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The Covid‐19 pandemic has highlighted many of the difficult ethical issues that health care professionals confront in caring for patients and families. The decisions such workers face on the front lines are fraught with uncertainty for all stakeholders. Our focus is on the implications for nurses, who are the largest global health care workforce but whose perspectives are not always fully considered. This essay discusses three overarching ethical issues that create a myriad of concerns and will likely affect nurses globally in unique ways: the safety of nurses, patients, colleagues, and families; the allocation of scarce resources; and the changing nature of nurses' relationships with patients and families. We urge policy‐makers to ensure that nurses' voices and perspectives are integrated into both local and global decision‐making so as to minimize the structural injustices many nurses have faced to date. Finally, we urge nurses to seek sources of support throughout this pandemic. [ABSTRACT FROM AUTHOR]

Few novel or emerging infectious diseases have posed such vital ethical challenges so quickly and dramatically as the novel coronavirus SARS‐CoV‐2. The World Health Organization declared a public health emergency of international concern and recently classified Covid‐19 as a worldwide pandemic. As of this writing, the epidemic has not yet peaked in the United States, but community transmission is widespread. President Trump declared a national emergency as fifty governors declared state emergencies. In the coming weeks, hospitals will become overrun, stretched to their capacities. When the health system becomes stretched beyond capacity, how can we ethically allocate scarce health goods and services? How can we ensure that marginalized populations can access the care they need? What ethical duties do we owe to vulnerable people separated from their families and communities? And how do we ethically and legally balance public health with civil liberties? [ABSTRACT FROM AUTHOR]

I was a member of the Massachusetts advisory working group that wrote the Commonwealth's crisis standards of care guidance for the Covid‐19 pandemic, and I was proud of the work we did, thinking carefully about whether age should matter and whether priority should be given to essential workers if there was a scarcity of medical resources, about whether protocols should address issues of structural racism, and so forth. But as a critical care physician, I have concluded that, no matter how sophisticated the ethical analysis, the fundamental approach we proposed was flawed and virtually impossible to implement. All the existing allocation protocols that states developed are based on the assumption that clinicians will be faced with the task of selecting which patients will be offered a ventilator from among a population of patients who are each in need of one. The protocols then assign patients a priority category, and the protocols specify "tie‐breaking" criteria to be used when necessary. The problem with this approach for ventilator allocation is that it has no relationship whatsoever to what happens in the real world. [ABSTRACT FROM AUTHOR]

Since the start of the Covid‐19 pandemic, debates have waged about "crisis standards of care" ("CSC")—the guidelines for the allocation of resources if those resources are too scarce to meet the needs of all patients. The Hastings Center Report's September‐October 2021 issue features a collection of pieces on this debate. In the lead article, MaryKatherine Gaurke and colleagues object to the idea that the allocation of scarce resources should aim to save the most "life‐years," arguing instead that the objective should be to save the most lives. Gaurke et al. assert that it is only theorists who have favored the life‐years strategy; the public has not—or at least, there is no good evidence that the public has. This claim is elaborated in the article by Alex Rajczi and colleagues, who argue that identifying and applying the public's will—a process they call "political reasoning"—is the core work in developing CSC. Five commentaries—two coauthored, by Douglas B. White and Bernardo Lo and by Anuj B. Mehta and Matthew K. Wynia, and three solo authored, by Govind Persad, Virginia A. Brown, and Robert D. Truog—offer further arguments about and insights into CSC. [ABSTRACT FROM AUTHOR]