Applying E-PAUSE to Ethical Challenges in a Pandemic

The coronavirus disease 2019 (COVID-19) pandemic has challenged the core of our health care system. People are dying (frequently alone) at alarming rates, and there are shortages of vital resources including personal protective equipment, ventilators, medications, and trained staff. We must deliver care differently than what we are used to; there are too many patients, limited beds, and limited trained personnel.^1–3  The pandemic has created new and perplexing ethical challenges for the health care team. It has required us to enlarge our usual patient-centered ethical framework to more intentionally include a public health ethical framework. Instead of grounding our actions exclusively on patient autonomy and engaging patients to balance the benefits and burdens of treatment on the basis of their values and preferences, triage teams are taking a more prominent role in decision-making as a result of extreme shortages of all resources. We are being asked to...