Epidemics and the healthcare professional's duty to care: Students' attitudes about work requirements before and during Covid-19 (2017-2021).

Context: The Covid-19 pandemic has added a new chapter to discussions about the professional duty to care. To understand how Covid-19 may have changed medical students' ethical attitudes towards this duty, we analysed policies written before and during the pandemic by first-year students completing a yearly educational exercise focused on work requirement expectations for healthcare professionals during a hypothetical epidemic.

Methods: Within a repeated cross-sectional design, consensus coding was performed on policies written over 5 years (2017-2021) using a codebook based on eight questions from the educational exercise for summative content analysis. Frequencies provided summative results and comparisons across years used Fisher's exact test.

Results: We analysed 142 written policies from 2017 to 2021 representing 884 first-year students working in small groups. Students' commitment to the duty to care remained stable during the Covid-19 pandemic, but during the pandemic, students were more likely to support exceptions to the duty to care (e.g. for healthcare professionals with medical conditions or concern for household members' health) and more likely to expect institutions to provide safe working conditions. Ethical values supporting students' policies were largely consistent before and during the pandemic, the most common being beneficence, justice, duty to care, non-maleficence and utility.

Conclusions: Our results suggest that students' support for the duty to care remained strong during the Covid-19 pandemic. We also found that students supported exceptions to this duty to reflect the needs of healthcare professionals and their families and that they expected institutions to provide safe working conditions. These findings can help inform ethics education and future pandemic preparedness.