Seeking Normalcy as the Curve Flattens: Ethical Considerations for Pediatricians Managing Collateral Damage of Coronavirus Disease-2019




COVID-19 (Coronavirus disease 2019)

Fearful. Uncertain. Overwhelmed. Committed. Hopeful. Pediatricians around the world have cycled through these emotions when considering the health and safety of patients and families during this coronavirus disease 2019 (COVID-19) pandemic. We worry about the direct medical effects of COVID-19. We also worry about the ancillary effects of the lockdowns, stay-at-home orders, closed clinics, schools, and daycare centers, and newly unemployed parents on the well-being of children. We focus on those concerns. We believe that responding to these ancillary effects of COVID-19 will be a bigger challenge for pediatricians than the clinical care of children with COVID-19. These challenges will be with us for the foreseeable future.


The COVID-19 pandemic presents quickly evolving ethical challenges for pediatricians. Some of the issues are not specific to COVID-19. They include moral distress, reprioritizing clinical goals, responding to unique vulnerabilities of children, addressing uncertainty in shared decision making, and considering how and when to proceed with pediatric clinical research. COVID-19 puts a new spin on all of them. It also offers opportunities to rethink solutions. How we respond matters. We must use the challenges of this pandemic as opportunities to improve the health of our children now and even after COVID-19 recedes. This pandemic highlights long-standing deficiencies and inefficiencies in our current system of child healthcare. As advocates for children, pediatricians are in a unique position to redesign the system in a way that prioritizes children and families, addresses the social determinants of health, decreases inequalities and health disparities, and ensures ethical research on the treatment and prevention of COVID-19.

Moral Distress and Utilitarian Prioritization in the Throes of Crisis

The COVID-19 pandemic has created experiences of moral distress in our lives at home, in the clinical setting, and as citizens in our communities.

Policy Brief: The impact of COVID-19 on children.