We use cookies to give you the best online experience. Let us know if you agree to these cookies.
This ethical hub topic shows ways in which our ethical guidance can be applied in this area of care and signposts to relevant resources. It does not set new professional standards and is not intended to replace the formal guidance.
We know that the coronavirus (COVID-19) pandemic put huge pressure on doctors and many of you are still working in challenging circumstances.
We'll continue to update this information, but for more detailed advice, please read our full guidance.
It’s important to look after yourself and seek support if you need it. To help, we’ve created a list of useful resources and links to organisations that can support both you and your colleagues.
Simple steps such as staying hydrated and well-fed and getting the rest you need can help. There are some really useful resources from the Association of Anaesthetists on fighting fatigue and there's a helpful poster about self-care for NHS staff.
But if you need more support it’s important to speak up and tell your employer how your feeling so they can take the steps needed to help you.
Regularly check in with your team members to see how they’re feeling and let them know they have your support. Setting up a buddy system on shifts and carrying our regular team debriefs can help provide a wellbeing safety net and help people to keep an eye on each other.
If you think a colleague is too tired to drive home after a shift, make sure you discuss your concerns with them before they leave – there may be an alternative, safer way for them travel or on-site accommodation available.
You can find resources on how you can support colleagues on our wellbeing page.
If you know or suspect you are infected with coronavirus, you should follow the current UK government public health advice. If your symptoms worsen, seek medical attention. Be aware that when unwell, your judgement is likely to be clouded, so don’t simply continue to self-treat if your condition worsens.
Paragraph 28 of Good medical practice says that if you suspect you have a serious condition that could be passed on to patients, you must consult a suitably qualified colleague and follow their advice about any changes to your practice they consider necessary.
If you have a pre-existing health condition that places you at increased risk, you should discuss working arrangements with your employer. It may be appropriate to ask another suitably qualified clinician to take over the care of patients who are suspected to have, or have been diagnosed as having, coronavirus.
This is a matter for employers and isn’t covered by professional standards for doctors. However, our Leadership and management guidance says that doctors in leadership positions must promote the health and wellbeing of staff they manage (paragraph 73).
Ensuring good support is in place will help reduce staff exhaustion and moral injury. Self-care and seeking any support you need is vital so that you can, in turn, support your colleagues.
Our Leadership and management guidance says that doctors in leadership positions must promote the health and wellbeing of staff they manage. It emphasises working collaboratively across the multi-disciplinary team, demonstrating respect and kindness, and stressing the importance of clear communication. Leadership needs to encourage kindness, civility and collaboration.
Dame Clare Marx wrote about the importance of compassionate leadership and how ‘kindness, civility and collaboration are not a distraction from delivering care, they’re an essential part of it’. Professor Michael West, co-author of the independent wellbeing report Caring for doctors, Caring for patients, and Suzie Bailey, Director of Leadership and Organisational Development at The King's Fund, have written about why compassionate leadership matters.
Ensure you have a system in place for raising concerns that is open, transparent and fair. Log these and let colleagues know what actions have been taken in response.
It's important to create a culture in your workplace where staff feel safe and supported to raise any concerns.
Identify colleagues who may have additional vulnerabilities and follow national guidelines for clinical staff with underlying health conditions. Be mindful that all colleagues will respond to this situation differently and those who don't have vulnerabilities may nevertheless experience significant anxiety. This should be managed supportively.
Our Leadership and management guidance says:
87 If you have a management role or responsibility, you will often have to make judgements about competing demands on available resources. When making these decisions, you must consider your primary duty for the care and safety of patients. You must take account of any local and national policies that set out agreed criteria for access to particular treatments and allocating resources, and make sure that these policies are available to clinical staff.
88 If you are concerned about how management decisions might conflict with your primary duty to patients, you must take steps to manage or deal with any conflict; for example, by:
We have more information about PPE in our Working safely section of this Q&A.
Doctors are entitled to hold and express personal views. They also have an overriding duty to patients, and to uphold the public’s confidence in the profession. It's vital that doctors raise any concerns that may adversely affect patient safety and/or their own well-being, but it is also equally important that these are raised via the appropriate channels.
Doctors should continue to follow our Raising and acting on concerns guidance and you should also direct colleagues to our guidance on Doctors’ use of social media and our ethical hub advice on social media.
We’re not directly involved in developing or regulating vaccines. But we understand that doctors and patients could have questions about the rollout of the coronavirus (COVID-19) vaccines, and how this will impact them.
We answer some of those common questions below.
In our guidance Good medical practice (2013), we say that doctors should be immunised against common serious communicable diseases unless doing so is contraindicated.
In our view, the potential risk to a doctors’ own health as well as the risk of inadvertently spreading COVID-19 to vulnerable patients weighs in favour of doctors being vaccinated. And reducing the number of staff who are sick due to COVID-19 has a positive impact on workforce capacity to respond to patient need and wider health service demands.
However we recognise that vaccination is not possible in all cases. If you are not vaccinated, you need to be confident that there are measures in place where you work to manage any risk to patients and colleagues. You will need to take appropriate steps to reduce risks and prioritise patient safety.
In 0-18 years: guidance for all doctors, we set out that young people aged 16 or over can consent to their own treatment and are presumed to have capacity to do so unless there is evidence to the contrary.
Children under the age of 16 can consent to treatment if they have the maturity to fully understand its nature, purpose, and possible consequences. This is also known as ‘Gillick competence’ after the legal case that established the concept in law.
Doctors should encourage children and young people to involve their parents in important decisions about their care but should usually abide by any decision the child or young person has the capacity to make themselves.
Doctors should take account of our Decision making and consent guidance when discussing treatment options, their risks, benefits, and potential outcomes.
It may be challenging to explain the risks and benefits of a vaccine in child-friendly terms especially if you work in a time-pressured environment. Support for this is available from Public Health England, Public Health Scotland, Public Health Wales and Public Health Agency who have produced a range of leaflets and information for children and young people, including simple text versions.
We suggest doctors use these resources to help children and young people understand the benefits and risks of the vaccine. They can then assess whether the young person has the maturity and understanding to make the decision about whether to receive the vaccine.
Doctors must be satisfied they have consent or other valid authority before they provide treatment to patients (paragraph 17 in Good medical practice). Our expectations are the same for doctors before they administer vaccines.
As part of this process, registered healthcare professionals, including doctors, nurses, pharmacists and many other professionals, will be responsible for speaking with patients to find out about allergies, their medical history and any contraindications.
The National Protocols for the approved vaccines include information on obtaining patient consent. You can find further information, resources and template consent forms for your area:
In all cases, doctors should familiarise themselves with our Decision making and consent guidance, in particular the seven principles and paragraphs 21-26 on discussing benefits and harms and uncertainties with their patients.
For adult patients who lack capacity, paragraphs 87-93 of our Decision making and consent guidance explains the ethical basis and process for treatment decisions.
For a vaccine to be approved for use in the UK, the Medicines and Healthcare products Regulatory Agency (MHRA) has said that robust standards of quality, safety, and effectiveness must be met.
NHS England publishes National Protocols for each vaccine as they are approved and become available. Protocols contain the safety information relevant to that vaccine. Information has also been published for:
This information will help doctors to give clear, accurate and up-to-date information to their patients so they can make informed decisions about vaccination. Our Decision making and consent guidance will support you to have these conversations with patients.
Doctors should use PPE in line with the most up to date guidance issued by the four UK health departments. Employers and contracting bodies should take all necessary steps to make sure staff are suitably equipped for their clinical setting in line with that guidance.
Doctors will need to use their professional judgement to make decisions about the safest and best course of action, taking account of the clinical situation.
Doctors will need to consider:
You should try to work with colleagues to find the best way forward in the circumstances. We do not expect doctors to leave patients without treatment, but we also don’t expect them to provide care without regard to the risks to themselves or others.
If having tried and exhausted alternative means of treating a patient you believe that this is not possible without unreasonable risk to you or to other healthcare professionals, you should escalate your concerns, record your decision and how you tried to address safety concerns.
If you and other healthcare staff may be put at risk by PPE which is below the standard set out in the most up to date guidance, you should raise your concerns with your employer. You should make a record of your decisions and how you handled your safety concerns.
If a concern was raised with us about a doctor refusing to treat a patient because of their concerns about inadequate PPE, we would look at the specific facts of the case, taking into account the factors relevant to the environment in which the professional was working. We would also take account of any relevant information about resource, guidelines or protocols in place at the time.
No two sets of circumstances are the same, and we would have to look at the specifics of any concern raised with us. We do not speculate on scenarios nor do we reach any conclusions without full knowledge of all of the factors involved.
Our expectation is that doctors will use our guidance and their professional judgement to take difficult decisions, and that they will work positively and constructively with colleagues and employers to try to find appropriate alternatives. They should document those discussions and decisions and be able to explain them.
When deciding the safest and best course of action in such circumstances, we advise you to:
In an emergency you should provide the safest care you can. If you think that patients are being exposed to avoidable risk, you should tell a senior colleague or manager and work with colleagues to find the best possible solution in the circumstances. Make sure to record any concerns about working outside of your competence and how this could impact on patient safety.
The primary requirement for all doctors is to respond responsibly and reasonably to the circumstances they face.
Doctors in training
If you are required to work in a less familiar clinical setting or at the limits of your competence for your stage of training, your employer should provide appropriate induction and clinical supervision. Supervision should be from an appropriately qualified senior doctor who is competent to make decisions within the relevant speciality or healthcare setting about treatment or discharge of patients.
Whether you consult with patients face to face or remotely, the fundamental principles remain the same: provide effective, evidence-based treatments that serve patients’ needs
Our remote consultation ethical hub sets out how our guidance applies when treating patients remotely. This includes a flowchart on remote consultations that can help you to decide whether face to face care is necessary, and answers to questions on:
Joint high level principles, agreed by UK health regulators, also set out what is expected of any professional who is delivering healthcare remotely.
And you may find it useful to keep these key points in mind:
You may use a mixture of telephone, photographs and video consultation depending on the patient’s condition, your relationship with them and their preferences. You should consider the benefits and potential risks of each method, and which helps you to deliver safe care.
All our ethical guidance continues to apply as far as is practical in the circumstances. The primary requirement for all doctors is to react responsibly and reasonably to the circumstances they face.
While some interventions need a signature because of local policies, nothing in our guidance requires that patients’ written consent must be obtained. For most healthcare decisions doctors can rely on a patient's verbal consent. The important thing is that the patient has had the opportunity to consider relevant information and has decided to go ahead with the intervention. In other words, the patient:
For doctors carrying out procedures which routinely need a patient's written consent, they should still try to obtain this. But all decisions about a patients’ treatment and care should be recorded in the patient’s record even if written consent is not obtained.
If options are limited by available resources, doctors may have to make very difficult decisions about how to prioritise access to treatment or care. We advise doctors who are faced with these decisions to:
As far as practical, these decisions should not rest on individual clinicians’ shoulders. They should be taken following discussion with colleagues and, if possible, with input from local clinical ethics committees. It’s also essential that employers recognise the significant emotional distress that clinicians will experience. They should take steps to provide appropriate support, including psychological support and advice from any local clinical ethics committees, where they exist.
If a decision is taken not to start or to withdraw some forms of treatment from a patient, doctors should still take all possible steps to alleviate the patient’s symptoms and distress and respect their dignity. The patient’s wishes, preferences and fears in relation to their future treatment and care should be explored as far as possible. This includes what interventions would be considered or undertaken in an emergency, such as cardiopulmonary resuscitation. If the patient is dying, they should receive the best available end of life care. We have detailed advice about treatment and care towards the end of life.
We recognise that doctors may feel anxious about how context is taken into account when concerns are raised about their decisions and actions in very challenging circumstances. We've provided guidance as to how we will carry out our role. The primary requirement for all doctors is to respond responsibly and reasonably to the circumstances they face.
Our Confidentiality guidance sets out that if a disclosure is required by law (for example, under health protection regulations) doctors must disclose information relevant to the request (paragraphs 17 and 18).
If disclosure is not required by law, doctors should usually ask for a patient’s consent to disclose information. But that is not always possible - for example because action must be taken quickly to detect or control outbreaks of communicable diseases (paragraph 14e).
Doctors can disclose information about patients without consent in the public interest if failure to do so may expose others to a risk of death or serious harm. The benefits to an individual or to society of the disclosure must outweigh both the patient’s and the public interest in keeping the information confidential (paragraphs 63-70).
The Information Commissioner’s Office has published a statement about how it will consider complaints about data protection practices during the pandemic along with resources that answer frequently asked questions. NHS X has also published information governance advice which sets out some of the tools that doctors can use to support individual care, share information and communicate with colleagues.
Our guidance Doctors’ use of social media recognises the benefits that online platforms can have for patient care and communication but also reminds doctors:
We have provided more detailed advice on our social media hub which explores the practical application of our social media guidance could apply practice.
Advance or anticipatory care planning (ACP) helps patients to consider what they want to happen if they become so unwell that they cannot make decisions about their medical care and treatment. It’s important that these discussions are personalised to the individual patient’s wishes and needs and that they are recorded. Advance care plans are not blanket policies that can be applied to a group of patients.
Patients should be offered the opportunity to discuss ACP as early as possible, so they can explore options and express their preferences, including if they want an advance care plan at all.
A good advance care plan is where the patient feels they have expressed their wishes and been heard. Those involved in providing care for the patient should know about the plan, including family and informal carers if the patient agrees. They may need to be involved with reviewing it, as the situation evolves.
However, ACP discussions and decisions may be taking place in highly pressurised situations and may often be extremely difficult for all concerned. You should do your best to ensure they are handled sensitively and with compassion.
It may be helpful to draw on the patient centred resources available from organisations such as Age UK and Compassion in Dying. The Resuscitations Council’s Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) can also support personalised care planning for a person’s clinical care.
Discussions should be tailored to the individual patient, but could include:
It’s important to be clear and honest about options. Cardiopulmonary resuscitation (CPR) is one area of decision making where patients and their carers highly value clear explanations.
For example, if the clinical team decides that CPR will not work for the patient in certain circumstances, and a do not attempt CPR (DNACPR) notice is appropriate, this should normally be discussed with the patient directly, or with family, friends or carers if the patient lacks capacity.
Patients and those close to them may have unrealistic expectations about the likely success of CPR, or not realise the risks of serious injuries or complications that may result from attempting CPR. It’s also important to explain that a decision on DNACPR doesn’t mean that other care would be denied or stopped.
You should review the plan to make sure it remains relevant. For example, a patient might not want to go to hospital or be put on a ventilator if they are ill with coronavirus, but they still might want to go to hospital and receive treatment for any other illness.
Where the patient has capacity, discussions should be carried out directly with them, and with their permission, those close to them such as family, friends or carers.
Where the patient doesn’t have capacity, you should consult those close to them for their views about what would be in that patient’s best interests or of overall benefit to them in the circumstances. You should do your best to find out if the patient has nominated someone to be consulted about their wishes and preferences, or if they’ve appointed a legal proxy (not available in Northern Ireland) who can make the relevant decisions on their behalf.
Family and friends can play a vital role in supporting and helping to deliver care and treatment to their loved ones. Doctors play a key role in making sure local arrangements are appropriate and safe for the patient and the carer.
Doctors should:
All our ethical guidance continues to apply as far as is practicable in the circumstances. The primary requirement is for doctors to act responsibly and reasonably.
You should follow our Treatment and care towards the end of life guidance covering ACP (paragraphs 50 – 74) and CPR (paragraphs 128-146), as far as possible, being honest about any uncertainties or likely outcomes for the patient.
We help to protect patients and improve medical education and practice in the UK by setting standards for students and doctors. We support them in achieving and exceeding those standards, and take action when they are not met.
Check the register status of a doctor.
The secure portal for doctors.
.svg?la=en&hash=3BFAD4683392DABF0E512E931617952CDAC385C4){kind=link}