Many hospitals have cancelled or postponed elective procedures due to the current COVID-19 pandemic. What kinds of considerations are ethics committees making when deciding to reopen elective procedures or keep it closed?

example of banned elective procedures:


2 Answers 2


A lot of hospitals are not currently performing elective surgeries because:

  1. Operating rooms and PACUs (post-anesthesia care units) have been converted to take care of patients with COVID
  2. Staffing shortages due to reassignments to COVID-related units
  3. Shortages of PPE (e.g. gowns) that are needed to perform surgery
  4. Unnecessary risk of coronavirus transmission to staff and patients performing/receiving these procedures and surgeries

You can review these considerations in recent guidance by the American College of Surgeons in the section titled "Why are surgeries being postponed?".

Hospitals make a substantial amount of their revenue from procedures and surgeries, and they have a financial incentive to perform them. They will decide to perform them based on the availability of 1-3 (space, staff, equipment) and their own balancing of the risk of virus transmission (some may prioritize revenue, others may prioritize safety).

  • While this seems like a good answer, it lacks supporting references, which we require here. They don't need to be doctoral thesis quality, but you do need to support your main assertions of fact. For example, where does your list of reasons why hospitals aren't performing elective surgeries come from?
    – Carey Gregory
    Apr 16, 2020 at 0:10
  • 1
    @CareyGregory thanks - fixed
    – Zac
    Apr 16, 2020 at 20:32

There is most probably no hard rule that will fit (almost) every hospital, because it depends on a variety of factors. Central hospitals with a lot types of surgery will have a bigger pressure to work on elective surgery. Also, the categories elective versus non-elective can be misleading: On a very strict level elective surgery would include every type of surgery not immediately designed to save a life, while on a more relaxed level it could include only those operations where patients are able to stay at home versus where they would have to stay in hospital waiting on surgery (see also Wikipedia: https://en.wikipedia.org/wiki/Elective_surgery, where there is also a term called 'semi-elective surgery').

With regards to the 'pressure' mentioned above, this could come from a variety of sources as well, such as the community, politics or financial reasons (some surgeries yield a lot more money than others). Of course, health of patients may be a factor: What at the moment may be a purely elective surgery down the road may become an emergency, that not only will have to be operated on, but also diminishes chances of a positive outcome somewhat.

Coming back to a (kind of) ruling when to re-open elective surgeries, most of these will have to be decided on a case-by-case basis, however, for some categories of surgery there is a practically non-existent danger of becoming emergencies, even if quite some time passes, e. g.: arthroscopy. On the other hand any currently elective heart surgery may have the patient deteriorate over time.

For some types of surgery intensive care monitoring is required, which in times of COVID-19 may be of severely limited availability as well.

In closing I believe the re-opening of elective surgery will be gradual and consider more eminently endangered categories of currently elective surgery first.

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