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J Med Ethics ; 2022 Aug 19.
Article in English | MEDLINE | ID: covidwho-2322878


The COVID-19 pandemic has exacerbated the drug poisoning epidemic in a number of ways: individuals use alone more often, there is decreased access to harm reduction services and there has been an increase in the toxicity of the unregulated drug supply. In response to the crisis, clinicians, policy makers and people who use drugs have been seeking ways to prevent the worst harms of unregulated opioid use. One prominent idea is safe supply. One form of safe supply enlists clinicians to prescribe opioids so that people have access to drugs of known composition and strength. In this paper, we assess the ethical case for clinicians providing this service. As we describe, there is much that is unknown about safe supply. However, given the seriousness of the overdose death epidemic and the current limited evidence for safe supply's efficacy, we argue that it is ethically permissible for clinicians to begin prescribing opioids for some select patients.

Healthc Manage Forum ; 34(6): 353-356, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1440872


Resource allocation under non-emergency conditions is often challenging. Within the context of a Public Health Emergency (PHE), allocation decisions become significantly more difficult as decisions are often necessary on very short timelines, where relevant information (either evidence or information "on the ground") is changing or incomplete, there is significant potential for harm, and resources are scarce, in unpredictable supply, and likely in high demand. An intentional value-based decision-making approach in such circumstances can clarify the values that ought to guide decisions, offering transparency and consistency, among other benefits. We use the example of vaccine allocation during the COVID-19 pandemic to explore value-based decision-making within a PHE context. We describe several core values that are relevant to PHE decision-making and outline their implications for approaches to vaccine allocation. While we focus on vaccine allocation, the values discussed are relevant to other system-level decisions in both emergency and non-emergency situations. Tips for leaders wishing to adopt a value-based approach to decision-making are offered.

COVID-19 , Public Health , Humans , Pandemics , Resource Allocation , SARS-CoV-2