Authors: James Agolia, Michelle Bayefsky, Maheetha Bharadwaj, Samuel Doernberg, Sun Fletcher, Melody Huang, Margaret Irwin, Maud Jansen, Bina Kassamali, Katie Kester, Benjamin Landwersiek, Chen Lu, Soumyaa Mazumder, Joe Montesano, Niyi Odewade, Phani Paladugu, Larisa Shagabayeva, Derek Soled, Sanjana Srinivasan, Tarika Srinivasan, Maria Thomas, Samson Yu, Allen Zhou, Angela Zou

Editor: Derek Soled, MSc

Reviewers: Edward Hundert, MD; David S. Jones, MD, PhD; Louise King, MD, JD; Christine Mitchell, RN, MS, MTS, FAAN; Robert D. Truog, MD; David Urion, MD; Matthew Baum, PhD, DPhil; Pamela Chen; Rahul Nayak, MD; Sophia Yin

Introduction

In Module 8 of this curriculum, students will begin to consider the ethical discussion surrounding the COVID-19 pandemic. The first section will give an overview of U.S. ethics and principles of allocation. The second section will focus on the ethics of resource distribution, particularly when supplies are limited. The third section will delve into the ethics regarding treatment and care of vulnerable populations, such as homeless individuals or children. The fourth section will center on the commitments and obligations of medical providers and trainees during public health crises. The fifth section will discuss the ethics of clinical trials, research, and treatment, especially when time is of the essence. The final section will analyze the ethics of public health interventions, particularly those that restrict individual liberties. As you work through this section, we encourage you to think critically about how these ethical debates affect your life, and how these conversations may change based on the context you are in. Please note that this module is not meant to be a comprehensive review of all ethical issues related to COVID-19, but rather provide a framework and highlight several salient topics. In addition, this module has a centrality of post-Scottish enlightenment thinking, which is the dominant framework in U.S. biomedical ethics. We recognize this bias and are working on subsequent sections that will include alternative models used throughout the world.

This module is different from the other modules; we recognize there are principles and terms with which you might not be familiar. Rather than providing facts and answers to your questions, the goal of this module is to equip our readers with a philosophical foundation for approaching ethical issues in healthcare, especially as they pertain to COVID-19. We expect that this module will take 2 hours to complete.

Learning Objectives

At the end of this module, medical students should be able to:

• Compare the rudimentary schools, frameworks, and principles to approach ethical issues in healthcare

• Apply ethical frameworks to debate how healthcare resources should be distributed during a pandemic

• Describe how COVID-19 differentially impacts populations that are already vulnerable

• Debate the boundaries of obligation for healthcare workers and medical students during a pandemic

• Discuss the ethical principles of clinical research design and vaccine development during times of crises

• Discuss the tension between autonomy and collectivism in relation to public health measures