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1.
PLoS One ; 16(2): e0246320, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33529237

RESUMO

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.


Assuntos
Doenças Transmissíveis Emergentes/terapia , Surtos de Doenças/ética , Alocação de Recursos para a Atenção à Saúde/ética , Doença pelo Vírus Ebola/terapia , Ensaios Clínicos Adaptados como Assunto/ética , Adulto , África Ocidental/epidemiologia , Feminino , Pessoal de Saúde/ética , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Terapias em Estudo/ética
4.
Bioethics ; 35(2): 125-134, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33325536

RESUMO

In March 2020, the rapid increase in severe COVID-19 cases overwhelmed the healthcare systems in several European countries. The capacities for artificial ventilation in intensive care units were too scarce to care for patients with acute respiratory disorder connected to the disease. Several professional associations published COVID-19 triage recommendations in an extremely short time: in 21 days between March 6 and March 27. In this article, we compare recommendations from five European countries, which combine medical and ethical reflections on this situation in some detail. Our aim is to provide a detailed overview on the ethical elements of the recommendations, the differences between them and their coherence. In more general terms we want to identify shortcomings in regard to a common European response to the current situation.


Assuntos
/terapia , Alocação de Recursos para a Atenção à Saúde , Padrão de Cuidado/ética , Triagem/ética , Fatores Etários , Europa (Continente)/epidemiologia , Pessoal de Saúde/ética , Pessoal de Saúde/psicologia , Prioridades em Saúde , Hospitalização , Direitos Humanos , Humanos , Unidades de Terapia Intensiva/ética , Guias de Prática Clínica como Assunto , Resultado do Tratamento , Ventiladores Mecânicos/provisão & distribução , Suspensão de Tratamento/ética
5.
J Infect Dev Ctries ; 14(9): 968-970, 2020 09 30.
Artigo em Inglês | MEDLINE | ID: mdl-33031082

RESUMO

The COVID-19 pandemic has created new challenges on multiple fronts including a few ethical concerns. Timely and appropriate access to health services and the need to protect vulnerable people are some of them. An important aspect to consider, at the global level, is the frailty of health systems in many developing countries and the constant threat of these collapsing due to shortage of resources and medical supply. Special attention should be placed towards protecting the health of care workers who are highly exposed to SARS-CoV-2 infection. Research and clinical trials involving COVID-19 patients and healthy human volunteers must be done in strict adherence to the fundamental principles of bioethics, even if finding a solution is an urgent need. Shared responsibility must be assumed as we collectively face a common problem and ethical conflicts must be resolved using, as reference, the guidelines developed by the World Health Organization and other relevant international and national organizations. This would allow responsible action in the face of the pandemic without harming human rights, the individual and collective well-being.


Assuntos
Betacoronavirus , Saúde Global/ética , Pandemias/ética , Ensaios Clínicos como Assunto/ética , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Países em Desenvolvimento , Pessoal de Saúde/ética , Disparidades em Assistência à Saúde/ética , Direitos Humanos/ética , Humanos , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Triagem/ética
6.
S Afr Med J ; 110(6): 450-452, 2020 05 14.
Artigo em Inglês | MEDLINE | ID: mdl-32880548

RESUMO

It is likely that the SARS-CoV-2 pandemic will affect a large part of the world's population and will last for several years. Many critical ethical issues have arisen in the healthcare context. While response from healthcare professionals to participating in the care of patients in the era of COVID-19 has generally been positive, there have also been disturbing experiences on the ground. The practice of medicine is a social contract with humanity. Challenges have arisen because the patient is both a victim and a vector of the coronavirus. All humans should have a natural instinct to care for those in need. Ethically and legally, healthcare professionals cannot be expected to assume a significant and unreasonable risk of harm. While fear is understandable, altruism and interest in serving the sick exemplify the value of solidarity. Social harms like stigmatisation and discrimination can occur. Concerns have been raised regarding protection of privacy and respect for rights of infected individuals. In the era of COVID-19, fear, misinformation and a detachment from one's calling put professionalism strongly to the test.


Assuntos
Infecções por Coronavirus/terapia , Assistência à Saúde/organização & administração , Pessoal de Saúde/organização & administração , Pneumonia Viral/terapia , Altruísmo , Infecções por Coronavirus/epidemiologia , Assistência à Saúde/ética , Pessoal de Saúde/ética , Humanos , Pandemias/ética , Pneumonia Viral/epidemiologia , Profissionalismo
11.
PLoS One ; 15(7): e0235509, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32663206

RESUMO

BACKGROUND: Healthcare professionals (HCPs), patients and families are often faced with ethical dilemmas. The role of healthcare ethics committees (HECs) is to offer support in these situations. AIM: The primary objective was to study how often HCPs encounter ethical dilemmas. The secondary objective was to identify the main types of ethical dilemmas encountered and how HCPs solve them. SUBJECTS AND METHODS: We conducted a cross-sectional, survey-based study among HCPs in 14 Slovenian hospitals. A questionnaire was designed and validated by HCPs who were selected by proportional stratified sampling. Data collection took place between April 2015 and April 2016. RESULTS: The final sample size was n = 485 (385 or 79.4%, female). The response rates for HCPs working in secondary and tertiary level institutions were 45% and 51%, respectively. Three hundred and forty (70.4%) of 485 HCPs (very) frequently encountered ethical dilemmas. Frequent ethical dilemmas were waiting periods for diagnostics or treatment, suboptimal working conditions due to poor interpersonal relations on the ward, preserving patients' dignity, and relations between HCPs and patients. Physicians and nurses working in secondary level institutions, compared to their colleagues working in tertiary level institutions, more frequently encountered ethical dilemmas with respect to preserving patients' dignity, protecting patients' information, and relations between HCPs and patients. In terms of solutions, all HCPs most frequently discussed ethical dilemmas with co-workers (colleagues), and with the head of the department. According to HCPs, the most important role of HECs is staff education, followed by improving communication, and reviewing difficult ethical cases. CONCLUSIONS: Waiting periods for diagnostics and treatment and suboptimal working conditions due to poor interpersonal relations are considered to be among the most important ethical issues by HCPs in Slovenian hospitals. The most important role of HECs is staff education, improving communication, and reviewing difficult ethical cases.


Assuntos
Pessoal de Saúde/ética , Inquéritos e Questionários , Adulto , Estudos Transversais , Feminino , Hospitais/estatística & dados numéricos , Humanos , Masculino , Eslovênia
12.
BMC Med Ethics ; 21(1): 60, 2020 07 15.
Artigo em Inglês | MEDLINE | ID: mdl-32664908

RESUMO

BACKGROUND: As the COVID-19 (coronavirus) pandemic develops, healthcare professionals are looking for support with, and guidance to inform, the difficult decisions they face. In the (current) absence of an authoritative national steer in England, professional bodies and local organisations have been developing and disseminating their own ethical guidance. Questions inevitably arise, some of which are particularly pressing during the pandemic, as events are unfolding quickly and the field is becoming crowded. My central question here is: which professional ethical guidance should the professional follow? MAIN BODY: Adopting a working definition of "professional ethical guidance", I offer three domains for a healthcare professional to consider, and some associated questions to ask, when determining whether - in relation to any guidance document - they should "bin it or pin it". First, the professional should consider the source of the guidance: is the issuing body authoritative or, if not, at least sufficiently influential that its guidance should be followed? Second, the professional should consider the applicability of the guidance, ascertaining whether the guidance is available and, if so, whether it is pertinent. Pertinence has various dimensions, including whether the guidance applies to this professional, this patient and/or this setting, whether it is up-to-date, and whether the guidance addresses the situation the professional is facing. Third, the professional should consider the methodology and methods by which the guidance was produced. Although the substantive quality of the guidance is important, so too are the methods by which it was produced. Here, the professional should ask whether the guidance is sufficiently inclusive - in terms of who has prepared it and who contributed to its development - and whether it was rigorously developed, and thus utilised appropriate processes, principles and evidence. CONCLUSION: Asking and answering such questions may be challenging, particularly during a pandemic. Furthermore, guidance will not do all the work: professionals will still need to exercise their judgment in deciding what is best in the individual case, whether or not this concerns COVID-19. But such judgments can and should be informed (and constrained) by guidance, and hopefully these preliminary observations will provide some useful pointers for time-pressed professionals.


Assuntos
Infecções por Coronavirus , Ética Médica , Pessoal de Saúde/ética , Pandemias , Pneumonia Viral , Guias de Prática Clínica como Assunto , Betacoronavirus , Códigos de Ética , Pesquisa sobre Serviços de Saúde , Humanos , Pandemias/ética
13.
Rev. bioét. derecho ; (49): 125-139, jul. 2020.
Artigo em Inglês | IBECS | ID: ibc-192098

RESUMO

Promoting measures that aim to mitigate discrepancies in the decision-making process, ensuring adequate training of physicians in the ethical aspect of care, and incrementing the wellbeing of patients and their families are becoming the principal objectives for high-quality care, especially in the Intensive Medicine Unit (ICU). In this paper, we're going to deal with the implementation of a specific ethics support for the ICU health care professionals, and considering the advanced Spanish experience on this matter, it deals with the current potentialities and limits of CEC's role to improve the quality of health care assistance


Promover medidas que tengan como objetivo mitigar las discrepancias en el proceso de toma de decisiones, garantizar la capacitación adecuada de los médicos en el aspecto ético de la atención e incrementar el bienestar de los pacientes y sus familias se están convirtiendo en los objetivos principales para una atención de alta calidad, especialmente en Medicina Intensiva. En este artículo abordaremos la implementación de un apoyo ético específico para los profesionales de la salud de la UCI. Teniendo en cuenta la amplia experiencia española en este tema, nos centraremos en el potencial y los límites actuales del rol del CEA para mejorar la calidad de asistencia sanitaria


Promoure mesures que tinguin com a objectiu mitigar els discrepàncies en el procés de presa de decisions, garantir la capacitació adequada dels metges respecte a l'aspecte ètic de l'atenció I incrementar el benestar dels pacients I els seves families s'estan convertint en els objectius principals per a una atenció de qualitat, especialment a Medicina Intensiva. En aquest article abordarem la implementació d'un soport ètic específic per a professionals de la salut de l'UCI. Tenint en compte l'àmplia experiència espanyola en aquest tema, ens centrarem en el potencial I els límits actuals del rol del CEA per a millorar la qualitat de l'assistència sanitària


Assuntos
Humanos , Pessoal de Saúde/ética , Cuidados Críticos/ética , Comitê de Profissionais/ética , Tomada de Decisões/ética , Diretivas Antecipadas/ética , Unidades de Terapia Intensiva/ética , Diretivas Antecipadas/legislação & jurisprudência
15.
J Med Ethics ; 46(8): 495-498, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32522813

RESUMO

Key ethical challenges for healthcare workers arising from the COVID-19 pandemic are identified: isolation and social distancing, duty of care and fair access to treatment. The paper argues for a relational approach to ethics which includes solidarity, relational autonomy, duty, equity, trust and reciprocity as core values. The needs of the poor and socially disadvantaged are highlighted. Relational autonomy and solidarity are explored in relation to isolation and social distancing. Reciprocity is discussed with reference to healthcare workers' duty of care and its limits. Priority setting and access to treatment raise ethical issues of utility and equity. Difficult ethical dilemmas around triage, do not resuscitate decisions, and withholding and withdrawing treatment are discussed in the light of recently published guidelines. The paper concludes with the hope for a wider discussion of relational ethics and a glimpse of a future after the pandemic has subsided.


Assuntos
Tomada de Decisões/ética , Ética Clínica , Alocação de Recursos para a Atenção à Saúde/ética , Equidade em Saúde/ética , Pessoal de Saúde/ética , Pandemias/ética , Betacoronavirus , Infecções por Coronavirus/virologia , Planejamento em Desastres , Humanos , Obrigações Morais , Pneumonia Viral/virologia , Pobreza , Guias de Prática Clínica como Assunto , Relações Profissional-Paciente , Ordens quanto à Conduta (Ética Médica) , Valores Sociais , Triagem/ética , Populações Vulneráveis , Suspensão de Tratamento/ética
16.
Psychol Trauma ; 12(S1): S138-S140, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32496101

RESUMO

Although little is known about moral injury in nonmilitary populations, the COVID-19 pandemic has made it clear that moral injury's relevance extends beyond the battlefield. Health care providers are experiencing potentially morally injurious events that may violate their moral code or values, yet almost no research has been conducted on moral injury among health care providers to date. The purpose of this commentary is to describe the relevance of moral injury to health care providers and to spark a dialogue that motivates future research, prevention, and intervention. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


Assuntos
Infecções por Coronavirus , Pessoal de Saúde/ética , Pessoal de Saúde/psicologia , Doenças Profissionais/psicologia , Pandemias , Pneumonia Viral , Trauma Psicológico/psicologia , Triagem/ética , Adulto , Esgotamento Profissional/etiologia , Esgotamento Profissional/psicologia , Infecções por Coronavirus/psicologia , Infecções por Coronavirus/terapia , Humanos , Princípios Morais , Doenças Profissionais/etiologia , Pneumonia Viral/psicologia , Pneumonia Viral/terapia , Trauma Psicológico/etiologia , Transtornos de Estresse Pós-Traumáticos/etiologia , Transtornos de Estresse Pós-Traumáticos/psicologia
17.
Otolaryngol Head Neck Surg ; 163(4): 621-622, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32513064

RESUMO

The widespread, tragic loss of life and the dedication of health care professionals have characterized the severe acute respiratory syndrome coronavirus 2 pandemic. While we mourn the loss of so many Americans to this novel virus, we also much acknowledge the positive effects to our profession, which are not insignificant. We have witnessed our larger community of otolaryngologist-head and neck surgeons pulling together in a manner not heretofore observed by this author. From the local level of practitioners to our national societies, there has been an amazing effort of collegial unity to develop the most clinically relevant guidelines for providing patient care with maximal safety, in the face of little scientific knowledge or experience with this virus. In addition, we as a specialty and individual otolaryngologists have, through our shared experiences, raised the bar for empathy, ethics, and professional interaction during these difficult times. We must reflect upon our professional growth and capture this renewal of altruism that lives at the heart of our calling.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Empatia , Pessoal de Saúde/ética , Pandemias , Assistência ao Paciente/ética , Pneumonia Viral/epidemiologia , Humanos
18.
Neurology ; 95(6): 260-265, 2020 08 11.
Artigo em Inglês | MEDLINE | ID: mdl-32482844

RESUMO

The sudden appearance and proliferation of coronavirus disease 2019 has forced societies and governmental authorities across the world to confront the possibility of resource constraints when critical care facilities are overwhelmed by the sheer numbers of grievously ill patients. As governments and health care systems develop and update policies and guidelines regarding the allocation of resources, patients and families affected by chronic disabilities, including many neuromuscular disorders that affect children and young adults, have become alarmed at the possibility that they may be determined to have less favorable prognoses due to their underlying diagnoses and thus be assigned to lower priority groups. It is important for health care workers, policymakers, and government officials to be aware that the long-term prognoses for children and young adults with neuromuscular disorders are often more promising than previously believed due to a better understanding of the natural history of these diseases, benefits of multidisciplinary supportive care, and novel molecular therapies that can dramatically improve the disease course. Although the realities of a global pandemic have the potential to require a shift from our usual, highly individualistic standards of care to crisis standards of care, shifting priorities should nonetheless be informed by good facts. Resource allocation guidelines with the potential to affect children and young adults with neuromuscular disorders should take into account the known trajectory of acute respiratory illness in this population and rely primarily on contemporary long-term outcome data.


Assuntos
Betacoronavirus , Tomada de Decisão Clínica/ética , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Doenças Neuromusculares/diagnóstico , Doenças Neuromusculares/epidemiologia , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Criança , Tomada de Decisão Clínica/métodos , Infecções por Coronavirus/terapia , Pessoal de Saúde/ética , Humanos , Doenças Neuromusculares/terapia , Pandemias , Pneumonia Viral/terapia
19.
Hastings Cent Rep ; 50(3): 56-58, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32596904

RESUMO

The crisis of Covid-19 has forced us to notice two things: our human interdependence and American society's tolerance for what Nancy Krieger has called "inequalities embodied in health inequities," reflected in data on Covid-19 mortality and geographies. Care is integral to our recovery from this catastrophe and to the development of sustainable public health policies and practices that promote societal resilience and reduce the vulnerabilities of our citizens. Drawing on the insights of Joan Tronto and Eva Feder Kittay, we argue that the ethics of care offers a critical alternative to utilitarian and deontological approaches and provides a street-ready framework for integration into public health deliberations to anchor public policy and investments concerning the recovery and future well-being of America's citizens and society.


Assuntos
Temas Bioéticos , Infecções por Coronavirus/epidemiologia , Assistência à Saúde/ética , Pessoal de Saúde/ética , Pneumonia Viral/epidemiologia , Betacoronavirus , Humanos , Pandemias , Estados Unidos/epidemiologia
20.
J Med Ethics ; 46(7): 441-443, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32424060

RESUMO

The current COVID-19 pandemic has raised many questions and dilemmas for modern day ethicists and healthcare providers. Are physicians, nurses and other healthcare workers morally obligated to put themselves in harm's way and treat patients during a pandemic, occurring a great risk to themselves, their families and potentially to other patients? The issue was relevant during the 1918 influenza epidemic and more recently severe acute respiratory syndrome epidemic in 2003. Since the risk to the healthcare workers was great, there was tension between the ethical duty and responsibility to treat and the risk to one's own life. This tension was further noted during the 2014 Ebola outbreak in West Africa that left hundreds of healthcare workers dead. The AMA Code of Ethics states that physicians are to 'provide urgent medical care during disasters…even in the face of greater than usual risk to physicians' own safety, health or life.'1 Classic Jewish sources have dealt with this question as well. There is an obligation 'to not stand by idly when your friends life is in danger'; however, the question arises as to whether there are limits to this obligation? Is one required to risk one's own life to save another's? There is a consensus that one is not required but the question open to debate is whether it is praiseworthy to do so. However, regarding healthcare workers, there is agreement for ethical, professional and societal reasons that they are required to put themselves in harm's way to care for their patients.


Assuntos
Infecções por Coronavirus/epidemiologia , Pessoal de Saúde/ética , Judeus/psicologia , Judaísmo/psicologia , Pneumonia Viral/epidemiologia , Betacoronavirus , Humanos , Obrigações Morais , Pandemias , Medição de Risco
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