How Much Is One Life Worth? The Right to Equity Healthcare for Improving Older Patients’ Health Infected by COVID-19

Merodio, Guiomar; Ramis, Mimar; Errazu, Diana Valero; Aubert, Adriana

doi:10.3390/su12176848

Cited by 20 publications

(24 citation statements)

References 25 publications

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“…The greatest morbidity and mortality from the pandemic has been in older patients. However, there has been ethical controversy about suggestions of rationing intensive care treatment on the basis of age, and proposals to do so in Italy at the height of the initial wave of the pandemic attracted considerable ethical criticism [ 40 , 41 ]. One important question is whether simple age-based cut-offs can be justified for ECMO allocation.…”

Section: Discussionmentioning

confidence: 99%

Ethical factors determining ECMO allocation during the COVID-19 pandemic

et al. 2021

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Background ECMO is a particularly scarce resource during the COVID-19 pandemic. Its allocation involves ethical considerations that may be different to usual times. There is limited pre-pandemic literature on the ethical factors that ECMO physicians consider during ECMO allocation. During the pandemic, there has been relatively little professional guidance specifically relating to ethics and ECMO allocation; although there has been active ethical debate about allocation of other critical care resources. We report the results of a small international exploratory survey of ECMO clinicians’ views on different patient factors in ECMO decision-making prior to and during the COVID-19 pandemic. We then outline current ethical decision procedures and recommendations for rationing life-sustaining treatment during the COVID-19 pandemic, and examine the extent to which current guidelines for ECMO allocation (and reported practice) adhere to these ethical guidelines and recommendations. Methods An online survey was performed with responses recorded between mid May and mid August 2020. Participants (n = 48) were sourced from the ECMOCard study group—an international group of experts (n = 120) taking part in a prospective international study of ECMO and intensive care for patients during the COVID-19 pandemic. The survey compared the extent to which certain ethical factors involved in ECMO resource allocation were considered prior to and during the pandemic. Results When initiating ECMO during the pandemic, compared to usual times, participants reported giving more ethical weight to the benefit of ECMO to other patients not yet admitted as opposed to those already receiving ECMO, (p < 0.001). If a full unit were referred a good candidate for ECMO, participants were more likely during the pandemic to consider discontinuing ECMO from a current patient with low chance of survival (53% during pandemic vs. 33% prior p = 0.002). If the clinical team recommends that ECMO should cease, but family do not agree, the majority of participants indicated that they would continue treatment, both in usual circumstances (67%) and during the pandemic (56%). Conclusions We found differences during the COVID-19 pandemic in prioritisation of several ethical factors in the context of ECMO allocation. The ethical principles prioritised by survey participants were largely consistent with ECMO allocation guidelines, current ethical decision procedures and recommendations for allocation of life-sustaining treatment during the COVID-19 pandemic.

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Section: Discussionmentioning

confidence: 99%

Ethical factors determining ECMO allocation during the COVID-19 pandemic

et al. 2021

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“…2 This is especially true in the post-Covid-19 era, which has brought unprecedented threats to the viability of health and social care systems across the world. 3,4 Such challenges are heralding a ‘new normality’ in health care, which calls for a revised managerial approach and for innovative leadership skills to steer health care organizations towards greater effectiveness and increased sustainability in a time of turbulence and uncertainty. 5…”

Section: Introductionmentioning

confidence: 99%

Leading through the ‘new normality’ of health care

Lega

Palumbo

2021

Health Serv Manage Res

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Health care institutions are witnessing a ‘new normality’, which profoundly reshapes the strategic and management challenges faced by health professionals in their attempt to achieve excellence in the design and delivery of care. This ‘new normality’ triggers a transformation of conventional managing models and leadership styles, which have proved to be unfit with the changed attributes of the external and internal contexts of health care organizations. The ‘new normal’ leadership style relies on the ability of leaders to make sense out of the new challenges that are faced by health care organizations and on their capability to act managerially, sticking to an empowering approach which enables followers. However, the transformation of conventional leadership style is impossible if a rethinking of training activities and learning experiences delivered to health professionals is missing. The article provides an overview of the issues that health leaders and managers encounter in the ‘new normality’ of health care, identifying several unanswered questions which should be addressed to thrive in the changed landscape of health services’ delivery.

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“…However, there is a lack of research concerning elderly travelers and other vulnerable groups. In particular, the outbreak of COVID-19 has affected the elderly population much more severely than the younger demographic [ 19 ]. Most of the elderly population mainly rely on public transport (i.e., subways and buses) for daily movement [ 20 , 21 ].…”

Section: Introductionmentioning

confidence: 99%

Examining Public Concerns and Attitudes toward Unfair Events Involving Elderly Travelers during the COVID-19 Pandemic Using Weibo Data

Liu

et al. 2021

IJERPH

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The Chinese government has launched a digital health code system to detect people potentially exposed to the coronavirus 2019 (COVID-19) disease and to curb its spread. Citizens are required to show the health code on their smartphones when using public transport. However, many seniors are not allowed to use public transport due to their difficulties in obtaining health codes, leading to widespread debates about these unfair events. Traditionally, public perceptions and attitudes toward such unfair events are investigated using analytical methods based on interviews or questionnaires. This study crawled seven-month messages from Sina Weibo, the Chinese version of Twitter, and developed a hybrid approach integrating term-frequency–inverse-document-frequency, latent Dirichlet allocation, and sentiment classification. Results indicate that a rumor about the unfair treatment of elderly travelers triggered public concerns. Primary subjects of concern were the status quo of elderly travelers, the provision of transport services, and unfair event descriptions. Following the government’s responses, people still had negative attitudes toward transport services, while they became more positive about the status quo of elderly travelers. These findings will guide government authorities to explore new forms of automated social control and to improve transport policies in terms of equity and fairness in future pandemics.

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How Much Is One Life Worth? The Right to Equity Healthcare for Improving Older Patients’ Health Infected by COVID-19

Cited by 20 publications

References 25 publications

Ethical factors determining ECMO allocation during the COVID-19 pandemic

Ethical factors determining ECMO allocation during the COVID-19 pandemic

Leading through the ‘new normality’ of health care

Examining Public Concerns and Attitudes toward Unfair Events Involving Elderly Travelers during the COVID-19 Pandemic Using Weibo Data

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