Reflections on COVID-19 and the ethical issues for healthcare providers

Abstract

PurposeHealthcare governance places medical ethics at the forefront of defining and maintaining the quality of care. Examples of serious ethical issues include sexual abuse of patients (Dubois, Walsh, Chibnall et al., 2017), criminal prescription of opioids (Johnson, 2019) and unnecessary surgical procedures (Tayade and Dalvi, 2016) or shortages in service delivery because of little knowledge or experience especially during pandemic outbreaks (Hay-David et al., 2020). In many cases involving medical ethics, patients are identified as the first victims; however, this study aimed to consider clinicians and other healthcare practitioners as other probable victims (Ozeke et al., 2019).Design/methodology/approachThe World Health Organization (WHO) estimates that tens of millions of patients worldwide suffer disabling injuries or death every year due to unsafe medical practices and services. Nearly, one in ten patients is harmed due to preventable causes while receiving health care in well-funded and technologically advanced hospital settings (WHO, 2016). Much less is known about the burden of unsafe care in non-hospital settings, where most healthcare services are delivered (Jha et al., 2013). Furthermore, there is little evidence concerning the burden of unsafe care in developing countries, where the risk of harm to patients is likely to be greater, due to limitations in infrastructure, technologies and human resources (Elmontsri et al., 2018).FindingsWhile these problems are endemic in health care, they are exacerbated in times of health and social crises such as the coronavirus disease of 2019 (COVID-19) pandemic. This pandemic has few precedents, being most closely paralleled with the global influenza pandemic of 1918 (Terry, 2020). Initially compared to the severe acute respiratory syndrome (SARS) outbreak of 2002–2003 (Parrym, 2003), COVID-19 is already proving much more deadly. The WHO’s estimates of the number of SARS cases from the start of the outbreak in 2002, until it was brought under control in July 2003, was 8,437 cumulative cases, with 813 deaths (WHO, 2003). The European Center for disease prevention and Control estimated that as of May 15, 2020, that 4,405,680 cases of COVID-19 have been reported with 302,115 deaths (ECDC, 2020)Research limitations/implicationsThe outbreak of COVID-19 was declared in February 2020 in the Islamic Republic of Iran, and up to March 2020, the cases of morbidity reached 12,729, with 611 deaths (Bedasht, 2020). The current figure at the time of editing (May 16, 2020) is 118,392 cases, with 6,937 deaths (Worldometer, 2020). Acting in cognizance of its ethical responsibility to the citizens of Iran, the Iranian government has taken the following action to attempt to mitigate the deleterious effects of the virus: in each province, one or more hospitals have been evacuated and allocated to patients with pulmonary problems with suspected to COVID-19. Access to intensive care units and specialist equipment is a primary ethical issue that concerns the Iranian healthcare system. The issue is exacerbated by the knowledge that these facilities are not distributed equitably in the country. Therefore, equity is the first ethical concern in this situation.Practical implicationsAll nurses, clinicians, practitioners and specialists have been asked to volunteer their services in hospitals in the most infected areas. This raises ethical concerns about access to personal protective equipment (PPE) such as appropriate masks, gowns, gloves and other equipment to protect healthcare workers from infection. Access to PPE was restricted because of government failure to stockpile the necessary amount of disposable medical equipment. This was related to lack of domestic capacity to produce the equipment and problems accessing it internationally due to political-economic sanctions that were imposed on Iran by the USA and some European countries. Such shortages can quickly lead to a catastrophic situation; current evidence demonstrates that about 40% of healthcare workers are vulnerable to the COVID-19 infection (Behdasht, 2020). However, it should be noted that this is not a problem limited to Iran. As of March 2020, the WHO was already warning about PPE shortages and the dangers this posed for healthcare workers around the world (WHO, 2020).Social implicationsA Disaster Committee was created by the Iranian Ministry of Health to take responsibility for decision-making and daily information sharing to the community. The ethical dilemma that arises in terms of reporting the situation is the conflict between transparently presenting accurate and timely information and the creation of public panic and fear that this may cause in the community.Originality/valueAs a steward for public health, the Ministry of Health was afforded direct responsibility to maintain intra-sector relationships and leadership with other organizations such as political executive organizations, municipalities, military agencies, schools, universities and other public organizations to reach consensus on the best methods of controlling the COVID-19 outbreak. An important ethical issue is found in potential areas of conflict between the therapeutic and preventive roles of the Ministry of Health and those related to public health and the civil administrations.

The Impact of Covid-19 on Islamic Economics and Finance Industry: Text Analytics using R

“…In everyday life, the word "Covid" is relatively closely related to the virus that is currently rampant in Indonesia. Research conducted on Covid and Islamic Economics is related to "Economics during Global Recession: Sharia-Economics as a Post Covid-19 Agenda" (Arfah, 2020), "The World Economy and Islamic Economics in the Time of Covid-19" (Benamraoui, 2021), "Reflections on Covid-19, and the ethical issues for healthcare providers" (Bastani, 2020) and "Islamic economics and Covid-19: The economic, social and scientific consequences of a global pandemic" (Choudhury, 2021).…”

Rethinking occupational welfare policies in long-term care organisations during the COVID-19 pandemic: an organisational ethics approach

“…Nonetheless, in contrast to other organisations, Fondazione Marangoni could not implement remote working methods for high-level employees because of the nature of their job, which required direct interaction with patients. For this reason, safety measures were accompanied by qualified training programs and by specific OWPs to support employees who were directly affected by the disruptions generated by COVID-19 (Bastani et al, 2020).…”

The Impact of Covid-19 on Islamic Economics & Finance Industry

“…This pandemic has created unexpected changes in every aspect of human life (Nicomedes & Avila 2020). As causing thousands of deaths worldwide (WHO, 2020), the ongoing financial burden on all countries (Barbier & Burgess 2020;Edwards 2020;Sahoo & Ashwani 2020;Zou, Huo & Li 2020), lowering economic confidence (Yang & Xin 2020), and increasing economic anxiety at the individual level (Mann, Krueger, & Vohs 2020). From a microeconomic perspective, the performance of cross-sectoral companies has also been impacted by COVID-19, where most countries have witnessed deteriorating profits (Fu & Shen 2020).…”