Corridor care, or the use of ‘temporary escalation spaces’ refers to the treatment of patients in non-designated areas such as hallways, storerooms and car parks due to overcrowding and limited clinical resources.[1] Initially intended as a temporary response to extreme systemic pressures within emergency departments, corridor care has since become increasingly normalised, prompting concerns regarding patient safety, quality of care and ethical decision-making. 

     A 2024 survey of 11,000 nursing and midwifery staff across the United Kingdom by the Royal College of Nursing reported that almost two-thirds of respondents believed that corridor care compromised patient dignity and privacy, while more than half admitted to omitting necessary care to avoid causing potential harm. The same report identified widespread moral distress and injury among healthcare professionals, compounded by increased workloads and stress-related absences. Notably, approximately 54% of those directly involved in providing corridor care claimed considering leaving their posts.[2] The Royal College of Emergency Medicine has similarly condemned corridor care, asserting that ‘it is not possible to provide safe and good-quality care in temporary escalation spaces’.[3] 

     Yet, official governmental guidance paradoxically acknowledges that while ‘care in temporary escalation spaces is … not acceptable’, it may nonetheless represent the ‘safest, most effective and highest quality care possible when necessary’.[4] Such contradictions underscore the profound ethical and practical incoherence at the heart of corridor care.

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Global Inequalities in Corridor Care

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     Corridor care is not limited to high-income nations; rather, it reflects a broader global health concern. Healthcare systems worldwide are increasingly overburdened by rising populations, ageing demographics, overcrowding, chronic underfunding, workforce shortages and the lingering aftershocks of global health crises such as the COVID-19 pandemic. In response, many governmental healthcare policies and initiatives resort to makeshift strategies such as corridor care; its prevalence signifying not a localised failure but a symptom of systemic strain and structural inequity in healthcare delivery globally.

     Corridor care is identifiable by different terminology – ‘ramping’[5] in Australia and ‘boarding’ in South Africa – but the clinical and ethical implications remain constant: loss of privacy, dignity and safety. A 2020 qualitative study across five high-volume public emergency centres in Cape Town documented the experiences of physicians and nurses treating patients in corridors and makeshift spaces. Many were frustrated at the reduced attention they could possibly give each patient and admitted: received, stating: ‘I may overlook things, forget about things because I'm attending to the previous patient.’ They also described the disparity of corridor care between public and private healthcare as ‘huge’.[6] Similar studies in Ireland and the United Kingdom reveal that patients perceive corridor care as symbolic of institutional indifference, ascribing a sense of betrayal, neglect and erosion of trust in healthcare institutions.[7] 

The tension between utilitarian imperatives (maximising net outcome) and deontological commitments (respect for patient autonomy and welfare) was especially visible during the COVID-19 pandemic. In the United States, a large cross-sectional analysis of 46.2 million hospitalisations between 2017 and 2024 found that by January 2022, 40.1% of patients were boarded for four hours or more, and 6.3% for over twenty-four hours, marking an unprecedented peak in emergency overcrowding. The study warned that ‘the health system is at risk of collapse in the event of another pandemic’.[8,9] 

     Corridor core, therefore, represents an ethical and clinical failure that transcends national borders – one that exposes the fragility of autonomy, dignity and trust when global healthcare systems operate under immense and sustained pressure.  

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Utilitarian Reasoning

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     Corridor care sparks enduring ethical debate. While some view it as a pragmatic means that benefits the greatest number of patients, aligning with act utilitarianism, it does so at the expense of individual rights. In such times of crisis, utilitarianism, as a population principle, takes precedence over deontological commitments to individual well-being. Adopting utilitarian logic, it may seem sensible to facilitate early discharge to free up beds, staff and medical equipment for patients who demand more immediate care. Similarly, expediting patient transfers to wards or other ‘less crowded’ facilities may also reduce overcrowding. While these solutions may temporarily ease the pressures of corridor care, it still poses potential harm to the patient and poses the question: is it possible to accurately determine the maximum utility of corridor care? 

     If we adopt Bentham’s theory of utilitarianism - ‘the greatest happiness for the greatest number’[10] – corridor care might appear defensible as a means of maximising the number of patients’ lives saved. However, a utilitarian approach would revoke the patient’s rights of autonomy and beneficence and inadvertently reduce them to numbers and bed capacity. Such utilitarian reasoning invites a crucial question at the heart of modern medical ethics: to what extent does the needs of the many outweigh the needs of the few? It becomes ever-so clear that even pragmatic attempts to mitigate corridor care must incorporate additional avenues of ethical reasoning to ensure that efficiency does not overshadow morality. 

 

Principlism in Practice: Applying the Four Pillars of Medical Ethics

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     The four-principles approach, or principlism, developed by Beauchamp and Childress - autonomy, beneficence, non-maleficence and justice – offers a model for physicians to navigate complex ethical decision-making and fulfil their prima facie duty to patients.[11] When principles conflict, much like Calabresi’s analogy of a juggler[12], physicians must carefully balance each principle so that not one is neglected at the expense of another. Corridor care epitomises this precarious balancing act. 

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Autonomy 

 

     Patient autonomy is often compromised when individuals are placed in corridors or makeshift spaces without consent or being properly informed. The impersonal nature of corridor care - marked by noise, lack of privacy, dignity and ineffective communication - can erode a patient’s sense of control, self-worth and engagement with their care. In cases when a patient is unconscious or incapacitated, autonomy is suspended, and physicians must rely on beneficence and non-maleficence to decide the best outcome. However, such principles might conflict (discussed later). Nevertheless, it is vital that patients and families are involved in all decision-making wherever possible, even amid pressures to optimise net outcome.  

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Balancing Autonomy with Consumerism

 

     Never are a patient’s right to autonomy more pronounced than through the lens of consumerism. Within a consumerist model, patients are empowered to choose and demand the level of care they deem appropriate. However, when a healthcare system fails to meet these expectations, as in corridor care, some patients may reject public healthcare and resort to private, exacerbating inequalities by rendering financially vulnerable populations without adequate access to care. Rather than lowering patients’ expectations, which would be inherently unethical, attempts should aim to maximise transparency, communication and shared decision-making in the confines of a doctor-patient relationship even within imperfect systems.[13] 

 

Limits on Beneficence and Non-Maleficence

 

     Corridor care, by its very nature, challenges the principles of beneficence and non-maleficence. Due to its high-traffic and inherent limited resources, corridor care exposes patients to a higher risk of infection, causing harm to vulnerable populations, such as the elderly or individuals with compromised immunity. Patients who are triaged as ‘non-urgent’ may face longer wait times, receive reduced medical attention and could be neglected until resources become available. 

     Nevertheless, despite significant shortcomings, corridor care arguably remains preferable to the alternative of no care at all. When adequately staffed and located near critical care resources, corridors and other makeshift spaces may offer a safer option than transferring patients to wards lacking specialised personnel and equipment. However, any potential benefit must be carefully weighed against the associated risks. This ethical trade-off raises a difficult question: at what point does the harm inflicted by corridor care outweigh its benefits, making the alternative of no care ethically preferrable? 

 

Moral Distress and Injury

 

     It becomes increasingly difficult for physicians to uphold the principles of beneficence and non-maleficence while a patient remains in corridor care. The physician’s ability to promote patient well-being is constrained and with ever-mounting pressures of resources shortages, staff are often compelled to prioritise utilitarian logic over individual patient needs. This not only compromises professional autonomy but also contributes to moral injury for both physicians and patients. This concern was notably captured in a joint open letter signed by fifteen healthcare and patient organisations, including the Royal Colleges of Nursing, Emergency Medicine, Physicians and the British Medical Association, which stated: ‘for staff, this means being forced to deliver compromised care … this causes moral distress and ultimately, moral injury’.[14] An opinion piece published in the BMJ in 2025 further elaborated on this, noting that moral injury arises from a severe dislocation between expectation and reality, leaving healthcare professionals unable to fulfil their ethical obligations and consequently, suffer psychological anguish and burnout.[15] 

     The impact of corridor care extends beyond hospital wards. Ambulance crews and emergency responders also face moral distress when prolonged handover times force them to remain at hospitals longer than expected, delaying their response to new emergencies. Moral distress arises from being unable to perform the ethically necessary action (attending promptly to incoming patients) due to systemic constraints imposed by corridor care. Over time, repeated exposure to such situations can escalate into moral injury, as individuals may feel complicit in actions that violate their professional and ethical standards. 

However, one must remain mindful of the limitations of self-reported distress, as such accounts are inherently subjective and may be influenced by personal bias. While self-reported experiences can be valuable in framing ethical considerations, they cannot substitute for empirical evidence and should be interpreted alongside objective data to ensure validity.

 

Distributive Justice Amidst Resource Scarcity

 

     The ethics of scarce resource allocation aligns with the principle of distributive justice, which requires physicians to prioritise resources for patients who are in greatest clinical need. One might argue that corridor care inevitably leads to an inequitable distribution of care and resources: while some patients receive adequate care in fully equipped and staffed, designated rooms or wards, others are treated in sub-optimal conditions within corridors or other makeshift spaces. However, it is important to distinguish between care that is perceived as unsatisfactory and care that is ethically inequitable. If corridor care represents the best available and safest option under severe resource constraints and is applied fairly, based on clinical urgency, then its use may still represent an equitable distribution of limited resources, coinciding with the principle of justice.[16]

     Nonetheless, the realities of resource allocation in high-pressure environments presents a challenging and complex ethical dilemma. Physicians must constantly balance their professional and moral duties, often in the absence of clear guidance, forcing one to question: how can we be certain that such decisions are made independent of error, emotional bias, systemic inequality, or undue utilitarian reasoning? To address this issue, some hospitals are recruiting intensivists dubbed as ‘corridor doctors’ whose aim is to provide impartial decision-making in allocating resources whilst providing clinical treatment.[17] While this may pose a useful solution, it fails to uproot the factors underlying corridor care. 

 

Principlism vs. Practicality: Applying a Kantian Perspective

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     If we were to uphold the four principles by applying a Kantian framework, physicians would be bound by a moral duty to respect each patients’ autonomy and dignity, regardless of external pressures. Kantian ethics reinforces the principle of autonomy by asserting that individuals must never be treated merely as a means to an end, but always as ends in themselves. In the context of corridor care, this poses a significant ethical dilemma: transferring a patient into a corridor to benefit others (i.e., by freeing up beds or staff) may be interpreted as using that patient as a means to an end, thereby breaching this moral obligation. From a strict Kantian perspective, such an act would be impermissible, and a physician might be ethically justified in refusing to deliver care in such circumstances. 

     Moreover, Kantian ethics insists that a true conflict of duties cannot exist; any perceived contradiction, Kant argues, must arise from a misunderstanding of one’s moral convictions. This absolute position, though philosophically consistent, fails to accommodate the complex ethical realities of modern healthcare, particularly in high-pressure and resource-scarce environments such as emergency departments. In such contexts, physicians often face competing duties daily: to treat patients, uphold patient dignity and respect and allocate resources justly and efficiently, none of which can be fulfilled simultaneously.[18]

     The practical application of a more nuanced Kantian approach may therefore lie in understanding the distinction between moral duty and clinical necessity. In practice, physicians who are guided by Kantian reasoning may be compelled to choose the lesser harm, for instance, providing corridor care to prevent greater suffering, while acknowledging that such an act remains ethically impermissible in principle. This aligns with the ‘minimise harm principle’ conceptualised by Professor of Philosophy at North Carolina State University (1967-2001), Tom Regan in which he argues that: ‘Whenever we find ourselves in a situation where all the options at hand will produce some harm to those who are innocent, we must choose that option that will result in the least total sum of harm’.[19,20]

     At first glance, Regan’s principle appears compatible with the clinical dilemma of corridor care, suggesting that when all available options invoke harm, the least harmful should be preferred. However, this yet again reveals an inherent tension between deontological and utilitarian reasoning. If one accepts that the harm to an individual patient can be justified by a reduction in total harm to the majority, this rationale begins to mirror utilitarian ethics and departs from Kant’s absolute prohibition against treating individuals as means to an end. Furthermore, accepting corridor care as the least harmful option risks overlooking alternative solutions that might cause even less harm without compromising patient autonomy or dignity. 

     Taken together, while the ‘lesser harm’ approach may reflect the realities of clinical necessity within an imperfect healthcare system, it does not render corridor care morally permissible within a strict Kantian framework. Rather, it highlights the moral dissonance faced by physicians who strive to uphold deontological ethics within a healthcare system that constrain their ability to act on moral duty. In such cases, a physician’s moral intent may remain Kantian in nature, even as their actions deviate towards utilitarian reasoning, representing a tragic compromise imposed by systemic limitations that render ethical action impossible.

While it may be difficult to apply pure Kantian ethics to the complexities of corridor care, its framework remains a valuable lens through which to examine clinical decision-making. Kantian ethics continues to underscore the inherent autonomy and dignity of each patient. Although, this perspective often conflicts with utilitarianism, particularly in high-pressure environments, Kantian theory serves as a crucial counterbalance, ensuring that ethical consideration is not substituted for outcome-driven logic. 

 

Comparative Ethics and the Limits of Moral Reasoning

 

     The ethical complexities of corridor care become most pronounced when systemic pressures, professional obligations and individual autonomy converge, exposing the points at which ethical principles intersect and, at times, conflict. When considered together, it becomes apparent that no single ethical framework can fully resolve the tensions inherent in corridor care. Utilitarianism prioritises outcome and efficiency, often justifying decisions based on population-level benefit over individual welfare. However, it cannot serve as the foundation for a long-term, sustainable healthcare solution. Kantian ethics, on the other hand, upholds individual dignity and promotes transparency and fairness in resource allocation; although, by resisting any decision that might reduce patients to means for systemic ends, it struggles to accommodate the increasing pressures and complex realities of an overstretched healthcare system. Principlism, by contrast, seeks to balance competing ethical principles (autonomy, beneficence, non-maleficence, and justice) but it remains implausible that all can be upheld equally, often leading to uncertainty over which principle should take precedence in practice in real-time. 

     This tension is especially visible when a patient exercises their autonomous right to refuse treatment in a corridor setting, while a physician’s moral duty of beneficence justifies immediate intervention to prevent harm or worsening prognosis. A real-world scenario might involve elderly or religious patients declining corridor care due to lack of privacy, modesty or gender-specific care requirements. For instance, a female Muslim patient may refuse examination by a male physician in a public corridor and choose to wait until a more appropriate setting becomes available. Here, the attending physician is confronted with an ethical negotiation: respect the patient’s autonomy and risk harm through inaction or prioritise beneficence and intervene against her expressed wishes. 

     In such cases, practical wisdom, or phronesis, classically defined by Aristotle as knowledge of what is good and what is bad, guides action. A broader contemporary interpretation of phronesis is the ability to make ethically sound judgements cultivated through experience over time. Thus, the intersection of clinical and ethical decision-making in corridor care relies less on rigid adherence to any single framework and more on the moral discernment and learned experience of physicians acting in real-time. In this light, one might posit that every decision made was informed by the culmination of all past decisions. However, even as we acknowledge the role of moral reasoning, one might question whether physicians have yet fully navigated the complex ethical terrain necessary to reach a competent decision within the scope of corridor care.

 

Moving Forward: Beyond Ethical Considerations

 

     By unpacking the conflicting ethical principles of corridor care, we gain deeper insight into the tensions at its core and with it, the hope of one day eliminating the need for such practices altogether. Until then, we must reconcile the imminent threats of corridor care and call upon urgent governmental intervention to enact real-time change. Advocating for increased staffing, funding and investment into the healthcare system is essential to limit our reliance of corridors or other makeshift spaces and ensure a fair distribution of resources without subjecting physicians to greater moral distress. Potential strategies such as establishing designated escalation wards or same-day care units might help divert and manage overflow patients from corridors more safely and alleviate pressures on emergency departments and healthcare staff. 

However, any solution must be grounded in ethical resilience, distributive justice and individualised care. Attempts to reduce corridor care cannot prioritise efficiency at the expense of the prima facie principles and rights of individual patients. Only through such ethically considerate, patient-centred system reforms can corridor care be truly mitigated and help shape a morally accountable and sustainable healthcare system of tomorrow.