Guiding Cardiac Care during the COVID-19 Pandemic: How Ethics Shapes Our Health System Response

Virani, Alice; Singh, Gurmeet; Bewick, David; Légaré, Jean-François; Chow, Chi-Ming; Leong-Poi, Howard; Clarke, Brian; Cowan, Simone; Fordyce, Christopher; Gin, Kenneth; Lau, Benny; Virani, Sean; Wood, David; Krahn, Andrew; Fournier, Anne; Gupta, Anil; Hardiman, Sean; Jackson, Simon; Sapp, John; Lamarche, Yoan; Mansour, Samer; Marelli, Ariane; Roifman, Idan; Ruel, Marc; Small, Gary; Turgeon, Ricky; Zieroth, Shelley

The COVID-19 pandemic has raised ethical questions for the cardiovascular leader and practitioner. Attention has been redirected from a system that focuses on individual patient benefit towards one that focuses on protecting society as a whole. Challenging resource allocation questions highlight the need for a clearly articulated ethics framework that integrates principled decision making into how different cardiovascular care services are prioritized. A practical application of the principles of minimizing harm, fairness, proportionality, respect, reciprocity, flexibility and procedural justice is provided, and a model for prioritization of the restoration of cardiovascular services is outlined. The prioritization model may be used to determine how and when cardiovascular services should be continued or restored. There should be a focus on an iterative and responsive approach to broader healthcare system needs, such as other disease groups and local outbreaks.