Should age matter in COVID-19 triage? A deliberative study

The COVID-19 pandemic put a large burden on many healthcare systems, causing fears about resource scarcity and triage. Several COVID-19 guidelines included age as an explicit factor and practices of both triage and 'anticipatory triage' likely limited access to hospital care for elderly patients, especially those in care homes. To ensure the legitimacy of triage guidelines, which affect the public, it is important to engage the public's moral intuitions. Our study aimed to explore general public views in the UK on the role of age, and related factors like frailty and quality of life, in triage during the COVID-19 pandemic. We held online deliberative workshops with members of the general public (n = 22). Participants were guided through a deliberative process to maximise eliciting informed and considered preferences. Participants generally accepted the need for triage but strongly rejected 'fair innings' and 'life projects' principles as justifications for age-based allocation. They were also wary of the 'maximise life-years' principle, preferring to maximise the number of lives rather than life years saved. Although they did not arrive at a unified recommendation of one principle, a concern for three core principles and values eventually emerged: equality, efficiency and vulnerability. While these remain difficult to fully respect at once, they captured a considered, multifaceted consensus: utilitarian considerations of efficiency should be tempered with a concern for equality and vulnerability. This 'triad' of ethical principles may be a useful structure to guide ethical deliberation as societies negotiate the conflicting ethical demands of triage. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

A Contemporary Mohist Reflection on Bioethics in the Post-epidemic Era

In response to various ethical problems that emerged after the 1976 Ebola hemorrhagic fever epidemic, WHO published the book Guidance for Managing Ethical Issues in Infectious Disease Outbreaks in 2016. The content of the book was organized around seven ethical principles, namely, justice, beneficence, benefit, respect for autonomy, freedom, reciprocity, and unity. These seven ethical principles can be used as a framework for countries to develop policies for coping with the COVID-19 pandemic. Drawing from contemporary Mohism, this paper reflects on the situation in Taiwan through the lens of these seven ethical principles. It aims to arrive at a Mohist understanding of bioethics and proposes concrete actions for the post-epidemic era.

Ethical Aspects of the Guidelines for Medical Education for Students in their Clerkship Year at the Schulich School of Medicine and Dentistry During the COVID-19 Pandemic

Guidelines for clerkship training at one Canadian medical school - Western University's Schulich School of Medicine and Dentistry - did not state the ethical principles associated with the decision to suspend and eventually resume clinical training during the COVID-19 pandemic. The absence of stated ethical principles was notable considering the impact these decisions had on various stakeholders, and since ethics plays a large role in the practice of medicine. This study assessed these guidelines using an ethical lens approach to identify ethical principles and tensions implicit in the guidelines. Clerkship is defined as the third year of training at this medical school, which consists of clinical rotations. While ethical principles were not documented, it was hypothesized that these could be identified within the guidelines. A literature search was conducted, which yielded a gap in knowledge concerning ethical considerations of clerkship clinical training. The guidelines were analyzed and ethical principles and tensions between conflicting principles were identified. The most prevalent principles were beneficence and non-maleficence. It is recommended that in the future, the ethical principles associated with guidelines responding to significant issues affecting undergraduate medical education be stated, in order to increase transparency to all parties involved, enhance communication with students, and to serve as an example of how ethics is applied in a medical education setting. One limitation of this study was the use of internal guideline documents, which were circulated internally but are not published.

[Prioritization of health resources in contexts of scarcity. SESPAS Report 2022]. / Priorización de recursos sanitarios en contextos de escasez. Informe SESPAS 2022.

The COVID-19 pandemic has been a clinical challenge, but also a legal and bioethical one. These three fundamental pillars are developed in the approach to prioritizing health resources in pandemic, clinical criteria, corresponding legal framework and applicable ethical principles. Initially, clinical criteria were applied to identify patients with the best survival prognosis, combining a clinical evaluation and the use of short-term and long-term prognostic variables. But the decision to prioritize the care of one patient over another has a legal-political burden, which poses a risk of falling into discrimination since fundamental rights are at stake. The prioritization criteria must be based on principles that reflect as a vehicle philosophy that which we have constitutionally assumed as a social and democratic State of Law, which did not respond to utilitarianism but to personalism. Any philosophy of resource distribution must bear in mind the scientific and constitutional perspective and, with them, those of fundamental rights and bioethical principles. In the prioritization of resources, ethical principles must be consolidated such as respect for the human dignity, the principle of necessity (equal need, equal access to the resource), the principle of equity (which advises prioritizing the most vulnerable population groups), transparency (fundamental in society's trust) and the principle of reciprocity (which requires protecting the sectors of the population that take more risks), among others.

Attitudes of Yoga Practitioners Toward COVID-19 Virus Vaccination: A Cross-Sectional Survey in Germany.

To avoid severe courses of COVID-19 infections and reduce death rates, vaccination against the SARS-CoV-1 virus was considered an essential strategy in fighting the pandemic. However, some yoga practitioners reject such vaccinations and assume that their yoga practices protect them. We therefore aimed to analyze how many yoga practitioners were vaccinated, their reasons for being vaccinated, and the influence of the ethical principles of yoga (yamas/niyamas) on these decisions. In a cross-sectional survey in summer 2021, we enrolled 1,545 yoga practitioners (86% women; mean age 51.1 ± 10.9 y). The majority of participants were already vaccinated (66%), and their percentage corresponded to that of the general population. Those who were not willing to get vaccinated scored significantly higher on the yama/niyama factors Contentment/Self-Reflection/Devotion and Surrender and Non-Possessiveness. Depending on the centrality of the yamas/niyamas in their lives, yoga participants differed on their vaccination decisions, but they did not relevantly differ on their pro-social reasons (protection of groups at risk, protection of family) when they were already vaccinated. This assumed protection against severe courses of the COVID-19 infection was higher in the nonvaccinated compared to the vaccinated individuals (Cohen's d = 0.99). This conviction was related to the niyama factor Contentment/Self-Reflection/Devotion and Surrender. Thus, in the yoga schools and other places of yoga practice the relevance of vaccination to also protect others should be discussed, and the consequences of following the yamas and niyamas for the sake of others should be clarified.

A privacy-preserving dialogue system based on argumentation

Dialogue systems are a class of increasingly popular AI-based solutions to support timely and interactive communication with users in many domains. Due to the apparent possibility of users disclosing their sensitive data when interacting with such systems, ensuring that the systems follow the relevant laws, regulations, and ethical principles should be of primary concern. In this context, we discuss the main open points regarding these aspects and propose an approach grounded on a computational argumentation framework. Our approach ensures that user data are managed according to data minimization, purpose limitation, and integrity. Moreover, it is endowed with the capability of providing motivations for the system responses to offer transparency and explainability. We illustrate the architecture using as a case study a COVID-19 vaccine information system, discuss its theoretical properties, and evaluate it empirically. © 2022 The Author(s)

Ethical-Pandemic Discourse: Searching a Normative Language

Discussions of the seemingly never-ending COVID-19 coronavirus pandemic are mainly emotional. Although “truth of the heart” contained in them is existentially accurate and convincing, it is not sufficient for public and productive discourse focused on countering the pandemic. The pandemic situation is an emergency requiring extraordinary measures. As experience shows, in emergency, the authorities’ actions are often lead to unjustified restriction and even direct violation of civil liberties and rights. The discussion of the problems associated with the pandemic needs an adequate normative language. Meanwhile, the fight against the epidemics of viral diseases of recent decades prompted UNESCO and WHO in awareness of the danger of pandemics, to initiate normative documents that formulated principles defining the ethical priorities of the authorities’ policy in the field of health and public safety. The article specifies the main documents accepted by these organizations, as well as some others related to the issues under discussion and presents the most important ethical principles of activities aimed at preserving people’s health. It shows how normative ethics “works” in practice — what is its structure and what ensures the imperative effectiveness of primary moral values, how they are translated into operational attitudes of political and professional activity. Besides guidelines for decision makers and political coordinators, ethical documents are important for they provide the society with criteria for assessment of public authorities and other social agents in their efforts to counter the pandemic. They propose a normative language, using which the society, including media, can claim the authorities, referring to universal and approved by the international expert community ethical principles. © 2022, Russian Academy of Sciences. All rights reserved.

Ethical values and principles to guide the fair allocation of resources in response to a pandemic: a rapid systematic review.

BACKGROUND: The coronavirus 2019 pandemic placed unprecedented pressures on healthcare services and magnified ethical dilemmas related to how resources should be allocated. These resources include, among others, personal protective equipment, personnel, life-saving equipment, and vaccines. Decision-makers have therefore sought ethical decision-making tools so that resources are distributed both swiftly and equitably. To support the development of such a decision-making tool, a systematic review of the literature on relevant ethical values and principles was undertaken. The aim of this review was to identify ethical values and principles in the literature which relate to the equitable allocation of resources in response to an acute public health threat, such as a pandemic. METHODS: A rapid systematic review was conducted using MEDLINE, EMBASE, Google Scholar, LitCOVID and relevant reference lists. The time period of the search was January 2000 to 6th April 2020, and the search was restricted to human studies. January 2000 was selected as a start date as the aim was to capture ethical values and principles within acute public health threat situations. No restrictions were made with regard to language. Ethical values and principles were extracted and examined thematically. RESULTS: A total of 1,618 articles were identified. After screening and application of eligibility criteria, 169 papers were included in the thematic synthesis. The most commonly mentioned ethical values and principles were: Equity, reciprocity, transparency, justice, duty to care, liberty, utility, stewardship, trust and proportionality. In some cases, ethical principles were conflicting, for example, Protection of the Public from Harm and Liberty. CONCLUSIONS: Allocation of resources in response to acute public health threats is challenging and must be simultaneously guided by many ethical principles and values. Ethical decision-making strategies and the prioritisation of different principles and values needs to be discussed with the public in order to prepare for future public health threats. An evidence-based tool to guide decision-makers in making difficult decisions is required. The equitable allocation of resources in response to an acute public health threat is challenging, and many ethical principles may be applied simultaneously. An evidence-based tool to support difficult decisions would be helpful to guide decision-makers.

Community preferences for the allocation of scarce healthcare resources during the COVID-19 pandemic: a review of the literature.

OBJECTIVE: The purpose of this thematic review is to examine the literature on the publics' preferences of scarce medical resource allocation during COVID-19. STUDY DESIGN: Literature review. METHODS: A review of Ovid MEDLINE, Embase, CINAHL and Scopus was performed between December 2019 and June 2022 for eligible articles. RESULTS: Fifteen studies using three methodologies and spanning five continents were included. Five key themes were identified: (1) prioritise the youngest; (2) save the most lives; (3) egalitarian allocation approaches; (4) prioritise healthcare workers; and (5) bias against particular groups. The public gave high priority to allocation that saved the most lives, particularly to patients who are younger and healthcare workers. Themes present but not supported as broadly were giving priority to individuals with disabilities, high frailty or those with behaviours that may have contributed to their ill-health (e.g. smokers). Allocation involving egalitarian approaches received the least support among community members. CONCLUSION: The general public prefer rationing scarce medical resources in the COVID-19 pandemic based on saving the most lives and giving priority to the youngest and frontline healthcare workers rather than giving preference to patients with disabilities, frailty or perceived behaviours that may have contributed to their own ill-health. There is also little public support for allocation based on egalitarian strategies.

New Role of Bioethics in Emergency Situations on the Example of COVID-19.

The COVID-19 pandemic has dramatically changed existing norm perception both in medical practice and in society. In the context of limited resources and absence of a known treatment protocol, this change particularly affected healthcare system, doctors, and the distribution of a life-support therapy. One of the main bioethical dilemmas presented by coronavirus epidemic is the discrepancy between public health ethics, characterized by the fair distribution of limited resources and public safety orientation, and patient-specific clinical ethics. The COVID-19 pandemic forced health workers into tragic situations that they had never previously experienced, when lack of available health care workers, ventilators, or hospital beds creates a necessity to classify and prioritize patients to determine who will get (or will not get) what type of care and where. Another important issue is the digital control of citizens who must reduce their freedom for the sake of the health of other citizens. This caused great concern among many people, who fear that the current situation will lead to their manipulation in the future. There is also a question of responsibility among politicians and authorized organizations for the health of not only the population of their country, but also the entire planet. These and other current issues require bioethical expertise.

The Relationship between Prevention and Panic from COVID-19, Ethical Principles, Life Expectancy, Anxiety, Depression and Stress.

The present study aims to assess the relationship between prevention and panic from COVID-19, ethical principles, life expectancy, anxiety, depression, and stress in auditors and financial managers of small- and medium-sized Iraqi firms. In other words, this paper seeks to answer the question of whether different types of prevention and panic from COVID-19 can enhance the ethical principles, life expectancy, anxiety, depression, and stress, or not. The study method is practical in its objective and descriptive survey procedure. The study's statistical population includes 185 employed auditors in audit firms, and 215 financial managers of small- and medium-sized Iraqi firms were selected as a sample of the study using the Cochran Sampling Method. In this paper, PLS tests are used to assess the effect of independent variables on the dependent variable. The results indicate no significant relationship between prevention from COVID-19 and ethical principles and life expectancy. However, the association between prevention from COVID-19 and anxiety, depression, and stress, and between panic from COVID-19 and ethical principles, life expectancy, anxiety, depression, and stress is positive and significant. The higher the panic from COVID-19, the more ethical principles, life expectancy, anxiety, depression, and stress. Since no study has been carried out so far on the effect of prevention and panic from COVID-19, ethical principles, life expectancy, depression, and stress in Iraqi firms, the present study results can provide valuable information and contribute to the development of science and knowledge.

Class Exercises Involving Ethical Issues Reinforce the Importance and Reach of Biomedical Engineering (and the Impact of the Coronavirus on Teaching Strategy and Measures of Assessment)

This paper builds on the ethical aspects of an introductory engineering course - BR200 - an Introduction to Biomedical and Rehabilitation Engineering. Various details of this course have been presented at ASEE Conferences in 2011, 2019 and here in 20211,2,3 and elsewhere.4 The course structure was described in 2011;one ethical innovation (story-writing) in 2019;and here in 2021 the didactic changes needed to adapt to a partial or full online presence as the result of the COVID pandemic. This present paper focuses on the impact of the COVID-19 on the teaching strategy used to introduce and discuss medical engineering ethical issues within the class as it abruptly transitioned from face-to-face instruction to completely remote in Spring 2020 (S20), and as it reappeared as a hybrid course in Fall 2020 (F20) and Spring 2021 (S21). The focus of this present paper is not on the instructional changes required by COVID (and discussed in our companion paper), but rather on how those in turn changed the approach to the handling of ethical questions and to the assessments of students' responses to those scenarios. One hypothesis is whether the content or style of the pre-post scenario answers and of the reflections changed between an answer handwritten under time-pressure and one electronically captured with little time constraint. Did the answers or reflections measurably change if more time were to be allowed for consideration? Another hypothesis was that the ethical dilemmas presented increased students' integration and appreciation of the biomedical engineering field regardless of comment modality. Biomedical engineering ethics can certainly be taught face-to-face, in a hybrid setting or completely online - but how well? Did ethics instruction suffer depending on modality? Our conclusion seemed clear - It didn't matter especially if each method employed a blended learning management system like Moodle or other similar platforms. An instructor receives qualitative feedback in the classroom (i.e., a sense of how students are responding). Data from off-line grading of responses can be assessed and quantified. In sum, the major consideration brought about by a switch among in-person, online and hybrid instruction was how to handle the interactive, immersive ethical vignettes that the students were required to respond to, sometimes as an in-class exercise and sometimes as a post-lecture submission. That is a major focus of this paper. Ethical vignette assignments used in BR200 were authentic assignments,5,6 a term used to describe assignments that often focused on messy, complex real-world situations and their accompanying constraints. The concepts of authentic assessment and authentic teaching are also explored in this paper, especially as they relate to ethical scenarios and the student's grasp of ethical principles. Our results indicate that applying authentic assignments, assessments and teaching strategies to the teaching of ethical principles and practices might prove to be a beneficial adjunct to packaged ethical case studies. © American Society for Engineering Education, 2021

Resolution of ethical dilemmas using basic ethical principles in cases of pregnancy with severe symptoms of coronavirus disease 2019 complications

BACKGROUND: Coronavirus disease 2019 (COVID-19) can attack the entire population, but is more aggressive in vulnerable populations such as the elderly, patients with chronic diseases, and pregnant women. For pregnant women, the management of COVID-19 treatment provided must be in line with efforts to reduce maternal mortality. The method of this study was a case report. A pregnant woman aged 40 years who was confirmed with severe COVID-19 symptoms. This patient had severe symptomatic hypoxemia and had a hypercoagulable state. Termination of pregnancy in patients is considered for the sake of fetomaternal safety so that an ethical dilemma arises. For this reason, a joint conference was held to get the best solution for the patient and the fetus. CASE REPORT: Using several basic ethical principles such as beneficence, nonmaleficence, justice, and autonomy, which are supported by the principles of minus malum, double effect, and prima facie, it was decided for the patient to terminate pregnancy to reduce severe symptoms of COVID-19. Termination of pregnancy in pregnant women with confirmed COVID-19 with severe symptoms is still an ethical dilemma that needs to be discussed further. Therefore, ethical considerations in this patient were carried out by reviewing obstetric, pediatric, pulmonology, anesthesia, and internal medicine indications. CONCLUSION: Termination of pregnancy in this patient with confirmed COVID-19 with severe symptoms can be done. Although termination of pregnancy has not completely saved the mother’s condition, this decision has the potential to provide benefits and safety for the patient and the fetus. © 2021 Taufik Suryadi, Sarjani Sarjani, Kulsum Kulsum.

Stress and Bio-Ethical Issues Perceived by Romanian Healthcare Practitioners in the COVID-19 Era.

OBJECTIVE: The COVID-19 pandemic had a major impact on different areas of life, especially in the medical system. Because of the pandemic outbreak, the medical system was remodeled to treat COVID-19 patients in secure conditions. Those changes and restrictive measures have put pressure on individual adaptability. The present study investigated the stress of Romanian healthcare practitioners (HCP) and the capacity to deal with new bio-ethical issues that emerged during the COVID-19 pandemic in 2020. METHODS: We analyzed results from a survey on 97 Romanian HCP in several areas: personal experience with COVID-19, perceived emotional distress, and appraisal of bio-ethical principles respected or infringed during the pandemic in 2020. RESULTS: Unlike previous studies, our respondents reported low to moderate stress levels. In addition, few bio-ethical principles were infringed on a personal level. Tendencies to sacrifice individual autonomy and make decisions affecting patients and co-workers were more prevalent among HCP with over 30 years of experience. CONCLUSIONS: Retrospectively, Romanian HCP in our sample appeared to share an embellished view of the COVID-19 pandemic in 2020. Potentially related factors and coping mechanisms with stress are discussed.

Ethical Challenges Related to the Novel Coronavirus (COVID-19) Outbreak: Interviews With Professionals From Saudi Arabia.

The new and dangerous coronavirus disease (COVID-19) has posed a serious challenge to the ability of healthcare systems of many countries to contain the spread of the disease and to mitigate its various consequences. The disease posed many ethical challenges both in itself and in the methods used in its management. Although the ethical principles that healthcare operates under are universal, a thorough understanding of the ethical difficulties it poses necessitates consideration of contextual, societal, and cultural factors. This study provides an in-depth exploration of the ethical challenges related to the COVID-19 pandemic outbreak in relation to healthcare providers, medical researchers, and decision-makers in Saudi Arabia. Four themes were extracted from participants' responses, namely, ethical challenges about disease-control measures, challenges to actions in certain groups, challenges regarding software programs, and finally ethics in research practices. Each theme likewise contained sub-themes. The themes and sub-themes were discussed in light of the ethical principles: autonomy, beneficence, non-beneficence, and justice, as well as other principles, such as protecting confidentiality, privacy, and preventing stigma and discrimination.

Whom Should Be Saved? A Proposed Ethical Framework for Allocating Scarce Medical Resources to COVID-19 Patients Using Fuzzy Logic.

COVID-19 is a global pandemic that affected the everyday life activities of billions around the world. It is an unprecedented crisis that the modern world had never experienced before. It mainly affected the economic state and the health care system. The rapid and increasing number of infected patients overwhelmed the healthcare infrastructure, which causes high demand and, thus, shortage in the required staff members and medical resources. This shortage necessitates practical and ethical suggestions to guide clinicians and medical centers when allocating and reallocating scarce resources for and between COVID-19 patients. Many studies proposed a set of ethical principles that should be applied and implemented to address this problem. In this study, five different ethical principles based on the most commonly recommended principles and aligned with WHO guidelines and state-of-the-art practices proposed in the literature were identified, and recommendations for their applications were discussed. Furthermore, a recent study highlighted physicians' propensity to apply a combination of more than one ethical principle while prioritizing the medical resource allocation. Based on that, an ethical framework that is based on Fuzzy inference systems was proposed. The proposed framework's input is the identified ethical principles, and the output is a weighted value (per patient). This value can be used as a rank or a priority factor given to the patients based on their condition and other relevant information, like the severity of their disease status. The main idea of implementing fuzzy logic in the framework is to combine more than one principle when calculating the weighted value, hence mimicking what some physicians apply in practice. Moreover, the framework's rules are aligned with the identified ethical principles. This framework can help clinicians and guide them while making critical decisions to allocate/reallocate the limited medical resources during the current COVID-19 crisis and future similar pandemics.

Ethical connotations of the treatment of COVID-19 disease.

The current situation of the COVID-19 pandemic has brought entirely new challenges to the health care professionals as well as to the general public, and together with them a number of new problems that the society needs to deal with. One of the groups of new challenges are undoubtedly ethical issues. For physicians in their daily practice, it is important to realize the significant role of ethical aspects during an epidemic or pandemic. The article aims to acquaint health care professionals with ethical principles in general, with their distinctiveness and application in the course of infectious diseases, and with the main ethical aspects of the COVID-19 treatment during the pandemic. One of the most important topics of the subject-matter experts discussions, which took place in connection with preparation of recommendations for the allocation criteria of scarce resources in the provision of health care services in the context of the COVID-19 pandemic, is particularly the allocation of scarce resources based on age and discrimination. The intention of the article is to support healthcare professionals to fulfil their responsibilities in providing health care services in a professional and equitable way that does not conflict with any legal obligations.