Sylvie Lemay contends that personal protective equipment should not be branded with commercial advertising.
Recently, I had the privilege to participate in a meeting of the Association of Ontario Midwives ethics committee. In the early days of the current pandemic and in the midst of a shortage of personal protective equipment (PPE), the Association had received two offers of donations of PPE from Chapmans Ice Cream and Tim Hortons. At face value, these were inoffensive corporate donors and the donations were greatly appreciated by midwifery practices and communities that benefitted from these gifts. The Association, taking a stewardship approach, ensured that any PPE not immediately needed by midwifery practices was shared with a community in need of PPE.
The donations sparked a question from the Executive Director: The Association of Ontario Midwives has a very strict corporate partnership policy – what if the corporations who were offering donations of PPE were on our specified list of unacceptable partners, such as weapons manufacturers, alcohol or tobacco companies, or infant formula manufacturers?
The ethics committee examined this hypothetical scenario in light of the Association’s Mission and Values statement and Corporate Partnership policy. The committee came to the pragmatic conclusion that our priority was the safety of midwives, the people we care for, and the larger community. If high quality PPE was being offered by an objectionable donor and there were no other options, safety is a clear priority and that objectionable donations of PPE were better than no PPE in the current context of the COVID-19 pandemic and known shortages. Healthcare providers have a duty of care and keeping midwives safe so they could continue providing care and prevent harm to themselves and the community they serve was worth the potential sacrifice of the organisation’s high ethical standards.
A member of the committee riffing on the topic asked, “what if the PPE was branded?” We were chuckling at the idea of wearing masks or face shields branded with Smirnoff or Tim Hortons. It was an amusing ethical quandary with many of us saying that during this pandemic we would rather wear a mask that said Smirnoff and keep a client safe than no mask.
A few days later, my partner who works in an operating room sent me a photo of his Ford branded face shield.
Health care is not a place of commerce. A pandemic is a crisis. Yet, clearly corporations that have retooled, and are being paid to provide PPE, are taking the opportunity to advertise. A face shield for personal protection branded with a car company logo may seem silly and inconsequential. But what does this precedent mean? What if the shield was branded or supplied by a tobacco or vaping company? How about by a pharmaceutical company? Accepting something as simple as a small gift such as a mug or pen from a pharmaceutical company has been shown to change physician behaviour. If a small gift can influence behaviour, it is highly likely that a branded product that is keeping you and your patient safe must also have an impact on health care provider behaviour. And remember, these shields were not gifts but are being paid for by institutions. So, in effect, health care organizations have paid for this marketing.
Our current crisis should not be an additional opportunity for corporations to market themselves. Professional associations like the Canadian Medical Association and the Association of Ontario Midwives have policies regarding interactions with pharmaceutical companies. For example, the CMA’s policy directs physicians to not accept gifts of significant value and warns about the possibility of even small gifts influencing clinical decision-making, but does not prohibit them. With branding of PPE starting to happen, it may be time for our institutions and professional associations to refuse and prohibit branded gear and it is definitely time to prohibit even small gifts such as branded pens or stationery. Our clinics, hospitals, and operating rooms should not be used as opportunities for advertisement.
Sylvie Lemay is a registered midwife and a graduate student in the Master of Bioethics program at the University of Toronto Joint Centre for Bioethics. @sblemay