The below are ethical analyses using the MORAL Balance framework relevant to the COVID 19 pandemic.
Please note we are not recommending any particular course of action in specific circumstances. Different people and institutions will weigh the Balancing Box differently.
That is to be expected.
Rather the framework is an aid to objectively describing an ethical situation, establishing facts and outcomes of relevance, providing a tool for balancing competing demands and a method for documentation.
This is useful for decision-making, communication, and conflict resolution.
We welcome feedback, suggestion and comments on the use of the framework to help patients, clinicians and families make decisions together.
Moral Balance Analysis 1
Restricting the mobility of patients without capacitySee also the compilated response by Dr El-Shirbiny of input from the UK Clinical Ethics Network.
Moral Balance Analysis 2
Non COVID-19 Cancer Surgical Prioritisation
Our thanks to input from members of Nottingham University Hospitals NHS Trust's Ethics of Clinical Practice Committee who helped identify additional facts and outcomes of relevance.
Moral Balance Analysis 3
COVID-19 - Commencing CPR without PPE and implications for DNACPR communication
Our thanks to Dr Ben Heeley (ICU Registrar in Nottingham) who drafted the first version and the input from members of Nottingham University Hospitals NHS Trust's Ethics of Clinical Practice Committee who helped identify additional facts and outcomes of relevance.
Updated analysis in light of conflicting advice The Resuscitation Council and Public Health England regarding chest compressions being an aerosol generating procedure.
Moral Balance Analysis 4
Is it unethical to ask staff at some risk due to health conditions to be patient facing, when their pregnant colleagues who are at no/very little additional risk (on the basis of very limited evidence) are given the choice of being patient facing?
This Moral Balance Analysis was carried out by Nottingham University Hospitals NHS Trust's Ethics of Clinical Practice Committee on the 8th April 2020.
Moral Balance Analysis 5
An initial MORAL Balance analysis from East Kent Hospitals University NHS Foundation Trust (EKHUFT) B.A.M.E NETWORK in response to the impact of COVID 19 on BAME healthcare workers.
Performed June 2020, to aid their deliberations.
Dr Ranjit Dulai (Intensive Care and Anaesthetic Consultant and Member of EKHUFT B.A.M.E COVID working party) who shared this analysis with us, said, "I think the MORAL Balance framework was the most useful exercise we carried out because it made everyone think about autonomy which seems to not exist when it came to staff when considering COVID. Also, it removed all the politics out of everything and brought it back to basics. Most importantly it has given everyone a basis for arguing their own individual case if they need too."