Open AccessRestarting Orthopaedic Care in a Pandemic: Ethical Framework and Case Examples
Author(s) -
Casey Jo Humbyrd,
Alexandra M. Dunham,
Amy L. Xu,
Travis N. Rieder
Publication year - 2020
Publication title -
journal of the american academy of orthopaedic surgeons
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.343
H-Index - 111
eISSN - 1095-8762
pISSN - 1067-151X
DOI - 10.5435/jaaos-d-20-00871
Subject(s) - medicine , triage , pandemic , clinical equipoise , health care , public health , flexibility (engineering) , bioethics , covid-19 , nursing , engineering ethics , medical emergency , disease , pathology , law , clinical trial , political science , statistics , mathematics , infectious disease (medical specialty) , engineering
The question about how to resume typical orthopaedic care during a pandemic, such as coronavirus disease 2019, should be framed not only as a logistic or safety question but also as an ethical question. The current published guidelines from surgical societies do not explicitly address ethical dilemmas, such as why public health ethics requires a cessation of nonemergency surgery or how to fairly allocate limited resources for delayed surgical care. We propose ethical guidance for the resumption of care on the basis of public health ethics with a focus on clinical equipoise, triage tiers, and flexibility. We then provide orthopaedic surgery examples to guide physicians in the ethical resumption of care.