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by Kei Mukohara, MD, Ph.D., Tsunetoshi Mogi, MD

COVID-19 REGISRY JAPAN(COVIREGI-JP, its official website [In Japanese])is an ongoing government-funded national registry study conducted principally at the National Center for Global Health and Medicine in collaboration with Fujita Health University, Hokkaido University, National Institute of Infectious Diseases and pharmaceutical companies. To create a national registry, it is requesting participating institutions to provide clinical data on hospitalized patients with COVID-19. The study is enrolling patients retrospectively and prospectively from January 1, 2020 to January 31, 2021. One of its objectives is to investigate safety and effectiveness of experimental administration of various candidate medications for COVID-19 including favipiravir, lopinavir-ritonavir, interferons, neuraminidase inhibitors, remdesivir, and ciclesonide, all of which except remdesivir are not yet approved for use in patients with COVID-19 in Japan.…

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by Amy C. Reese, Pharm.D.

My pharmacy received a prescription for prednisolone solution written for a 5-year-old patient. We only had the manufacturer of prednisolone with 5% alcohol in it as a solvent. I did not want to deny the child medication, but I was hesitant about giving medication with alcohol to a child because some people are strictly opposed to the practice of giving children alcohol. When the mother arrived at the pharmacy, I explained the situation to her and told her what her options were. She could chose to give her child the prednisolone with alcohol or she could abstain from picking up the prescription.…

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by Mario Picozzi, MD Ph.D., Federico Nicoli, Ph.D., Paolo Severgnini, MD

The Varese Hospital is located in northern Lombardy and has a total of 582 beds. Last April, 206 of these were dedicated to positive Covid19 patients and 47 were reserved for the Intensive Care Unit (ICU).

During the emergency, we have chosen to carry out triage with reference to the criterion of proportionality. This criterion considers both clinical indications and patient preferences, along with treatment costs. We have decided to use this criterion for two reasons: first of all, it actually allows a choice on a case-by-case basis, without falling into arbitrariness; in addition, it is respectful of both objective clinical criteria and the peculiarity of the patient.…

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by Christine Grady, RN Ph.D., and Connie Ulrich, Ph.D. RN FAAN

In Shakespeare’s Hamlet, Claudius famously notes “When sorrows come, they come not single spies, but in battalions.” Today, during the coronavirus pandemic, we are seeing and hearing “battalions” of sorrow reflected on the faces and in the voices of nurses and other healthcare workers, as well as from patients and families across the global community. Nurses and other healthcare workers are often working under grueling workplace conditions. They are physically and mentally exhausted from the complexity of care needs for COVID-19 patients, from staffing shortages, inadequate personal protective equipment (PPE), medicines, and life-sustaining technologies, from witnessing firsthand racial-based disparities, from being alone with dying patients without the support of patients’ families, anguishing over necessary but tragic ethical decisions, and harboring mistrust of a broken system that was meant to protect them.  …

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by Nicole Martinez-Martin, JD, PhD

Many organizations that are working to end police brutality (the #BlackBioethics Toolkit provides a list of many relevant resources) advise that just reforming police policy is insufficient to address police violence– there need to be sustained efforts for cities to restructure and reprioritize how social services and crime are addressed. ‘Defunding the police’ is a proposal focused on reallocating police funding towards people and services in marginalized communities. While the idea of “defunding police” can seem radical to some, many people have also been shocked in recent days as they realize the outsized budget portion that most cities’ police departments consume.…

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by R. Thomas DayBradley S. Guidry, Brian C. Drolet, Ellen W. Clayton

The United States has never experienced the grim realities of a resource-limited healthcare environment like that brought by Covid-19. Dire projections of overwhelmed ICUs introduced the public to novel concepts such as flattening the curve, triaging, and resource allocation. In response, hospitals and states moved quickly to update resource scarcity protocols to preserve ventilators and personal protective equipment.

Fortunately, massive public health efforts were able to slow viral spreading enough that medical systems were only overwhelmed in a few locations. Accordingly, scarcity protocols were not widely implemented.

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by Thomas D. Harter, PhD, Mary E. Homan, DrPH, MA, MSHCE

COVID-19’s emergence in the US has once again thrust the field of bioethics in the public spotlight. While many individual ethicists have been asked to opine on a variety of pandemic related issues, the general focus of bioethics conversations and concerns relate to the direct threat the pandemic poses to overwhelm the capacity of scarce, life-saving resources in acute care settings. Of primary concern is the possibility that shortages, and subsequently rationing, will occur, causing situations in which patients may be denied life-saving resources or having resources that were originally dedicated to a particular patient reallocated to another patient.…

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by Carlo Alfredo Clerici, MD, Tullio Proserpio, PhD, Costanza Raimondi, PhD candidate

The COVID pandemic has exposed us to our own fragility and has forced the entire world to confront a condition with no cure. We have all been forced to use ancient practices, such as isolation and quarantine, waiting for better, clearer solutions , while demonstrating renewed solidarity within communities. This in and of itself would be a great lesson for us all, but we must also look at how healthcare structures have responded to the crisis to see what experiences can be carried over as we go back to rebuilding our wounded society and medical system.…

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The #BlackBioethics Toolkit serves as a resource on articles about bioethics and race, specifically about African-Americans and Black People in the U.S.

Join us for our first-ever webinar on Black Bioethics, hosted by associate editor Kayhan Parsi, JD, Ph.D., featuring panelists Keisha Ray, Ph.D., Brian Williams, MD, Ruqaiijah Yearby, JD, MPH, and Patrick Smith, Ph.D., as they discuss racism, police brutality, and what it means for black health.

July 14, 2020 11am-12pm PST. Click here to register

 

 

General Resources

  • Campaign Zero – “analysis of policing practices across the country, research to identify effective solutions to end police violence, technical assistance to organizers leading police accountability campaigns and the development of model legislation and advocacy to end police violence nationwide
  • #8CantWaitIdeas to reduce police violence and reports on their adoption in different cities.

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by Craig Klugman, PhD, Kelly Michelson, MD, MPH, Kayhan Parsi, JD, PhD

In response to the COVID-19 pandemic, groups of regional ethicists have organized to better foster collaboration and dialogue in their cities and states.  Here in the Chicago metropolitan area, the COVID-19 Chicago Bioethics Coalition (CBC) was created on March 20, 2020, the same day Governor J.B. Pritzker announced the “shelter at home” order for the state of Illinois.  One of the authors (KM) organized the coalition to discuss the bioethical challenges of the current pandemic.  The CBC is comprised of over 50 bioethics experts from over a dozen Chicago-area institutions (and a few outside the region), including major academic medical centers, universities, and health systems.…

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