Pandem-ethics: Post-mortem reflection on healthcare worker ethics during the time of coronavirus disease 2019 pandemonium

Abstract

Background: The coronavirus disease 2019 (COVID-19) pandemic created ethical and legal tension for healthcare workers (HCWs), who had to balance professional obligations with personal safety, family responsibilities and resource limitations. The concept of ‘duty to care’ re-emerged as a contested ethical construct during periods of workforce vulnerability and healthcare scarcity.
Aim: This article examines the ethical and juridical dimensions of HCWs’ duty of care during the COVID-19 pandemic, focusing on the South African constitutional framework, occupational health obligations and professional regulation, and whether this duty is absolute or subject to reasonable limits.
Setting: The discussion is situated within South Africa’s healthcare response to the COVID-19 pandemic and the ethical expectations placed on clinicians in high-risk and emergency settings.
Method: A narrative review was conducted using PubMed, Google Scholar and grey literature. Sources included peer-reviewed ethical analyses, legal frameworks and policy documents. A thematic synthesis analysed moral theory, legal duty, reciprocity and public health ethics.
Results: The duty of care is substantial but not limited. South African law supports coexistence of rights rather than hierarchical obligations. Ethical analysis shows that proportionality, reciprocity and reasonable risk mitigation conditions professional duty. Employers must ensure adequate protection, transparent triage systems and psychosocial support. Failure to ensure reciprocity risks moral coercion and workforce attrition. The pandemic highlighted the need to define the thresholds where professional obligation yields to legitimate self-protection.
Conclusion: The duty of care should be reconceptualised as a conditional, relational obligation grounded in constitutional values and public health ethics, with clear risk thresholds and enforceable reciprocal protections.
Contribution: This article contributes to post-COVID-19 pandemic ethics literature by clarifying between the duty to treat, care and serve, proposing a Decatrad of operational reforms, reframing the duties as conditional, reciprocal and legally bounded.