Medical ethics during COVID-19 pandemic: An experience with death investigation.

Abstract

Introduction Medical ethics is a key element in the practice of medicine. This study highlights the application and conceptualization of those principles in the process of death investigation during the COVID-19 pandemic. Objective To identify different ethical principles and their application in deaths during the COVID-19 pandemic. Methodology Autopsy information of 41 deaths from 2020-2021, which came for inquests with positive Polymerase Chain Reaction (PCR) test for COVID-19 or positive rapid antigen test was analysed. The death investigation process was conceptualized against the ethical principles; justice, autonomy, beneficence, and non-maleficence. Results The majority of deaths (36.59%) were aged between 71-80 years, with less gender disproportion (M:F- 51:48). Home deaths (63.41%) were commoner, while deaths of non-vaccinated people (80.49%) were predominant. PCR was done in <24 hours after death in 36.59% and within 24-48 hours in 58.54%. Comorbidities were present in 78.05%. Cycle threshold (Ct) value <30 group was 75.61% with the primary cause of death being related to COVID-19 infection in 83.87%, while the duration of illness was >3 weeks in 12.9% and 2-3 weeks in 3.23%. Ct value >30 group was 17.07% with COVID-19 infection being a contributory cause of death in 57.14%, while all had a duration of illness of <2 weeks. Conclusion Justice has prevailed in this cohort. The PCR report influences the autonomy in claiming and releasing the bodies to the relatives. A higher Ct value may suggest less infectivity, which may be considered when releasing the body after excluding lung changes in an autopsy. Therefore, more research is needed with regard to Ct values and infectivity of dead bodies.