A state of emergency has been declared by the King of Malaysia. This is due to the drastic increase in the deaths and actions from the government with regards movement control. It is although worrying to many as to what would be the consequences of an EO. However, 85% of the 200,000 polled were of the opinion that an EO, could bring about a cessation to the progression of the pandemic, if the Ministry of Health is permitted to carry out their duties without the interference of political undercurrents, which includes constant advise to the private health care providers of the necessity of expanding their responsibilities on how best to manage suspected or confirmed COVID-10 patients.
Almost a year since the pandemic and COVID-19 patients have been cared for in public facilities. Assistance in the form of screening and managing non COVID-19 patients is offered by the Private hospitals, and the “Commercial Sector of the Malaysian health care system. They site reasons such as safety, costs and the quality of the care. One of the main constraints for this is the inability of the present pre-existing insurance schemes related costs of management of COVID-19, particularly emphasizing on testing, the PPE and relevant treatment. This critical situation might even warrant for hospitals to close. However, a few were anxious about settling for holistic care for their patients given that COVID-19 is a very small segment of the patient’s medical or surgical requirements.
Ethical Dimensions
Private hospitals cover a quarter of the hospital beds in the country and house half of the total number of clinical specialists in the country, many of whom were the nation’s top brains and earners. The expanded roles they will play in off-loading the currently overwhelmed public systems during the worst time of the crisis will be impactful to the country. Thus, it is time to revisit some of the concerns about healthcare professionals’ competing obligations and safety during a pandemic and steps that could be taken.
One fourth of hospital beds in the country are in Private hospitals and accommodate half of the total number of clinical specialists in the country , many of whom are classified as elite in earnings as well. The additional responsibilities these specialists are required to outlay in terms of un-burdening the public system during this critical time will have repercussions to the country. Given this scenario, it is important that some of the worries of the health care professionals who are challenging these obligations be revisited and safety precautions be taken during this pandemic.
The health care professional’s main struggle with the requirements during this pandemic is having to care for patients and maintaining personal safety at the same time. It is mandatory that all healthcare professionals wear the full PPE during high risk procedures, such as intubation and resuscitation. Without these adequate safety requirements in place, ideally they should not perform any high risk procedures even if the patient’s life is at risk. The effect on a patient could be lessened by early preparation and ample training. It is a less unsafe moment in the event it’s a patient with respiratory symptoms and requires physical examination. In this case the most important items needed are protective barriers (face mask, face shield and apron) and hand gloves. Without a doubt, healthcare professionals are in a position to deliver both the obligations towards the patients and themselves except those with pre-existing conditions such as, age, heart, pregnancy for which the risk of major complications for COVID-19 should not be over-looked.
Discussions are taking place on the trend of conscientious objections (CO) among healthcare professions in wanting to treat patients based on personal values and beliefs. While CO may protect ones moral integrity, might also endanger care that has had no pro-active planning and necessary care transfer. During a pandemic, it is probable that CO may be the most suited for value-laden triaging processes but not prima-facie duty to care. Healthcare professions cannot avoid treating a patient in an emergency particularly when the requirements cannot be got elsewhere as in the case of a pandemic crisis. For a unique volatile virus such as COVID-19, for the professional healthcare workers it would be fast learning from scientific evidence and other clinical experiences. It is their moral duty to perform at the highest level when public health is facing a crisis. If they don’t, then who will? If this situation falls within the purview of the private healthcare system or other professional regulatory bodies, they too are obligated to conform to their Job Descriptions as stated in the agreement.
Recommendations
All of the contents mentioned above should be considered while rejecting to care although it’s not absolute and permanent. We have to bear in mind that this virus affects everyone globally and healthcare and our lives go hand in hand and this point has to be stressed on during these critical moments. It is a must that private healthcare professionals rise up to the occasion as it is no longer a facility for care on a voluntary basis. It will be a close watch by the public as to who they could trust during the crisis and beyond. Has it ever occurred to find out if they could have more choices for their care? The disruption of the care could well be prevented together with their co-morbids being better managed.
In the event healthcare professionals were to offer their services over and above their call of duty (outside of usual specialty with heightened risks to personal health and moral distress) during a crisis or “supererogatory acts” to care for COVID-19 patients, it then becomes a reciprocal obligation of all other healthcare institutions to offer their support. In an effort for the healthcare professionals to carry out their duties unhindered particularly when it is mandatory that all safety measures are in place together with an adequate supply of equipment and drugs besides there also being triaging decisions on specific patients. It is said that, healthcare professionals should not worry about the patients cost instead it should be the responsibility of the Government and insurance companies to take away the worries from the overseeing clinical authorities
Healthcare professionals should provide care based on ethical principles (respect for autonomy, beneficence, non-maleficence, and justice), the latest evidence, and sound clinical judgement. Mental health should be monitored, and moral distress during difficult decision-making is addressed through appropriate bioethics support and guidance.
Given the limited experience, it must be discussed and based on the capacity of the private healthcare facilities, if they can manage outbreaks and have in-place established protocols to curb infections. Trainings are a must and in place while making do to accommodate physical space and clinical management. For this purpose, it would be effective to recognize and designate private hospitals. Clear pathways to manage cases based on private healthcare facilities’ capacities will ensure better co-managing for COVID-19 and other patients. It is of utmost importance that payment be secondary to that of the patient’s life and there should be no delay in the implementation of these agreements. All voices, be it stakeholders, the public and end-users, must be heard. While the input on bioethics should never be dismissed, a COVID-19 advisory group is most welcome.
Conclusion
It’s the joint responsibility of all concerned to work as one. Without working together as one and collective efforts, it is impossible to halt the transmission, immaterial of time frame of the lock down or even the presence of an EO. It is envisaged that there will be more casualties among COVID-19 and non COVID-19 persons in the ensuing months. Unless otherwise all healthcare professions in Malaysia unite and ask “what can do for the country” the pandemics exponential trajectory will be a nightmare.
