A COVID code of conduct — what does a patient owe to others?

Everyone entering a clinic space should sign on to a formal code of conduct, pledging to live in a way that minimizes risk of infection, says the European Society of Human Reproduction and Embryology. 

Last week, the European Society of Human Reproduction and Embryology (ESHRE) held a webinar about how fertility clinics should prepare for reopening.

During the Q&A, one participant asked for guidance on how best to keep the illness out of the clinic. "If you want to have a COVID-free clinic," answered Luca Gianaroli, a member of the ESHRE COVID-19 working group, "don't do anything. Just keep your clinic closed."

Completely COVID-free may be more than anyone can promise or expect, but clinics are taking a hard look at how they can minimize risk. 

They'll do as many appointments as possible by telemedicine, for instance. They'll require fewer blood tests and ultrasounds. They'll stagger appointment times. They'll move the waiting room chairs further apart. Everyone will wear masks. 

Many clinics plan to run a tight triage, both two weeks in advance of an in-person appointment and at the front desk when the person arrives. Those with risk factors or symptoms will have to be cleared through testing, maybe more than once.

Procedures might change too. Local or intravenous anaesthetic might be preferred over general. A shorter ovarian stimulation protocol might be preferred over a longer one. If the community's local infection rate is high, a doctor might suggest freezing rather than transfer. And some lab and freeze-storage details might change.

All of this was interesting. But most intriguing of all was the idea, advocated by ESHRE, that everyone who enters the clinic space should sign on to a code of conduct.

The code of conduct would specify the kind of behaviour everyone is agreeing to undertake. It would discourage gathering in large groups, for instance. It would discourage contact with any persons at risk. Even as others might be widening their social circles, people with dealings at the clinic would be asked to keep their bubbles small.

The instructions should be "compulsory" for staff, ESHRE recommends, and attendance at work should be tied to abiding by them. Staff would have to regularly confirm in writing that they were adhering to the code, and they would have to come clean about any infringements. 

Patients too would have to sign on. So would cleaners, people servicing microscopes and ultrasound machines, company reps — anyone who walks through the front door would be asked to put their name to the code.

The signed documents would be kept on file.

The code of conduct would mean a new kind of intimate pact. It would no longer be just the doctor who pledges to do no harm. Everyone participating in any way in the fertility clinic would owe a duty of care to the others, and each person would be made to think seriously about that. Doctors and workers owe it to each other and the patients. But now patients would owe it in return — not only to staff but to their fellow fertility patients. 

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Webinar

ESHRE resources on COVID-19

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