Ethics for laboratory professionals during the Covid pandemic

It is not wrong to say that ethical issues have been given limited attention by professionals in laboratory medicine as compared to other fields of medicine (1). The most ethically problematic laboratory examinations are those dealing with genetic testing, autopsies, prenatal and HIV examinations and now, testing microbial agents in epidemics or pandemics, like Covıd-19.

The Covıd-19 pandemic presents us with fresh challenges, one of these being the professional and moral duty of healthcare workers, including microbiologists, during such an outbreak. There should be a middle ground of reasonable expectations from microbiologists when testing samples that carry serious risk of infection. While all should act to further beneficence in society, not all individuals should be expected to become martyrs for society.

During large scale hospital quarantine in Beijing and Taiwan, during the SARS epidemic, the hospitals were cordoned off and no one could leave. At the time, many healthcare professionals in Taiwan had rejected the title of “heroes”. Some said the more people called them heroes, the more they feared they were in danger (2). After this experience during SARS, what can one expect with the far greater intensity of Covıd-19?

Many healthcare professionals in modern times, especially microbiologists, have so far only faced remote fears of death. It is a shock for many to realise that, even with the necessary precautions, they still have to run a certain amount of risk, so their duties as members of their families will draw them home (2). Although SARS was reported to have a relatively low mortality rate, it attacks the young and healthy as well as the old and frail. Moreover, both SARS and Covıd-19 have been totally new diseases, we still know very little about them. Hence, the healthcare workers’ anxiety about being infected will always cast a shadow over their care of patients. Will the public accept health professionals exercising their right to remain off the the job in these critical times? (3)

Medical professionals who stick to their posts should be respected; however, those who need to take a break to recover themselves would also be acting within their human rights and what is expected of a reasonable citizen (4). There are recorded cases where physicians spent weeks without a break, continuosly battling the disease, and there is need for a proper assesment of how fatigue may have led to mistakes in care for patients and in safety precautions.

Although the primary ethical obligation of physicians is to their patients, they also have a long-recognised public health responsibility (5). In the context of infectious disease, this may include the use of quarantine and isolation to reduce the transmission of disease and protect the health of the public. In such situations, physicians have a further responsibility to protect their own health to ensure that they remain able to provide care. These responsibilities are potentially in conflict with the patients’ right to self-determination, with the physicians’ duty to advocate for the best interests of individual patients, and to provide care in emergencies (3).

New technology has been a catalyst for re-examination of medical and social ethics and international dialogue on ethical principles. All these discussions need to be revisited now in the time of Covıd-19 and all healthcare professionals including microbiologists, being the first line healthcare professionals encountering Covıd-19, should be aware of the arguments and answers to these questions. Ideally, these ethics courses should be added to the regular educational curriculum of all laboratory professionals, not when humanity is living in the shadow of a pandemic, as now.

The primary guidance in these times is the WHO’s “Guidance for managing ethical ıssues ın ınfectious disease outbreaks”. It covers the fourteen main ethical issues of quarantine ethics. (6). The importance given to communication during an infectious disease outbreak can make or break public health efforts. This WHO document, the work of an international group of stakeholders, outlines the ethical principles that should guide communication, planning, and implementation at every level from frontline workers to policy‑makers. From now on, the information of this guideline should be added to the education of all laboratory disciplines.