A Theoretical Framework for Ethical Decision-Making During Public Health Emergencies

Abstract

The new theoretical ethical framework is a general frame or tool for ethical agents, developed to guide ethical reasoning during public health emergency preparedness and response. The TEF is based on the assumption that no existing ethical discourse in medical ethics alone is sufficient to address ethical issues of a PHE. The solutions suggested by existing approaches are limited in practicability and effectiveness, because they cannot address root problems and interplay among ethical problems. The reason for this insufficiency rests on the argument that ethical problems of PHEs have causal and reciprocal relationships, and any ethical decision-making framework should provide a wide enough perspective to consider relevant ethical norms and theories to suggest practical, implementable, coherent solutions compatible with the communal values and cultural norms. The TEF we suggest for PHEs embraces a holistic and integrated ethical perspective that enables us to comprehend that ethical problems that arise in various settings caused by PHE phenomena are in relationship with each other instead of addressing them as a standalone problem. The TEF provides decision-makers to achieve a coherent web of considered judgements compatible with ethical values and principles in various settings. This type of conceptualization offers a wide perspective to see causal and relational relationships among problems and produce outcomes that would not be possible by eclectic approaches.

Ethical Decision Making in Disaster and Emergency Management: A Systematic Review of the Literature

“… 15 The work of Ekmekci and Folayan was influenced by the impacts of the coronavirus disease 2019/COVID-19 pandemic to improve decision-making practices; the proposed framework would benefit from evaluation and testing in the context of an all hazards approach. 16 Similarly, Knebel, et al proposed a decision-making process for government leadership in allocation of resources in disaster and developed a logic model utilizing a values-based framework. 17 A focused investigation of ethical decision making of EMS in Iran undertaken by Torabi, et al revealed themes of maintaining patient dignity and respect and regulation-based actions as key tenets guiding EMS decision making.…”

A dialog on common morality in medical ethics in a pluralist setting in Iran: a qualitative content analysis

“…Some scholars claim that the neutrality of moral agents and freedom from bias are unrealistic ideals that may make the CM theory less practical ( 11 ). When the CM theory is introduced to normative issues, problems with coherence and practicality arise because the CM theory ignores the role of the moral agent who interprets and applies the principles.…”

“…The wide reflective equilibrium approach facilitates the examination of the solutions to ethical problems by integrating basic ethical principles with the ethical paradigm of the context in which they arise; the role and competence of the moral agent are also effective in this approach. Some scholars claim that the neutrality of moral agents and freedom from bias are unrealistic ideals that may make the CM theory less practical (11).…”