Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Amid COVID, first do no harm

Elisheva Nemetz, Sunit Das, MD, PhD, and Karen Devon, MD
Physician
May 18, 2020
Share
Tweet
Share

I am a surgeon, mother, daughter, researcher, and ethicist. These multiple roles dancing together to a more discordant tune amid this unprecedented time. The “daughter” has managed to convince her ageing parents that they really ought to not leave the house and that she will step in to accommodate their needs. Simultaneously, the “surgeon” is surprised when her 80-year-old mother, Layla, relays that she received a phone call telling her she needs to present to the hospital for some tests. Those tests, the “ethicist” realized were actually additional screening bloodwork for a study Layla was being enrolled in regarding an anti-amyloid agent for mild cognitive dysfunction. “This must be a misunderstanding” the “researcher” thought, as hospital directives have halted all non-essential research, as evident in her own hospital. Either way the “daughter” says: “No way. You are not going and how are you supposed to get there?” Layla had been told that in an effort to limit contact with the public, she should take an Uber. After clarifying with the study coordinator it was concluded that the request to present at the hospital to engage in the continuation of a clinical trial was not a mistake. As a surgeon, mother, daughter, researcher, and ethicist, I’m tasked with navigating this unchartered territory.

The recently published JAMA article “Preserving Clinical Trial Integrity During the Coronavirus Pandemic” addresses many issues of importance regarding research, which is being threatened by the pandemic. The authors share the benefits of continuing clinical trials, including: preservation of invested resources, the devoted effort and time of participants, the potential to help numerous individuals, and the integral role of research in improving health and preventing disability. The authors balance the risks and benefits of continuing clinical trials. The idea that “ongoing trials have potential to benefit millions of people with debilitating chronic diseases long after the coronavirus pandemic has ended” resonates strongly. Thus, unintended consequences of actions that arise during the pandemic require consideration, including the risks of altering or halting research.

I can’t sleep. I’m upset that the timelines for this study have not changed and I worry about my obligation to inform others. While managing obligations to my work and my now daycareless children, I have the additional difficult task of undoing the blasé suggestion to my parents by a medical professional, that taking an Uber is safe. Despite the fact that I engage in research, which inherently involves potential unknown risks, I’m disappointed that those in charge of the study feel that any degree of risk is acceptable for my family. Moreover, if my mother is no longer allowed in the trial because I have questioned these things, she has no chance of getting the promising study drug. Might I be the cause of her future demise, or have to trade in her present safety?

Even Drs. McDermott and Newman advance their reasoning with the comment that trials may “provide [the patient’s] only hope of survival.” However, the authors’ reasoning illustrates that acting with the interests of a clinician while simultaneously acting with the interests of a researcher leads to role conflict. The goal of clinical medicine is to treat, to cure, and to attain goals of care. Conversely, the goal of research is not treatment, but rather the generation of knowledge. Failure to appreciate this difference is deemed therapeutic misconception. When clinical equipoise exists, participants should not be enrolled in trials with an expectation, by patient or researcher, of a therapeutic outcome. Furthermore, truly informed research participants understand and accept the known and unknown risks of participation, even if they remain optimistic about a particular therapy. So, while the continuation of clinical trials may be crucial amidst the pandemic, it is flawed to justify continuation on the grounds that a study may be a patient’s last treatment option. Therapeutic misconception lies at the heart of role conflict, leading to a deficiency in the professional responsibility of researchers.

I call a friend. He has more objectivity by being removed from the study subject. He reminds me that research is not meant to be for the study participant. He reminds me research is supposed to be on hold right now. He reminds me that I’m only trying to protect my parents and that staying at home is the best way to do so. He reminds me that she may not get the drug of interest in a randomized control trial. So the solution becomes clear. As a surgeon, mother, daughter, researcher, and ethicist, I withdraw her from the study.

Engaging in multiple roles has value. The daughter-clinician can empathize better with a daughter caring for her elderly parent. The ethicist-clinician can share an honest lens towards the provision of equitable care. The researcher-clinician can understand the impact of research on clinical medicine with a passionate foundation. Multiple roles that each of us hold make us better, more successful, and compassionate physicians. The goal should not be to hang these hats on the top shelf of a dusty closet, but rather to be aware of biases we hold, whether they are neutral, negative, or positive. Amid this pandemic, as treatments and elective surgeries are curtailed, individuals might feel obliged to turn to clinical trials to obtain treatment. It is a physician’s duty, now more than ever, to make the morally obligatory distinction between care and research, and to first, do no harm.

Elisheva Nemetz is a bioethicist and medical student. Sunit Das is a neurosurgeon. Karen Devon is a surgeon and bioethicist. 

Image credit: Shutterstock.com

Prev

The crisis of rotation availability during a pandemic: a medical student’s ethical conundrum

May 17, 2020 Kevin 0
…
Next

Physicians and the psychological trauma of COVID-19

May 18, 2020 Kevin 0
…

Tagged as: COVID, Infectious Disease, Surgery

Post navigation

< Previous Post
The crisis of rotation availability during a pandemic: a medical student’s ethical conundrum
Next Post >
Physicians and the psychological trauma of COVID-19

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

Related Posts

  • Why social media may be causing real emotional harm

    Edwin Leap, MD
  • A patient’s COVID-19 reflections

    Michele Luckenbaugh
  • COVID-19 shows why we need health insurance

    Jingyi Liu, MD
  • Finding happiness in the time of COVID

    Anonymous
  • Birthing in the era of COVID

    Jennifer Roelands, MD
  • How to get patients vaccinated against COVID-19 [PODCAST]

    The Podcast by KevinMD

More in Physician

  • Ethical dilemmas in using unclaimed bodies for medical research

    M. Bennet Broner, PhD
  • The Nova Oath: a physician’s pledge to courageous and ethical care

    Kenneth Ro, MD
  • True stories of doctors reclaiming their humanity in a system that challenges it

    Alae Kawam, DO & Kim Downey, PT & Nicole Solomos, DO
  • Why wanting more from your medical career is a sign of strength

    Maureen Gibbons, MD
  • How a rainy walk helped an oncologist rediscover joy and bravery

    Dr. Damane Zehra
  • How inspiration and family stories shape our most meaningful moments

    Arthur Lazarus, MD, MBA
  • Most Popular

  • Past Week

    • When did we start treating our lives like trauma?

      Maureen Gibbons, MD | Physician
    • Why removing fluoride from water is a public health disaster

      Steven J. Katz, DDS | Conditions
    • How to speak the language of leadership to improve doctor wellness [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why some doctors age gracefully—and others grow bitter

      Patrick Hudson, MD | Physician
    • How to survive a broken health care system without losing yourself [PODCAST]

      The Podcast by KevinMD | Podcast
    • How the shingles vaccine could help prevent dementia

      Marc Arginteanu, MD | Conditions
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • Addressing the physician shortage: How AI can help, not replace

      Amelia Mercado | Tech
    • Why medical students are trading empathy for publications

      Vijay Rajput, MD | Education
    • Physician patriots: the forgotten founders who lit the torch of liberty

      Muhamad Aly Rifai, MD | Physician
  • Recent Posts

    • How to speak the language of leadership to improve doctor wellness [PODCAST]

      The Podcast by KevinMD | Podcast
    • Ethical dilemmas in using unclaimed bodies for medical research

      M. Bennet Broner, PhD | Physician
    • The Nova Oath: a physician’s pledge to courageous and ethical care

      Kenneth Ro, MD | Physician
    • AI is not a threat to radiologists. It’s a distraction from what truly matters in medicine.

      Fardad Behzadi, MD | Tech
    • How deep transcranial magnetic stimulation is transforming mental health care

      Muhamad Aly Rifai, MD | Conditions
    • True stories of doctors reclaiming their humanity in a system that challenges it

      Alae Kawam, DO & Kim Downey, PT & Nicole Solomos, DO | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • When did we start treating our lives like trauma?

      Maureen Gibbons, MD | Physician
    • Why removing fluoride from water is a public health disaster

      Steven J. Katz, DDS | Conditions
    • How to speak the language of leadership to improve doctor wellness [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why some doctors age gracefully—and others grow bitter

      Patrick Hudson, MD | Physician
    • How to survive a broken health care system without losing yourself [PODCAST]

      The Podcast by KevinMD | Podcast
    • How the shingles vaccine could help prevent dementia

      Marc Arginteanu, MD | Conditions
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • Addressing the physician shortage: How AI can help, not replace

      Amelia Mercado | Tech
    • Why medical students are trading empathy for publications

      Vijay Rajput, MD | Education
    • Physician patriots: the forgotten founders who lit the torch of liberty

      Muhamad Aly Rifai, MD | Physician
  • Recent Posts

    • How to speak the language of leadership to improve doctor wellness [PODCAST]

      The Podcast by KevinMD | Podcast
    • Ethical dilemmas in using unclaimed bodies for medical research

      M. Bennet Broner, PhD | Physician
    • The Nova Oath: a physician’s pledge to courageous and ethical care

      Kenneth Ro, MD | Physician
    • AI is not a threat to radiologists. It’s a distraction from what truly matters in medicine.

      Fardad Behzadi, MD | Tech
    • How deep transcranial magnetic stimulation is transforming mental health care

      Muhamad Aly Rifai, MD | Conditions
    • True stories of doctors reclaiming their humanity in a system that challenges it

      Alae Kawam, DO & Kim Downey, PT & Nicole Solomos, DO | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...