Ethical principles in health care prove critical to protecting health care workers in pandemic

Health care practitioners and professionals are central to the world’s defeat of COVID-19, as well as to our societies’ ability to recover from this global health and economic crisis. These workers require a safe work environment even when scenarios are changing rapidly, and that is why a set of ethical principles that embraces health worker safety can be so important.

Many health care workers have seen their practice disrupted and their patients suffer fallout during the pandemic, from delayed procedures to non-adherence and psychological distress. Those who are frontline responders are also facing considerable risks to their own health while they dedicate themselves to save and improve patient lives. These heroes need protection for themselves and their families. 

The International Council of Nurses (ICN) estimated in June that at least 450,000 health care workers had been infected with COVID-19 to-date. This is just one reason why it is so important for health care institutions, from large municipal hospitals to community clinics, to provide safe work environments for health care workers to perform their essential duties, including upholding regulations regarding occupational safety.

A safe work environment is but one of several vital areas highlighted during this pandemic where the business of health care is greatly strengthened through the implementation of and adherence to ethical conduct. But in the immense and highly diverse world of private health care providers, payors, and investors, we have seen an equally large and disparate approach to furthering ethics and integrity into each respective organization. That trend is about to change. In similar fashion to what the medical technology and biopharmaceutical sectors have achieved by extending ethical practices to more than 20,000 enterprises over the past decade through the APEC Kuala Lumpur Principles and APEC Mexico City Principles, respectively, the Ethical Principles in Health Care (EPiHC), open to all private health care providers, payors, and investors are being elevated at exactly the right time. 

Starting June 2020, EPiHC is open to new signatories and serves as a global network of private health care providers, payors, and investors committed to ethical conduct. Developed in 2019 by the International Finance Corporation (IFC), a member of the World Bank Group, EPiHC provides health care organizations with ten clear principles to navigate complex ethical decisions – principles that have never been more critical than in the midst of the COVID-19 pandemic. These include:

1.     Respecting laws and regulations, conducting business legally and responsibly while ensuring staff understand and respect such laws, regulations, policies, and standards. The pandemic has already had a substantial impact on public policies and best practice regulations in health care and this trend will continue for the foreseeable future.  

2.     Making a positive contribution to society, including the broader health system when planning and delivering services while not undermining the goals of the health system. This principle also encourages local partnerships and broader stakeholder engagement. COVID-19 has brought into sharp focus the importance of meaningful collective action in health care to reinforce trust

3.     Promoting high-quality standards, especially quality of care and patient safety with formal processes for continuous improvement as well as recognition of evidence-based international practices and decision-making that is based on the best quality outcome for the patient. Health care organizations are realizing the essential role of health system resilience underpinned by high-quality standards in confronting the challenges of COVID-19.  

4.     Conducting business matters responsibly, with accuracy and honesty at the forefront without taking unfair advantage or entertaining a conflict of interest. The pandemic is likely to serve as a turning point in our societies’ focus on responsible business conduct, particularly in health care, as some unscrupulous actors take advantage of emergency health resources and economic upheaval for immediate benefit. Organizations seeking long-term sustainability will prioritize this principle

5.     Respecting the environment, minimizing negative impacts as well as proper collection, storage, and disposal of biomedical waste. 

6.     Upholding patients’ rights, including respect of personal values and beliefs as well as such areas as dignity, privacy, and confidentiality. Each of these important considerations have been on display amidst the pandemic, along with ethical approaches to research activities and ensuring persons enrolled in clinical research are informed of the risks and benefits.

7.     Safeguarding information and using data responsibly, maintaining appropriate administrative, technical, and physical protections while adhering to data standards that consider new and emerging technologies. 

8.     Preventing discrimination, harassment, and bullying, through a positive and respective environment for everyone with a zero tolerance for anything less.  

9.     Protecting and empowering staff, through a safe working environment as previously mentioned. Ensuring health care workers are fully trained and provided the tools they need to do their jobs safely will be a major commitment for every health care organization following the COVID-19 pandemic. 

10.  Supporting ethical practices and preventing harm, such as formal policies and procedures for areas with ethical concerns, ideally considering accepted international best practices. All health care organizations should ensure mechanisms are in place to address current and future ethical concerns that may arise.

Rapid uptake of EPiHC around the world will undoubtedly aide our health systems’ resurgence from the present crisis, strengthening protections for health workers and those they serve in their everyday work. EPiHC also provides a foundation to better position our societies’ response to the next pandemic. 

Andrew Blasi is a former foreign service fellow to the U.S. Ambassador in London and director at C&M International where he supports several of the world’s largest public-private partnerships to strengthen business integrity. Katherine Nunner is a senior consultant at C&M International. They serve as advisors to the Ethical Principles in Health Care (EPiHC) secretariat in collaboration with the International Finance Corporation (IFC), a member of the World Bank Group.