Table 2 Percentages of health workers, who experienced ethical challenges in managing difficult medical decisions
Situations | Very frequently | Frequently | Sometimes | Rarely | Never/Not applicable |
|---|---|---|---|---|---|
A. DOING GOOD OR HARMING | |||||
1. You worried if you were helping or hurting the patient with the interventions | 50(23) | 62(28.6) | 51(23.5) | 42(19.4) | 12(5.5) |
2. You felt that the patient's need for treatment was not in agreement with the patient's family needs or welfare | 37(17) | 46(21.2) | 28(12.9) | 92(42.4) | 14(6.5) |
3. You felt conflicted between your obligations to care for non- COVID-19 patients who have dental complaints | 15(6.9) | 41(18.9) | 46(21.2) | 81(37.3) | 34(15.7) |
4. You felt conflicted between your obligations to care for non- COVID-19 patients who have respiratory tract infection complaints | 90(41.5) | 59(27.2) | 46(21.2) | 13(6) | 9(4.1) |
5. You encountered involuntary hospitalization of suspected or confirmed COVID-19 patients | 80(36.9) | 50(23) | 44(20.3) | 24(11.1) | 19(8.7) |
B. END-OF-LIFE ISSUES | |||||
1. You were asked to help a patient to have a voluntary euthanasia | 0 | 0 | 6(2.8) | 13(6) | 198(91.2) |
2. You cared for a terminally ill patient and the question of when to stop treatment or a "Do not resuscitate" order came up | 25(11.5) | 59(27.2) | 18(8.3) | 46(21.2) | 69(31.8) |
3. You were withholding (not starting) potentially a life-prolonging treatment for a seriously sick patient to prevent prolonged death and suffering | 5(2.3) | 7(3.2) | 11(5.1) | 13(6) | 181(83.4) |
4. You were withdrawing (removing) potentially life-prolonging treatment to a seriously sick patient to prevent prolonged death | 9(4.1) | 11(5.1) | 15(6.9) | 37(17.1) | 145(66.8) |
C. ALLOCATION OF COVID-19 RESOURCES & HEALTH COMMODITIES | |||||
1. You felt you were over-treating patients, i.e. providing treatment or diagnostic tests they could not benefit from | 8(3.7) | 15(6.9) | 63(29) | 72(33.2) | 59(27.2) |
2. You were restricting treatment to a patient to give those resources to someone who could benefit more (i.e. hospital/ICU bed, ventilator, medication) | 37(17.1) | 98(45.2) | 52(23.9) | 23(10.6) | 7(3.2) |
3. The preferred course of treatment was not pursued because of a patient's inability to pay | 108(49.8) | 73(33.6) | 20 (9.2) | 13(6) | 3(1.4) |
4. The limitation of resources used for the treatment and prevention of COVID-19 required you to make a difficult choice | 113(52.1) | 69(31.8) | 28(12.9) | 5(2.30) | 2(0.92) |
5. There was significant disagreement among health workers on continuing the treatment of the patient due to a lack of resources | 50(23) | 93(42.9) | 35(16.1) | 29(13.4) | 10(4.6) |
6. Been so troubled by limited resources that you regretted your choice of profession | 72(33.2) | 89(41) | 27(12.4) | 16(7.4) | 13(6) |
7. Seen a situation where a patient was infected with COVID-19 as a result of limited resources in the health care system | 11(5.1) | 37(17) | 29(13.4) | 87(40.1) | 53(24.4) |
D. CONFLICTING INTERESTS | |||||
1. Your preferred course of treatment conflicted with institutional policies, professional codes of ethics, or laws | 14(6.5) | 28(12.9) | 33(15.2) | 89(41) | 53(24.4) |
E. DISAGREEMENT WITH PATIENT OR FAMILY | |||||
1. There was significant disagreement among family members on the continuing treatment of the patient | 6(2.7) | 16(7.4) | 47(21.7) | 72(33.2) | 76(35) |
2. A patient's cultural or religious views conflicted with your proposed course of treatment | 18(8.3) | 20(9.2) | 51(23.5) | 61(28.1) | 67(30.9) |
F. PATIENT CAPACITY TO CONSENT | |||||
1. You cared for patients that were not in a state to decide for themselves (like unconscious/ disabled), and you had to decide for them | 25(11.5) | 58(26.7) | 71(32.7) | 42(19.4) | 21(9.7) |
G. UNETHICAL OR INAPPROPRIATE CARE | |||||
1. You witnessed that a colleague was not acting according to professional standards(like not being honest, fair, responsible, and respectful) | 33(15.2) | 49(22.6) | 81(37.3) | 35(16.1) | 19(8.8) |
2. You came across colleagues that compromised the quality of care for the fear of COVID-19 | 38(17.5) | 72(33.2) | 57(26.3) | 37(17) | 13(6) |
3. You came across colleagues not providing appropriate care because of inadequate medical knowledge and skills in the prevention and treatment of COVID-19 | 44(20.3) | 57(26.3) | 74(34.1) | 35(16.1) | 7(3.2) |
H. DISCLOSURE OR CONFIDENTIALITY ISSUES | |||||
1. You were in doubt if a diagnosis of COVID-19 should be disclosed to the patient | 64(29.5) | 33(15.2) | 77(35.5) | 25(11.5) | 18(8.3) |