Expanding the concept of the professional integrity of obstetrics during a public health emergency

Frank A. Chervenak 1 , 2 , Amos Grünebaum 1 , Eran Bornstein 1 , Shane Wasden 1 , Adi Katz 1 , Burton L. Rochelson 1  and Laurence B. McCullough 1
  • 1 Department of Obstetrics and Gynecology, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
  • 2 Department of Obstetrics and Gynecology, Lenox Hill Hospital, 100 East 77St., New York, NY 10075, USA
Frank A. Chervenak
  • Corresponding author
  • Department of Obstetrics and Gynecology, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
  • Department of Obstetrics and Gynecology, Lenox Hill Hospital, 100 East 77thSt., New York, NY 10075, USA
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, Amos Grünebaum
  • Department of Obstetrics and Gynecology, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
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, Eran Bornstein
  • Department of Obstetrics and Gynecology, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
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, Shane Wasden
  • Department of Obstetrics and Gynecology, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
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, Adi Katz
  • Department of Obstetrics and Gynecology, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
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, Burton L. Rochelson
  • Department of Obstetrics and Gynecology, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
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and Laurence B. McCullough
  • Department of Obstetrics and Gynecology, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
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Abstract

The coronavirus disease 2019 (COVID-19) pandemic has placed great demands on many hospitals to maximize their capacity to care for affected patients. The requirement to reassign space has created challenges for obstetric services. We describe the nature of that challenge for an obstetric service in New York City. This experience raised an ethical challenge: whether it would be consistent with professional integrity to respond to a public health emergency with a plan for obstetric services that would create an increased risk of rare maternal mortality. We answered this question using the conceptual tools of professional ethics in obstetrics, especially the professional virtue of integrity. A public health emergency requires frameshifting from an individual-patient perspective to a population-based perspective. We show that an individual-patient-based, beneficence-based deliberative clinical judgment is not an adequate basis for organizational policy in response to a public health emergency. Instead, physicians, especially those in leadership positions, must frameshift to population-based clinical ethical judgment that focuses on reduction of mortality as much as possible in the entire population of patients served by a healthcare organization.

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