ABSTRACT
During the COVID-19 pandemic, Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions were made differently. This included more prominent roles for specialties such as psychiatry and doctors in training. Concerns about inappropriate DNAR decisions led to anxiety for doctors, patients and the public. Positive outcomes may have included earlier and better-quality end-of life-discussions. However, COVID-19 exposed the need for support, training and guidance in this area for all doctors. It also highlighted the importance of effective public education about advanced care planning.
Subject(s)
COVID-19 , Cardiopulmonary Resuscitation , Humans , Resuscitation Orders , Pandemics , Death , Decision MakingABSTRACT
Prisons represent sites of singular healthcare need-characterized by high levels of distress and disorder. In many jurisdictions, practitioners are ethically charged with delivering healthcare that is "equivalent" to that available in the wider community. This claim has been much debated-yet the emergence of a global coronavirus pandemic has highlighted the arguments in a particularly stark manner. In the following conceptual analysis, we explore the emergent discourse of the coronavirus and consider its particular significance for prison healthcare decision making and the concept of equivalence. For example, both the coronavirus pandemic and practice of prison incarceration induce a sense of varied temporality: The discourse of prison is replete in this area-such as the concept of "hard time." Alongside this, the discourse in relation to coronavirus has highlighted two competing modes of temporal understanding: The political-where the pandemic is conceptualized as has having a discrete "beginning and end", and the scientific-where the "new normal" reflects the incorporation of the "novel" coronavirus into the wider ecology. The impact of these disparate understandings on the prison population is complex: "Locking down" prisoners-to safeguard the vulnerable against infection-is relatively simple, yet it has traumatic repercussions with respect to liberty and psychosocial health. Easing lockdown, by contrast, is a difficult endeavor and risks collision between the temporalities of prison-where "hard time" is accentuated by separation from the "real world"-the political and the scientific. Whither then the concept of equivalence in relation to a field that is definitively non-equivalent? How can practitioners and policy makers maintain a just ethical stance in relation to the allocation of resources when it comes to a politically marginalized yet manifestly vulnerable population? We argue that further debate and consideration are required in this field-and propose a framework for such discussion.
Subject(s)
COVID-19 , Disease Transmission, Infectious/prevention & control , Infection Control , Prisons , Vaccination , COVID-19/mortality , COVID-19/prevention & control , England/epidemiology , Humans , Infection Control/methods , Infection Control/organization & administration , Infection Control/standards , Mortality , Needs Assessment , Organizational Innovation , Prisons/organization & administration , Prisons/statistics & numerical data , Risk Assessment , SARS-CoV-2 , Vaccination/methods , Vaccination/standards , Wales/epidemiologyABSTRACT
Telemedicine has become increasingly used by prison mental health services throughout the COVID-19 pandemic. In this editorial, we explore the benefits and risks of the remote provision of forensic mental healthcare, with consideration of the clinical, financial, ethical and legal consequences.
Subject(s)
COVID-19 , Delivery of Health Care , Prisons , Telemedicine , England , Health Services Accessibility , Humans , Pandemics , SARS-CoV-2ABSTRACT
Self-harm is a major international public health concern and is especially prevalent among prisoners. In this editorial, we explore recent trends in prisoner self-harm during the coronavirus lockdown, and consider strategies for improving the prevention and management of self-harm in prisons as we emerge from the pandemic.