Table 1

Ethical principles and procedural values with example applications in the case of visitation restrictions

PrincipleDescriptionExample application
Respect for autonomyThe ability to determine one’s own course of action in accordance with one’s values without external interference.
  • Permitting residents or patients to receive visitors if they choose to do so.

  • Allowing residents or patients freedom of movement within an institution.

Maximising well-being (beneficence)Promoting the overall benefit—clinically, emotionally and psychologically—of individual patients. In the public health context, well-being is defined collectively rather than individually.
  • Acting to ensure the well-being of vulnerable patients and residents by protecting them against the spread of disease.

  • Ensuring that patients or residents who are seriously ill or dying have the social and emotional support they need.

Avoiding harmTaking action to minimise harm, or taking preventative steps to minimise foreseeable harms.
  • Ensuring that psychological, social or emotional harm to patients or residents posed by restrictions on visitors is kept to a minimum.

SolidarityA collective commitment to a particular cause, even if there is some cost to oneself.
  • Identifying a commitment to protecting vulnerable members of society and then restricting visitation to protect those individuals, even at personal cost.

FairnessTreating individuals, or similarly situated individuals, the same by providing equal access or opportunity.
  • Restricting or facilitating visitation for all patients or residents, irrespective of individual or unique circumstances.

EquityEnsuring that individuals, or similarly situated individuals, are provided with equal access or opportunity based on need or to overcome disadvantage.
  • Restricting or facilitating visitation for similarly situated individuals but allowing for flexibility based on individual need, such as allowing visitation for a resident with developmental disability to assist with self-care and meals.

Procedural values
ProportionalityEnsuring that measures put in place to minimise risk and maximise benefit are an appropriate response to the nature, likelihood and severity of the anticipated risk and based on best available evidence.
  • Restricting or facilitating visitation based upon the nature, likelihood and severity of the risk of transmission in a given population and setting.

TransparencyA commitment to openness around the decision-making process.
  • Clearly communicating how decisions are made and how values, burdens and benefits are weighed or impacted.

ConsistencyApplying a rule or guideline in the same way across multiple instances.
  • Facilitating or restricting visitation for individual patients or residents in similar circumstances over time.

AccountabilityA willingness to take responsibility for decisions that are made.
  • Leaders being open to scrutiny of decisions made regarding the facilitation or restriction of visitation.