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by Asma Fazal, M.B.B.S, MRCPI, MHSc

 

To care for children in the neonatal intensive care unit (NICU) and the pediatric intensive care unit (PICU) is not easy because in addition to having an emotionally charged environment with high morbidity and mortality, it has a patient population who is not autonomous. Caring for these children in a highly tense environment requires difficult decision-making, which can be ethically challenging at times. These ethical challenges may arise, and vary from lack of interprofessional collaboration, conflicts in values regarding what is the right thing to do in the clinical context, to inter-professional disputes between physicians and other healthcare professionals which leads to moral distress.

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Widespread corruption and racism in Mexico created extra hurdles for the development of Mexico’s recently published federal guidelines for deciding who gets to access scarce medical resources (e.g. ventilators in the case of Covid-19). Dr César Palacios-González (Oxford), who helped develop these guidelines,  talks about these challenges.

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by Father Marcin Ferdynus

The COVID-19 pandemic is unprecedented in scope and beyond anything we have ever experienced. A global plague of unparalleled proportions resulting in health, economic, social and religious consequences, the pandemic has revealed deficiencies in global and domestic health institutions and systems. Countries around the world have faced the difficult task of caring for the health of citizens and securing their basic needs. Many European Union countries as well as public health institutions failed in the first phase of the pandemic. Nevertheless, some governments, such as the Polish government, have taken swift and decisive action to limit the spread of the virus.

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George Floyd could not breathe while his neck was trapped under the knee of a police officer for nearly nine minutes. Yet despite the impressive scholarship of bioethics on ventilation and other technologies that prolong human breathing capabilities, it is largely silent on the suffocating effects of racism. Bioethics must speak out against racial injustice.

The post Bioethics and Black Lives: A Call for Bioethics to Speak Against Racial Injustice appeared first on The Hastings Center.

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by Mathias Wirth, Ph.D.; Laurèl Rauschenbach, MD; Brian Hurwitz, MA, MSc, MD, FRCP, FRCGP; Heinz-Peter Schmiedebach, MD; Jennifer A. Herdt, Ph.D

Although the number of severely ill people is declining in some epicenters, there is a risk of a second wave of COVID-19 infection with a large number of patients who are likely to require ventilation or other forms of intensive care. In the current state of the pandemic, second-wave scenario planning should give consideration to alternatives to triage. The shortage of ventilators showed that despite the existence of triage guidelines, moral questions remain. Care ethics suggest that considerations of justice offer incomplete responses to moral dilemmas.…

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by Dalia M. Feltman, MD, MA and Craig Klugman, Ph.D.

Our country is polarized to a breaking point on too many issues.  Black vs. white.  Liberal vs. Conservative.  Documented vs. undocumented.  Haves vs. Have-Nots. Politics have perversely crept into all areas of life, even into matters of health and pandemic response such as wearing a mask and access to a ventilator. In public health ethics, we know that some communities have the determinants necessary to live healthy lives–safe neighborhoods and built environments, economic stability, good quality education, strong communities, and access to health–but many do not, a difference often divided on racial and ethnic lines thanks to redlining and other urban policies.

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A brand new multi-society statement provides guidance on how to make decisions for incapacitated patients without surrogates. This statement builds off a series of articles in which I assess the law (or lack of it) on this problem. Last week, mountain...

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Karen Wyatt interviews Fred Mirarchi at the End of Life University about improving advance directives by using video technology.

Mirarchi is an emergency medicine physician and the principal investigator of the TRIAD Research Series (The Realistic Interpretation of Advance Directives). He discusses how his research has confirmed that there is a nationwide patient safety risk due to confusion surrounding living wills, DNR and POLST orders. 

Wyatt and Mirarchi also discuss MIDEO, a video advance directive and physician’s medical order that improves both the quality and safety of advance care planning. I have also recently written about the advantage of supplementing advance directives with videos.


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by Anne Zimmerman, JD, candidate MS (Bioethics)

At first it seemed like violence in the US had subsided during the pandemic. Outrage over police violence against unarmed black men was shelved while COVID-19 news took over the internet and cable news. The current civil outrage is evidence that violence against unarmed black men carries on concurrently with COVID-19’s economic and physical devastation that hurts the poor and the darker-skinned disproportionately. The causes are the same: The economic and physical effects of COVID-19 and police violence are caused by structural inequality.

The social determinants of health feed the most common comorbidities that make COVID-19 more severe: high blood pressure, obesity, and heart disease.…

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By Daniela Vargas As a public health nurse, I work in reproductive justice, prenatal and postpartum care at a Federally Qualified Health Center (FQHC) in San Francisco. I am aware that my job comes with a high responsibility as I am assessing for social and structural determinants of health as women begin their prenatal care. […]

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