Abstract

Background and aims. The outbreak of the COVID-19 pandemic has posed several challenges to societies, individual healthcare systems, and global public health. Additionally, the pandemic has entailed new ethical dilemmas that healthcare professionals and institutions are forced to manage both individually as well as institutionally. Many countries, including Estonia, had already prepared ethical guidelines by April 2020 to support healthcare professionals in their potentially challenging ethical decisionmaking. The aim of this article was to analyse the evaluations of frontline healthcare professionals regarding these situations, as well as their individual strategies and perceptions related to the management of ethically challenging medical cases in the context of the pandemic.
Methods. The research made use of a combined method of a quantitative webbased survey (n=220) and eight qualitative semi-structured in-depth interviews. The sample consisted of frontline healthcare professionals from 5 institutions (Kuressaare Hospital, Tartu University Hospital, North Estonia Medical Centre and the Ambulance Foundations of Tallinn and Tartu) which were affected the most by the first wave of the pandemic. Quantitative data was analysed using descriptive statistics (cross tabulation) with the MS Excel and BlueSky Statistics (version 7.0). Qualitative textual analysis was used for data analysis. The research was granted ethical approval by the Research Ethics Committee of the University of Tartu.
Results. The majority of the respondents felt very much or quite confident about their clinical role. In the case of potentially limited resources, the majority (40%) of the respondents suggested that their confidence depended on the situation. The six main sources of work-related stress were concerns about family, concerns about limited resources, lack of knowledge about COVID-19, rapidly changing public health situation and increased workload, as well as the issue of missing equipment for personal
protection. Thus, more detailed guidelines, mental health support, and both external and internal communication were seen as necessary measures to be adopted. The
analysis revealed that the pandemic as an ethical issue might increase health inequalities and social stigmatization.
Conclusions. In addition to medical aspects, it is necessary to pay attention to the development of crisis management plans, which involve more detailed guidelines and increased support for the social, psychological and ethical capacity of frontline health workers.