Ethical thinking and awareness are crucial in all areas of public health, but they are even more significant in the delicate, multifaceted field of public health emergency preparedness. This study investigated the ethical issues and moral dilemmas experienced by frontline health workers during the coronavirus disease-19 (COVID-19) pandemic in Ethiopia. A nationwide survey was conducted among frontline health workers at nineteen public hospitals. Participants were asked to fill out a self-administered questionnaire. All data were weighted and evaluated through descriptive statistical methods.
Of the 285 frontline health workers who received the questionnaires, 217 completed and returned them (response rate: 76.1%). Participants frequently described facing difficult rationing choices involving medical supplies needed for COVID-19 prevention and treatment. The majority (83.9%) reported experiencing ethical challenges very often or often. Nearly all [215(99.1%)] reported that shortages of resources directly intended for COVID-19 treatment and prevention were a major issue. The proportion of health workers who faced problems delivering essential clinical services ranged from 77% to 98.7%, depending on the service. More than half of the respondents reported difficulties in providing clinical care on a daily or weekly basis. Among rationing approaches, the creation of separate COVID-19 treatment units and restrictions on hospital admissions were the most commonly used strategies, with two-thirds of health workers using them daily or weekly. Frontline health workers faced a wide range of ethically difficult situations throughout the COVID-19 pandemic. More than half reported ethical difficulties when rationing limited resources and when providing essential clinical services, including family planning services, maternal and child healthcare, immunization, and chronic disease management. With scarce resources such as ventilators and hospital beds, healthcare providers have had to make tough choices about which patients receive access and which do not. In summary, the COVID-19 pandemic created many ethical dilemmas for healthcare professionals, underscoring the critical need for strong ethical awareness in healthcare delivery. Recognizing these challenges and establishing clear policies to manage them can help providers deliver optimal patient care while maintaining high ethical standards.
