by Kate Jackson-Meyer, Ph.D.
Policy makers, hospitals, and health care professionals are facing, or are likely to face, excruciating ethical decisions about resource allocation and risk calculation due to the COVID-19 pandemic and medical supply shortages. Emphasizing the principle of proportionality in resource allocation can help to correct for the shortcomings and limits of the maximizing approach, which is the dominant approach being put forward.
A limited number of life-saving ventilators means that decisions will have to be made about who receives ventilators and who does not. Due to a limited availability of masks and personal protective equipment (PPE), health care workers take on risks of virus transmission when they treat COVID-19 patients or suspected COVID-19 patients. …
This editorial presented by the American Journal of Bioethics. You can see the April 2020 issue by clicking here.
by Emily Shearer & David Magnus
In their article, “The ‘Ought-Is Problem:’ An Implementation Science Framework for Translating Ethical Norms into Practice,” Sisk et al. correctly draw a distinction between aspirational norms (“broad claims that are easily agreed upon”–e.g. “Everyone should have their goals of care met at the end of life”)–and specific norms (claims that provide “direct guidance” about specific actions that should ensue–e.g. “Doctors should complete Advance Health Care Directives with every patient to ascertain their goals of care for the end of life”).…
Presented in conjunction with the American Journal of Bioethics. You can see the April 2020 issue by clicking here.
by Nanette Elster & Kayhan Parsi
We live in a representative democracy. We presumably have the franchise to elect who will represent our interests. Moreover, we live in a society with a range of organizations that advocate for certain causes and represent the interests of a variety of stakeholders. The autism “community” is no different. Yet, no monolithic set of interests represents all the members of the autism community. A great deal of heterogeneity exists, among stakeholders and among representatives of those interests.…
Presented courtesy of the American Journal of Bioethics. You can see the April 2020 issue by clicking here.
by Jordan P. Richardson & Richard R. Sharp
Patient advocacy organizations emerged in the 1950s to collectivize patient power and promote patient’s shared interests and rights. Since that time, patient advocacy organizations have grown in number and influence, filling an assortment of roles that include increasing public awareness, providing support to patients and families, building community, and advocating for research. It is their role in political activism that McCoy et al. consider in this issue of the Journal, offering an analysis of the autism community and a divide that has emerged between self-advocates and parent-advocates.…
by Amal Cheema
“When pestilence prevails, it is [a physician’s] duty to face the danger, and to continue their labors for the alleviation of suffering, even at the jeopardy of their own lives.” Baker, R., A. Caplan et al. 1999
The COVID-19 pandemic has changed the course and experience of medical training for thousands of students. Many, if not all, medical schools have moved classes entirely online, postponing anatomy labs and clinical skills classes. Heeding the guidance of the Association of American Medical Colleges, allopathic schools have canceled all rotations. Our professors, mentors, and healthcare professionals are at the frontlines, serving their communities and defending against a healthcare system collapse.…
by Nicki Reno-Welt, PA-C, MSHS, MFA
I am distraught about Covid-19. But not just for all the valid reasons we hear about on the news.
I am a 45-year-old, licensed, board-certified physician assistant. I have spent my entire career working with the underserved. I have studied bioethics and health care rationing in times of catastrophe. I am a professor in a PA program dedicated to teaching students to care for the underserved. In hindsight, my entire life has been preparatory work for this pandemic. I am the perfect person to combat this virus on the front lines of the most vulnerable.…
by Amy C. Reese, MBe, PharmD
This country is in the midst of a health crisis. These past few weeks have reminded me of the ingrained duty that each healthcare professional has to patients. We take an oath to provide care and protect our patients when we are inaugurated into the profession of our chosen healthcare field. I am a pharmacist who currently works in the community; as such, I am the most accessible healthcare professional (I am considered a provider in some states). I was reminded of my duty to each patient this week because the crisis poured into community pharmacies.…
Bioethics.net and the American Journal of Bioethics have assembled a bioethics toolkit for people dealing with COVID-19.
We have a collection of important blogs from around the internet that you can find here. We also highly recommending our growing catalog of our original blog posts by leading scholars writing on bioethics in pandemics.
Other compendium resources
- The Hastings Center has assembled a number of reports and resources.
- Thomas Cunningham at Kaiser-Permanent has put together a comprehensive resource of academic articles, government plans, and allocation frameworks.
- AMA COVID-19 Ethics Resource Center
For the best scientific information:
- Centers for Disease Control & Prevention
- World Health Organization
- Johns Hopkins University Global Case Counter
- Epidemiology on COVID
For ethical Guidelines for Responding to Crisis:
- Nuffield Council on Ethics Policy Papers
- Ireland’s Ethical Framwork for Decision-Making in a Pandemic
- UNESCO: Ethical Considerations from a Global Perspective
- Illinois Ethics Framework Crisis Standards of Care White Paper
- Maryland Framework for Public Health Emergency 2017
- AMA Code of Medical Ethics: Guidance in a Pandemic
- Ethical Guidance for Leaders and Health Care Professionals in the VA
For plans on triage:
- Italian Guidelines for Distributing Resource Scarcity
- Swiss Academy of Medical Sciences Pandemic Triage Under Scarcity Guidelines
- From NEJM: Fair Allocation of Scarce Medical Resources in the Time of COVID-19
- State of Minnesota guidance for triaging scared resources
- State of Texas Pandemic Resource Allocation Plan
- Papdimos, Hardart, Stawicki.
by Stephen P. Wood, MS, ACNP-BC
I haven’t had this question from a patient yet, but I know it’s coming. The information disseminated by us, to us and for us is a bit conflicting when it comes to COVID-19, the disease caused by the novel virus SARS-CoV-2. We saw a similar trend with the SARS outbreak in 2003, MERS in 2012 and one of the most devastating Ebola outbreaks in 2014. Especially with SARS and MERS, we knew little about these viruses, their transmission, incubation or natural course. Even Ebola, a disease first identified in 1976, raised questions about the appropriate level of protection As a result, the recommendations for personal protection equipment (PPE) and hygiene was evolving in real-time, with several changes throughout the course of these epidemics.…
by Charlene Sathi, HBSc, MS and Lydia Dugdale, MD, MAR
When sailors used to become sick at sea, their mates had to decide whether to throw them overboard or isolate them below deck until they could find help in harbor towns.
The crew of the Grand Princess cruise ship, recently stranded with COVID-19 off California’s coast, didn’t face decisions this stark. But the ship certainly met with resistance in port and the governmental response further muddied the waters, leaving thousands of individuals anxiously floating miles from American soil, without answers. If the Grand Princess fiasco teaches us anything, it’s that we need ethical guidance for the care of quarantined individuals on cruise ships.…