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Accessible Unlicensed Requires Authentication Published by De Gruyter May 6, 2020

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

Frank A. Chervenak, Amos Grünebaum, Eran Bornstein, Shane Wasden, Adi Katz, Burton L. Rochelson and Laurence B. McCullough


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.

Corresponding author: Frank A. Chervenak, MD, Department of Obstetrics and Gynecology, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA; and Department of Obstetrics and Gynecology, Lenox Hill Hospital, 100 East 77thSt., New York, NY 10075, USA

  1. Research funding: None declared.

  2. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: Authors state no conflict of interest.


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Received: 2020-04-22
Accepted: 2020-04-24
Published Online: 2020-05-06
Published in Print: 2020-06-25

©2020 Walter de Gruyter GmbH, Berlin/Boston