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Throughout history, few events have proved so disastrous as those associated with infectious disease outbreaks. The 14th-century plague known as the “Black Death” is estimated to have taken up to 200 million lives (Hunter, 2017). In Europe during that time, 60% of the population perished during a single two-year period (Hunter, 2017). The 1918 “Spanish Flu” pandemic killed at a rate of 1,000,000 people per week, every week, over its first six months (Hunter, 2017). More contemporary threats like COVID 19, SARS, Ebola, and agents of bio-terror are situated in a world not only vastly more populated, connected, and transit than ever before. Effectively meeting these public health challenges and saving lives requires a considerable focus on ethical practices, ethical values, ethical decision-making, and ethical leadership (Thomas, 2004).
Robbins and Judge (2017) outline that ethical decision making relies on three primary structural blocks:
- 1.
The greater good for most of the people involved with the outcomes of a decision.
- 2.
Alignment of decisions with fundamental liberties, rights, and privileges, as covered by the Bill of Rights.
- 3.
Equity in the spread of justice to everyone with no conditions applied.
Understanding ethical codes around medical care, especially during the emergence of COVID 19, has made the role of leadership in perpetuating ethical organizational cultures in healthcare vital. The global rise of COVID 19 has created new complexities around ethics, values, priorities, and decision making. Further complex ethical questions include the following:
What communities should have access to rapid COVID 19 testing over those that do not?
What COVID 19 patients should get a ventilator when there are more sick patients than ventilators?
The World Health Organization (2020) created an ethical basis for deciding which individuals or groups might be prioritized, including the principles to be applied around COVID 19, are presented in Table 1.
Table 1.
World Health Organization (2020) Ethical considerations when deciding who to prioritize
| Principle | Description | Practice implication |
| Equality | Each person's interest should count equally unless there are good reasons for the differential prioritization of resources.
Irrelevant characteristics of individuals, such as race, ethnicity, creed, ability, or gender, should not serve arbitrarily as the basis for the differential allocation of resources.
This principle can be used to justify the allocation of resources by a lottery – that is, randomly by chance – or by a system of first come, first served. | Maybe be most appropriate to guide the allocation of scarce resources among individuals or populations who can be expected to benefit from the resource, such as vaccines among high-risk populations, or ventilators among those with similar clinical indicators for benefit. |
| Best outcomes (utility) | This principle can be used to justify the allocation of resources according to their capacity to do the most good or minimize the most harm, such as using available resources to save the most lives possible. | Maybe be most appropriate to guide the allocation of scarce resources that confer substantially different benefits to different individuals, such as ventilators, to those expected to derive the most benefit. |
| Prioritize the worst off | This principle can justify the allocation of resources to those in greatest medical need or those most at risk. | Maybe most appropriate to guide the allocation of resources that are designed or intended to protect those at risk, for example, PPE for health care workers, vaccines for those most at risk of infection and severe illness, or those most in need, as in the case of provision of drugs in short supply to those needing them most urgently. |
| Prioritize those tasked with helping others | This principle can be used to justify the allocation of resources to those who have specific skills or talents that can save many other people, or because something is owed to them on account of their participation in helping others. | Maybe most appropriate to guide the allocation of resources to health care workers, first responders, etc. |