This review aimed to map the main ethical tensions experienced by health workers in low- and middle-income countries during infectious disease outbreaks.

We conducted a critical interpretive review of qualitative research studies. After searching 3 databases, 4445 articles were exported to Rayyan, deduplicated, and screened for eligibility. Of the 98 articles retained for full review, 25 met the inclusion criteria. Data were extracted to an Excel spreadsheet and key ethical tensions were identified using a descriptive content and thematic analysis approach.

Twenty-three of the studies focused on the COVID-19 pandemic, and two addressed Ebola epidemics. Three major ethical tensions were experienced by health workers, which involved conflicts between their professional duty to patients, colleagues, and communities, as against their concerns for personal safety, the well-being of their families, and facing stigma and discrimination. Secondary tensions arose when health workers seeking to manage these primary ethical tensions experienced further uncertainty about whether to disclose information about their professional roles with family members or community.

Ethical tensions are unavoidable during contagions, and may be amplified due to structural features. Authorities must take steps to support health workers as they navigate ethical tensions during localized epidemics or global pandemics.