Neurosurgery During a Pandemic

The COVID-19 pandemic dramatically affected the provision of global neurosurgical care. Through the pandemic, neurosurgeons around the world were forced to adapt to changing operative capacity, stressors associated with redeployment, and uncertain working conditions. With extreme resource scarcity, there was an increased requirement to advocate for patients with neurosurgical emergencies. Triage and resource allocation emerged as a priority for hospital decision-makers around the world. We apply and synthesize several ethical frameworks to guide individuals through challenging resource allocation decisions associated with resource scarcity. We specifically discuss the accountability for reasonableness metaethical framework as well as a generalizable mechanism for policy implementation, data-driven reassessment, and iteration that allows decision-makers to continuously respond to dynamic pandemic conditions. Pandemic response initiatives and neurosurgical triage practices should be catered to health system microenvironments. Additionally, we explore the ethical and moral conflicts associated with redeployment and comment on the tension between provider obligations to safe working conditions and their simultaneous obligation to serving patients. Further ethical conceptual conflicts arise when deontological and utilitarian notions conflict one another. The following chapter emphasizes challenges associated with neurosurgical care during a pandemic and contextualizes these difficulties using the following core ethical principles: equality, equity, promotion of instrumental value, transparency, maximizing benefit, favoring those worst off, autonomy, relevance, appeals, and oversight. We emphasize the importance of forward planning during non-pandemic circumstances to create contingency schemas for future circumstances of resource scarcity.