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2.
Camb Q Healthc Ethics ; 30(2): 390-402, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33764294

RESUMEN

The coronavirus disease (COVID-19) crisis provoked an organizational ethics dilemma: how to develop ethical pandemic policy while upholding our organizational mission to deliver relationship- and patient-centered care. Tasked with producing a recommendation about whether healthcare workers and essential personnel should receive priority access to limited medical resources during the pandemic, the bioethics department and survey and interview methodologists at our institution implemented a deliberative approach that included the perspectives of healthcare professionals and patient stakeholders in the policy development process. Involving the community more, not less, during a crisis required balancing the need to act quickly to garner stakeholder perspectives, uncertainty about the extent and duration of the pandemic, and disagreement among ethicists about the most ethically supportable way to allocate scarce resources. This article explains the process undertaken to garner stakeholder input as it relates to organizational ethics, recounts the stakeholder perspectives shared and how they informed the triage policy developed, and offers suggestions for how other organizations may integrate stakeholder involvement in ethical decision-making as well as directions for future research and public health work.


Asunto(s)
Ética Institucional , Personal de Salud , Participación del Paciente , Formulación de Políticas , Asignación de Recursos/ética , Actitud del Personal de Salud , Asignación de Recursos para la Atención de Salud/ética , Humanos , Política Organizacional , Triaje/ética
3.
J Clin Ethics ; 32(1): 73-76, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33656459

RESUMEN

During the COVID-19 pandemic, the number of patients who require intensive care treatment may outnumber the number of intensive care beds, even in industrialized nations. Consequently, triage may become necessary. In Italy, France, and Spain, age has been used as a leading parameter to decide who is admitted to the intensive care unit, and who receives palliative care. Although age is an objective and easy-to-use parameter, it is ethically not ideal to withdraw ventilator therapy from elderly people who suffer from COVID-19. We have developed a simple and easy-to-use scoring system to allow for triage that is based upon scientific outcome data and, at the same time, fulfills ethical standards.


Asunto(s)
Ocupación de Camas , Asignación de Recursos para la Atención de Salud/ética , Unidades de Cuidados Intensivos , Pandemias , Triaje/ética , Anciano , Francia , Capacidad de Camas en Hospitales , Humanos , Italia , España , Triaje/métodos
5.
Kennedy Inst Ethics J ; 31(1): 53-76, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33716227

RESUMEN

Several ethicists have defended the use of responsibility-based criteria in healthcare rationing. Yet in this article we outline two challenges to the implementation of responsibility-based healthcare rationing policies. These two challenges are, namely, that responsibility for past behavior can diminish as an agent changes, and that blame can come apart from responsibility. These challenges suggest that it is more difficult to hold someone responsible for health related actions than proponents of responsibility-sensitive healthcare policies suggest. We close by discussing public health policies that could function as an alternative to contentious, responsibility-sensitive rationing policies.


Asunto(s)
Asignación de Recursos para la Atención de Salud/ética , Política de Salud , Justicia Social , Responsabilidad Social , Humanos , Principios Morales
6.
Recenti Prog Med ; 112(3): 167-170, 2021 03.
Artículo en Italiano | MEDLINE | ID: mdl-33687352

RESUMEN

For covid-19, a disease that has proved fatal in many cases, a specific therapy has not yet been found, but the vaccine. This has triggered a further series of issues. Who to vaccinate first, how to achieve the so-called "herd immunity", especially if it is right, as it is being done, start with the medical staff and immediately after safeguard the elderly which also involve the problem of a clear explanation and acceptance, through informed consent, which it can be particularly difficult to illustrate.


Asunto(s)
/prevención & control , Asignación de Recursos para la Atención de Salud , /inmunología , Anciano , Asignación de Recursos para la Atención de Salud/ética , Asignación de Recursos para la Atención de Salud/normas , Personal de Salud , Prioridades en Salud , Necesidades y Demandas de Servicios de Salud , Derechos Humanos , Humanos , Inmunidad Colectiva , Exposición Profesional , Derecho a la Salud , Justicia Social , Vacunación
9.
BMC Med Ethics ; 22(1): 28, 2021 03 22.
Artículo en Inglés | MEDLINE | ID: mdl-33752662

RESUMEN

BACKGROUND: The worsening COVID-19 pandemic in South Africa poses multiple challenges for clinical decision making in the context of already-scarce ICU resources. Data from national government and the last published national audit of ICU resources indicate gross shortages. While the Critical Care Society of Southern Africa (CCSSA) guidelines provide a comprehensive guideline for triage in the face of overwhelmed ICU resources, such decisions present massive ethical and moral dilemmas for triage teams. It is therefore important for the health system to provide clinicians and critical care facilities with as much support and resources as possible in the face of impending pandemic demand. Following a discussion of the ethical considerations and potential challenges in applying the CCSSA guidelines, the authors propose a framework for regional triage committees adapted to the South African context. DISCUSSION: Beyond the national CCSSA guidelines, the clinician has many additional ethical and clinical considerations. No single ethical approach to decision-making is sufficient, instead one which considers multiple contextual factors is necessary. Scores such as the Clinical Frailty Score and Sequential Organ Failure Assessment are of limited use in patients with COVID-19. Furthermore, the clinician is fully justified in withdrawing ICU care based on medical futility decisions and to reallocate this resource to a patient with a better prognosis. However, these decisions bear heavy emotional and moral burden compounded by the volume of clinical work and a fear of litigation. CONCLUSION: We propose the formation of Provincial multi-disciplinary Critical Care Triage Committees to alleviate the emotional, moral and legal burden on individual ICU teams and co-ordinate inter-facility collaboration using an adapted framework. The committee would provide an impartial, broader and ethically-sound viewpoint which has time to consider broader contextual factors such as adjusting rationing criteria according to different levels of pandemic demand and the latest clinical evidence. Their functioning will be strengthened by direct feedback to national level and accountability to a national monitoring committee. The potential applications of these committees are far-reaching and have the potential to enable a more effective COVID-19 health systems response in South Africa.


Asunto(s)
Cuidados Críticos/ética , Toma de Decisiones/ética , Asignación de Recursos para la Atención de Salud/ética , Unidades de Cuidados Intensivos , Pandemias , Triaje/métodos , Conducta Cooperativa , Emociones , Ética Médica , Recursos en Salud , Humanos , Inutilidad Médica , Pronóstico , Sudáfrica , Triaje/ética
10.
PLoS One ; 16(2): e0246320, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33529237

RESUMEN

Emerging infectious diseases such as Ebola Virus Disease (EVD), Nipah Virus Encephalitis and Lassa fever pose significant epidemic threats. Responses to emerging infectious disease outbreaks frequently occur in resource-constrained regions and under high pressure to quickly contain the outbreak prior to potential spread. As seen in the 2020 EVD outbreaks in the Democratic Republic of Congo and the current COVID-19 pandemic, there is a continued need to evaluate and address the ethical challenges that arise in the high stakes environment of an emerging infectious disease outbreak response. The research presented here provides analysis of the ethical challenges with regard to allocation of limited resources, particularly experimental therapeutics, using the 2013-2016 EVD outbreak in West Africa as a case study. In-depth semi-structured interviews were conducted with senior healthcare personnel (n = 16) from international humanitarian aid organizations intimately engaged in the 2013-2016 EVD outbreak response in West Africa. Interviews were recorded in private setting, transcribed, and iteratively coded using grounded theory methodology. A majority of respondents indicated a clear propensity to adopt an ethical framework of guiding principles for international responses to emerging infectious disease outbreaks. Respondents agreed that prioritization of frontline workers' access to experimental therapeutics was warranted based on a principle of reciprocity. There was widespread acceptance of adaptive trial designs and greater trial transparency in providing access to experimental therapeutics. Many respondents also emphasized the importance of community engagement in limited resource allocation scheme design and culturally appropriate informed consent procedures. The study results inform a potential ethical framework of guiding principles based on the interview participants' insights to be adopted by international response organizations and their healthcare workers in the face of allocating limited resources such as experimental therapeutics in future emerging infectious disease outbreaks to ease the moral burden of individual healthcare providers.


Asunto(s)
Enfermedades Transmisibles Emergentes/terapia , Brotes de Enfermedades/ética , Asignación de Recursos para la Atención de Salud/ética , Fiebre Hemorrágica Ebola/terapia , Ensayos Clínicos Adaptativos como Asunto/ética , Adulto , África Occidental/epidemiología , Femenino , Personal de Salud/ética , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Terapias en Investigación/ética
15.
Hastings Cent Rep ; 51(1): 16-22, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33486774

RESUMEN

Ethical issues around triage have been at the forefront of debates during the Covid-19 pandemic. This essay compares both discussion and guidelines around triage and the reality of what happened in the United States and in Europe, both in anticipation of and during the first wave of the pandemic. Why did the issue generate so many vivid debates in the United States and so few in most European countries, although the latter were also affected by the rationing of health care resources? Are countries with socialized health care systems better equipped to face the hard choices of triaging? Important lessons in transparency, trust, and accountability for policy-makers can be drawn from this comparison, demonstrating that fostering public involvement and ethical debate remains a critical element for the sustained acceptance of any triage plan.


Asunto(s)
/terapia , Triaje/ética , Confianza , Europa (Continente) , Asignación de Recursos para la Atención de Salud/ética , Asignación de Recursos para la Atención de Salud/métodos , Humanos , Triaje/métodos , Estados Unidos
16.
J Med Ethics ; 47(2): 108-112, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33335068

RESUMEN

One prominent view in recent literature on resource allocation is Persad, Emanuel and Wertheimer's complete lives framework for the rationing of lifesaving healthcare interventions (CLF). CLF states that we should prioritise the needs of individuals who have had less opportunity to experience the events that characterise a complete life. Persad et al argue that their system is the product of a successful process of reflective equilibrium-a philosophical methodology whereby theories, principles and considered judgements are balanced with each other and revised until we achieve an acceptable coherence between our various beliefs. Yet I argue that many of the principles and intuitions underpinning CLF conflict with each other, and that Persad et al have failed to achieve an acceptable coherence between them. I focus on three tensions in particular: the conflict between the youngest first principle and Persad et al's investment refinement; the conflict between current medical need and a concern for lifetime equality; and the tension between adopting an objective measure of complete lives and accommodating for differences in life narratives.


Asunto(s)
Toma de Decisiones/ética , Ética Clínica , Asignación de Recursos para la Atención de Salud/ética , Equidad en Salud/ética , Justicia Social , Triaje/ética , Prestación de Atención de Salud/ética , Análisis Ético , Prioridades en Salud/ética , Estado de Salud , Humanos , Principios Morales
17.
Semergen ; 47(2): 122-130, 2021 Mar.
Artículo en Español | MEDLINE | ID: mdl-33358090

RESUMEN

Public health emergencies, such as the current SARS-CoV-2 coronavirus pandemic, have led to tragic resource constraints that prevent lives from being saved. This has led to tensions in patient-centered care as the backbone of the system in normal conditions and the same care in emergencies originating in the COVID-19. In this review we address some of the healthcare, organizational and ethical problems that this scenario has caused in primary care such as: cancellation of programmed activities; scarce home care and follow-up of elderly, chronically ill and immobilized patients; shortage of PPE and the exposure to risk of healthcare professionals, and finally the problems associated with telemedicine and telephone attention to patients.


Asunto(s)
/prevención & control , Asignación de Recursos para la Atención de Salud/ética , Accesibilidad a los Servicios de Salud/ética , Control de Infecciones/métodos , Atención Primaria de Salud/ética , Telemedicina/ética , /epidemiología , Asignación de Recursos para la Atención de Salud/métodos , Asignación de Recursos para la Atención de Salud/organización & administración , Accesibilidad a los Servicios de Salud/organización & administración , Servicios de Salud para Ancianos/ética , Servicios de Salud para Ancianos/organización & administración , Humanos , Control de Infecciones/instrumentación , Control de Infecciones/organización & administración , Pandemias , Equipo de Protección Personal/provisión & distribución , Atención Primaria de Salud/métodos , Atención Primaria de Salud/organización & administración , Calidad de la Atención de Salud/ética , Calidad de la Atención de Salud/organización & administración , España/epidemiología , Telemedicina/métodos , Telemedicina/organización & administración
19.
Health Commun ; 36(1): 116-123, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33191801

RESUMEN

Communication plays a critical role in all stages of a pandemic. From the moment it is officially declared governments and public health organizations aim to inform the public about the risk from the disease and to encourage people to adopt mitigation practices. The purpose of this article is to call attention to the multiple types and the complexity of ethical challenges in COVID-19 communication. Different types of ethical issues in COVID-19 communication are presented in four main sections. The first deals with ethical issues in informing the public about the risk of the pandemic and dilemmas regarding communicating uncertainty, using threats and scare tactics, and framing the pandemic as a war. The second concerns unintended consequences that relate to increasing inequities, stigmatization, ageism, and delaying medical care. The third raises ethical issues in communicating about specific mitigation practices: contact tracing, wearing face masks, spatial (also referred to as social) distancing, and handwashing or sanitizing. The fourth concerns appealing to positive social values associated with solidarity and personal responsibility, and ethical challenges when using these appeals. The article concludes with a list of practical implications and the importance of identifying ethical concerns, which necessitate interdisciplinary knowledge, cross-disciplinary collaborations, public discourse and advocacy.


Asunto(s)
/epidemiología , Control de Enfermedades Transmisibles/métodos , Comunicación en Salud/ética , Administración en Salud Pública/ética , Ageísmo/psicología , Asignación de Recursos para la Atención de Salud/ética , Asignación de Recursos para la Atención de Salud/organización & administración , Humanos , Pandemias , Medición de Riesgo , Estereotipo , Incertidumbre
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