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J Med Ethics ; 47(2): 69-72, 2021 02.
Article in English | MEDLINE | ID: covidwho-852703


Healthcare policies developed during the COVID-19 pandemic to safeguard community health have the potential to disadvantage women in three areas. First, protocols for deferral of elective surgery may assign a lower priority to important reproductive outcomes. Second, policies regarding the prevention and treatment of COVID-19 may not capture the complexity of the considerations related to pregnancy. Third, policies formulated to reduce infectious exposure inadvertently may increase disparities in maternal health outcomes and rates of violence towards women. In this commentary, we outline these challenges unique to women's healthcare in a pandemic, provide preliminary recommendations and identify areas for further exploration and refinement of policy.

COVID-19 , Delivery of Health Care/ethics , Health Policy , Pandemics , Social Justice , Women's Health/ethics , Women's Rights/ethics , COVID-19/prevention & control , Ethics, Clinical , Female , Gender-Based Violence , Health Status Disparities , Humans , Maternal Health Services/ethics , Pregnancy , Pregnancy Complications/prevention & control , Public Health , SARS-CoV-2
Pediatrics ; 146(1)2020 07.
Article in English | MEDLINE | ID: covidwho-203500


The coronavirus disease 2019 pandemic has affected nearly every aspect of medicine and raises numerous moral dilemmas for clinicians. Foremost of these quandaries is how to delineate and implement crisis standards of care and, specifically, how to consider how health care resources should be distributed in times of shortage. We review basic principles of disaster planning and resource stewardship with ethical relevance for this and future public health crises, explore the role of illness severity scoring systems and their limitations and potential contribution to health disparities, and consider the role for exceptionally resource-intensive interventions. We also review the philosophical and practical underpinnings of crisis standards of care and describe historical approaches to scarce resource allocation to offer analysis and guidance for pediatric clinicians. Particular attention is given to the impact on children of this endeavor. Although few children have required hospitalization for symptomatic infection, children nonetheless have the potential to be profoundly affected by the strain on the health care system imposed by the pandemic and should be considered prospectively in resource allocation frameworks.

Betacoronavirus , Pandemics/ethics , Pediatrics/ethics , Resource Allocation/ethics , COVID-19 , Child , Coronavirus Infections/therapy , Delivery of Health Care/ethics , Delivery of Health Care/methods , Humans , Pediatrics/methods , Pneumonia, Viral/therapy , Resource Allocation/methods , SARS-CoV-2