very clearly show that the best way to contain the spread of COVID-19 is social distancing and that person-to-person contact is the major source of spread of the virus. Telephone and video teleconferencing may not be ideal in the course of routine care, but in the current circumstances are essential.”
Brendel emphasized that psychiatrists and health care professionals must also be mindful of their own health, for their own sake and the sake of their families, but also for the greater good. “Psychiatrists have a personal but also a professional responsibility to be healthy and available in this extraordinary new circumstance,” she said.
(Image: iStock/izusek)
Join APA-NABH Webinar on Caring for Patients Through COVID-19 Crisis: April 1
APA and the National Association for Behavioral Healthcare (NABH) will host a joint webinar on Wednesday, April 1, from 2 p.m. to 3 p.m. EDT with experts working in inpatient, residential, and other nonambulatory care settings about how they are assessing the current environment and developing new protocols to care for their patients during the COVID-19 crisis. Hear from experts about the management of different types of services, key messages to give your team leaders, unique challenges for people with serious mental illness (SMI), how to handle group therapy, and more. Questions can also be submitted via chat during the live session. A recording will be posted after the event. More information about the webinar, including how to register, is posted here.
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