COVID-19 and involuntary detention – An emergency medicine or emergency management responsibility?

Associate Professor Nicola Cunningham1, Doctor Joel Wilson1, Ms Trudy Cox1

1St Vincent’s Hospital Melbourne, , Australia, 2Victorian Institute of Forensic Medicine, , Australia

The COVID-19 pandemic has thrown up innumerable challenges throughout the world, nowhere are these more evident than in the healthcare system. In emergency medicine, there is new urgency around the clinical and ethical dilemmas we face as we make decisions that impact upon the lives of our patients. We are accustomed to upholding our duty of care and acting in the best interests of patients when they are incapacitated, intoxicated or psychiatrically unwell. But what is our duty of care when the actions and decisions are weighed against the impact of COVID-19 on the lives of others?

Are there circumstances in which our duty of care to our community trumps our duty to our patient? Can we breach our duty to an individual patient to protect the best interests of the wider community? How much danger does the community need to be in, and how imminent does that danger need to be? The COVID-19 pandemic has pushed these questions to the forefront.

We present a case that explores the complex issues of respect for autonomy and the principle of non-maleficence, in the setting of COVID-19 and public health orders. We illustrate the uncomfortable uncertainty that exists surrounding care of some of the most vulnerable and disenfranchised patients in the community when their actions are contrary to public health recommendations. With reference to mental health and public health legislation across Australian jurisdictions, we examine the ethical and legal considerations when faced with these difficult, and increasingly common scenarios.


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