Restarting Orthopaedic Care in a Pandemic: Ethical Framework and Case Examples

J Am Acad Orthop Surg. 2021 Jan 15;29(2):e72-e78. doi: 10.5435/JAAOS-D-20-00871.

Abstract

The question about how to resume typical orthopaedic care during a pandemic, such as coronavirus disease 2019, should be framed not only as a logistic or safety question but also as an ethical question. The current published guidelines from surgical societies do not explicitly address ethical dilemmas, such as why public health ethics requires a cessation of nonemergency surgery or how to fairly allocate limited resources for delayed surgical care. We propose ethical guidance for the resumption of care on the basis of public health ethics with a focus on clinical equipoise, triage tiers, and flexibility. We then provide orthopaedic surgery examples to guide physicians in the ethical resumption of care.

Publication types

  • Case Reports

MeSH terms

  • Adolescent
  • Aged
  • Arthroplasty, Replacement, Hip
  • Arthroplasty, Replacement, Knee
  • COVID-19* / epidemiology
  • Clavicle / injuries
  • Clavicle / surgery
  • Clinical Decision-Making
  • Female
  • Femoral Neoplasms / surgery
  • Fractures, Bone / surgery
  • Giant Cell Tumors / surgery
  • Humans
  • Male
  • Middle Aged
  • Orthopedic Procedures / ethics*
  • Orthopedics
  • Pandemics
  • Practice Guidelines as Topic
  • Public Health Administration / ethics*
  • Rotator Cuff Injuries / surgery
  • SARS-CoV-2
  • Therapeutic Equipoise
  • Triage