Moral Balance Analysis 4 - Pregnant Staff
20/04/20 13:12
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.
The full analysis can be downloaded here.
Nottingham University Hospital’s Ethics of Clinical Practice Committee considered that the ethical points and principles to consider in response to this question are:
Protecting babies and vulnerable is a societal good (high emotional cost in not doing so).
Two at risk when considering pregnant staff.
Clear factual basis for considering > 28 weeks at high risk if infection
Currently insufficient data to clarify this risk < 28 weeks
• First trimester is always considered the highest risk period for causing congenital abnormalities
• Some reassuring evidence no harm from other coronaviruses. But COVID-19 too soon to know.
Giving choice to pregnant staff may be empowering and supportive of the professionalism of staff to help patients.
Need to maintain patient safety (enough staff members) – duty of care
• Consider other roles that are not patient focusing
• Graduated response may be needed such that if pandemic worsened and patient care compromised a request for help from all staff with the requisite skills may be required (high emotional challenge if pandemic deteriorates)
Guidance from the Royal College of Obstetrics and Gynaecology that "pregnant women of any gestation should be offered the choice of whether to work in direct patient-facing roles during the COVID-19 pandemic", should be followed unless there is a strong argument against.
Fairness and consistency – do other vulnerable patient groups need similar protection as pregnant staff?
This Moral Balance Analysis was carried out by Nottingham University Hospitals NHS Trust's Ethics of Clinical Practice Committee on the 8th April 2020.
The full analysis can be downloaded here.
Nottingham University Hospital’s Ethics of Clinical Practice Committee considered that the ethical points and principles to consider in response to this question are:
Protecting babies and vulnerable is a societal good (high emotional cost in not doing so).
Two at risk when considering pregnant staff.
Clear factual basis for considering > 28 weeks at high risk if infection
Currently insufficient data to clarify this risk < 28 weeks
• First trimester is always considered the highest risk period for causing congenital abnormalities
• Some reassuring evidence no harm from other coronaviruses. But COVID-19 too soon to know.
Giving choice to pregnant staff may be empowering and supportive of the professionalism of staff to help patients.
Need to maintain patient safety (enough staff members) – duty of care
• Consider other roles that are not patient focusing
• Graduated response may be needed such that if pandemic worsened and patient care compromised a request for help from all staff with the requisite skills may be required (high emotional challenge if pandemic deteriorates)
Guidance from the Royal College of Obstetrics and Gynaecology that "pregnant women of any gestation should be offered the choice of whether to work in direct patient-facing roles during the COVID-19 pandemic", should be followed unless there is a strong argument against.
Fairness and consistency – do other vulnerable patient groups need similar protection as pregnant staff?