Table 1 Ethical questions in the application of genomics to COVID-19 management decisions
From: Genomics in the era of COVID-19: ethical implications for clinical practice and public health
Clinical decisions Is it ethically acceptable … | to withhold scarce resources from patients with higher (or lower) genetic risk of mortality? |
to deny hospital admission to patients with higher (or lower) genetic risk of mortality? | |
to use genetic information to make decisions about which patients are admitted to the ICU or put on a ventilator? | |
to prioritize access to experimental treatments (which are in short supply) to those who are genetically at higher risk of serious disease? | |
for visitation policies to be informed by genetic testing of family members to determine their risk of contracting or transmitting COVID-19? | |
to mandate that adherence to DNR orders should be stricter for patients with higher genetic risk of mortality? | |
Workforce decisions Is it ethically acceptable … | for hospitals/ICUs to mandate genetic testing of the workforce to inform work assignment decisions? |
for hospitals/ICUs to prohibit a health care worker with increased genetic risk of infection from providing direct patient care? | |
for hospitals/ICUs to prioritize health care workers with decreased risk of infection to serve as first responders? | |
to use genetic information on health care workers’ susceptibility to COVID-19 to determine the level of personal protective equipment to which they have access? | |
Public health policies and practices Is it ethically acceptable … | for quarantine measures/policies to be informed by genomics, i.e., those who are at lower risk of contracting the disease do not have to stay at home? |
for school attendance/closure policies to be informed by genomics, i.e., schools can remain open for students and teachers at lower risk? | |
for travel and immigration restrictions to be informed by genomics (e.g., super-spreaders face increased restrictions)? | |
for vaccine (once available) distribution to be prioritized for those most likely to develop severe disease or least likely to show symptoms (and therefore unknowingly spread disease)? |