Ethical Challenges Arising in the COVID-19 Pandemic: An Overview from the Association of Bioethics Program Directors (ABPD) Task Force

McGuire, Amy L.; Aulisio, Mark P.; Davis, F. Daniel; Erwin, Cheryl; Harter, Thomas D.; Jagsi, Reshma; Klitzman, Robert; Macauley, Robert; Racine, Éric; Wolf, Susan M.; Wynia, Matthew K.; Wolpe, Paul Root

doi:10.1080/15265161.2020.1764138

Cited by 122 publications

(122 citation statements)

References 34 publications

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“…22 The latter point is particularly salient for the current pandemic and its disproportionate impact on minority communities. 15 For example, African Americans often report greater mistrust of the healthcare system due to historical experiences of abuse and suboptimal care. Although medical mistrust contributes to lower rates of health-seeking behaviours and preventive measures, it conversely correlates with higher rates of emergency department utilisation.…”

Section: Hcw Prioritisation May Exacerbate Mistrustmentioning

confidence: 99%

“…Definitionally, reciprocity refers to a societal duty to provide HCWs with certain privileges in recognition that they have assumed great risk in serving the greater good. 15 Narrow social utility refers to the instrumental value of an individual that is relevant and specific to the public health emergency at hand. 4 It is surprising that the analysed triage policies do not ground or consider HCW prioritisation in terms of the five most common framing ethical principles and occasionally ignore some altogether.…”

Section: Trustworthiness Through Consistency: the 'Ethics Framework'mentioning

confidence: 99%

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Mistrust and inconsistency during COVID-19: considerations for resource allocation guidelines that prioritise healthcare workers

Cheung

Parent

2020

J Med Ethics

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As the USA contends with another surge in COVID-19 cases, hospitals may soon need to answer the unresolved question of who lives and dies when ventilator demand exceeds supply. Although most triage policies in the USA have seemingly converged on the use of clinical need and benefit as primary criteria for prioritisation, significant differences exist between institutions in how to assign priority to patients with identical medical prognoses: the so-called ‘tie-breaker’ situations. In particular, one’s status as a frontline healthcare worker (HCW) has been a proposed criterion for prioritisation in the event of a tie. This article outlines two major grounds for reconsidering HCW prioritisation. The first recognises trust as an indispensable element of clinical care and mistrust as a hindrance to any public health strategy against the virus, thus raising concerns about the outward appearance of favouritism. The second considers the ways in which proponents of HCW prioritisation deviate from the very ‘ethics frameworks’ that often preface triage policies and serve to guide resource allocation—a rhetorical strategy that may undermine the very ethical foundations on which triage policies stand. By appealing to trust and consistency, we re-examine existing arguments in favour of HCW prioritisation and provide a more tenable justification for adjudicating on tie-breaker events during crisis standards of care.

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Section: Hcw Prioritisation May Exacerbate Mistrustmentioning

confidence: 99%

Section: Trustworthiness Through Consistency: the 'Ethics Framework'mentioning

confidence: 99%

Mistrust and inconsistency during COVID-19: considerations for resource allocation guidelines that prioritise healthcare workers

Cheung

Parent

2020

J Med Ethics

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“…The physician decides which patient may likely die or lives, which patient should be connected to the ventilator, which is in short supply worldwide. Allocation of these scares medical resources must be done fairly and with justice [16,34]. This has created a high ethical dilemma which intensivists have to deal with [35].…”

Section: Coronavirus-2019 (Covid-19) Testingmentioning

confidence: 99%

Medical Ethics

Buowari¹,

Kanmodi²

2021

Bioethics in Medicine and Society

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Medical ethics is very important at this time of medicine due to the covid-19 pandemic which has caused a lot of mortality and morbidity world wide. Medical is important in guiding clinicians and other healthcare workers not to cause harm while caring out their duties. There are various aspects of medical ethics such as negligence, do not cause harm, beneficent and others. Not practicing medical ethics has caused some physicians to face litigation by their patients and clients and also face medical disciplinary boards. Some have even been suspended from medical practice for a number of months or years or even have their names struck off from the register of the licensing board of their country.

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“…A second question is whether benefit could be maximized by making an exception to the rule of prioritizing institutional treatment protocols to instead prioritize individual PAA requests from front-line health care workers (Chen et al 2020;DeJong et al 2020;Emanuel et al 2020;Jecker et al 2020;McGuire et al 2020;Sokol and Gray 2020). These workers have experienced disproportionately high rates of infection with the novel coronavirus (CDC 2020a), which in turn prevents them from providing medical care to COVID-19 patients (and others).…”

Section: Maximizing Benefitmentioning

confidence: 99%

Ethically Allocating COVID-19 Drugs Via Pre-approval Access and Emergency Use Authorization

Webb

Shah

Lynch

2020

The American Journal of Bioethics

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Allocating access to unapproved COVID-19 drugs available via Pre-Approval Access pathways or Emergency Use Authorization raises unique challenges at the intersection of clinical care and research. In conditions of scarcity, prioritization approaches should minimize harm, maximize benefit, and promote fairness. To promote continued data collection, patients seeking access to unproven COVID-19 drugs should receive lower priority for allocation when they decline to participate in clinical trials, either of the requested drug or other investigational products, offering a comparable balance of risks and benefits; special attention should be paid to concerns of voluntariness and distrust. In addition, institutional treatment protocols that can contribute more robust real world data should be preferred to single patient requests for access, with priority for inclusion based on traditional clinical allocation criteria relying on available evidence. Fairness demands distribution of these protocols across a diverse range of sites, particularly those serving marginalized populations, among other protections.

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Ethical Challenges Arising in the COVID-19 Pandemic: An Overview from the Association of Bioethics Program Directors (ABPD) Task Force

Cited by 122 publications

References 34 publications

Mistrust and inconsistency during COVID-19: considerations for resource allocation guidelines that prioritise healthcare workers

Mistrust and inconsistency during COVID-19: considerations for resource allocation guidelines that prioritise healthcare workers

Medical Ethics

Ethically Allocating COVID-19 Drugs Via Pre-approval Access and Emergency Use Authorization

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