Needs to address clinicians' moral distress in treating unvaccinated COVID-19 patients.

BACKGROUND: Moral dilemmas have arisen concerning whether physicians and other providers should treat patients who have declined COVID vaccination and are now sick with this disease. Several ethicists have argued that clinicians have obligations to treat such patients, yet providing care to these patients has distressed clinicians, who have at times declined to do so. Critical questions thus emerge regarding how best to proceed. MAIN BODY: Providers face moral tensions: whether to place the benefits to an unvaccinated patient over their duties to protect themselves and their families, staff and other patients, and goals of working collaboratively with patients. Clinicians' duties to treat such patients arguably outweigh claims otherwise, but these obligations are creating moral conflict and distress for providers. Moral distress has been associated with burnout, post-traumatic stress disorder, and interpersonal and work difficulties. Given ongoing vaccine refusals, these problems are unlikely to disappear in the foreseeable future. Society has obligations to address this moral distress due to principles of reciprocity, and implicit social contracts, as part of which physicians risk their lives in caring for patients for the good of society as a whole. Responses are thus urgently needed at several levels: by hospitals, medical schools, professional societies, governments, media, providers and patients. Medical training on professionalism should address these stresses, probing why doctors have duties to treat these patients, but also how moral conflicts can ensue, and how best to address these tensions. Governments and institutions should thus alter relevant policies and devote more resources to addressing clinicians' psychological strains. Institutions should also improve organizational culture. Public health organizations and the media described clinicians, earlier in the pandemic, as heroes, committed to treating COVID patients. This narrative should now be changed to highlight the strains that unvaccinated patients cause-endangering hospital staff and others. CONCLUSIONS: Unvaccinated COVID patients should receive care, but multi-level strategies, involving enhanced policies, education and practice are vital to alleviate ensuing moral distress, and thus aid these clinicians and their patients. Ethical arguments that providers must treat these patients have not considered these obligations' effects on clinicians, but should do so.

Pandemic – Utopia – Bioethics

Although it does not seem so at first glance, the COVID-19 pandemic did not make any fundamental changes, both in terms of the socio-economic framework of our actions and in terms of moral action. The reason for this lies primarily in the neglect of the utopian approach, which turned out to be necessary for looking at the socio-economic relations in the sphere of morality. Bioethics can provide a framework for such an in-depth moral questioning. I start this paper with the presentation of the attitude toward the pandemic, which remains within the parameters the inalterability of the world dogma. I then briefly ponder the notion of utopia and the concept of ‘degrowth’, the latter being an exemplary utopian approach to the human relationship toward the environment. Since the destructive attitude toward nature is the main cause of pandemic outbreaks, and both issues are of interest to bioethics, the latter should consider the attitude towards pandemics in a utopian way, primarily because the human destructiveness towards life stems primarily from the current socio-economic system. A characteristic of non-utopian thinking is that it neglects the reasons for the occurrence of certain moral conflicts, thus enabling it to be constantly perpetuated. As I try to show in the last part of the paper, the pluri-perspective methodology of integrative bioethics provides the tools to thwart this perpetuation. © 2022 University of Rijeka, Faculty of Medicine. All rights reserved.

Paranormal Beliefs, Vaccine Confidence, and COVID-19 Vaccine Uptake

Conservative religious ideologies have been linked to vaccine hesitancy. Yet, little is known about how paranormal beliefs relate to vaccine confidence and uptake. We hypothesize that paranormal beliefs will be negatively related to both confidence and uptake due to their association with lower levels of trust in science and a greater acceptance of conspiratorial beliefs. We test this hypothesis using a new nationally representative sample of U.S. adults fielded in May and June of 2021 by NORC. Using regression models with a sample of 1,734, we find that paranormal beliefs are negatively associated with general vaccine confidence, COVID-19 vaccine confidence, and COVID-19 vaccine uptake. These associations are partially or fully attenuated net of trust in science and conspiratorial belief. Although not a focus of the study, we also find that Christian nationalism's negative association with the outcomes is fully accounted for by measures of trust in science and conspiratorial beliefs.

Validation of the German Version of the Moral Injury Symptom and Support Scale for Health Professionals (G-MISS-HP) and Its Correlation to the Second Victim Phenomenon.

INTRODUCTION: Comparable to second victim phenomenon (SVP), moral injury (MI) affects health professionals (HP) working in stressful environments. Information on how MI and SVP intercorrelate and their part in a psychological trauma complex is limited. We tested and validated a German version of the Moral Injury Symptom and Support Scale for Health Professionals (G-MISS-HP) instrument, screening for MI and correlated it with the recently developed German version of the Second Victim Experience and Support Tool (G-SVESTR) instrument, testing for SVP. METHODS: After translating Moral Injury Symptom and Support Scale for Health Professionals (MISS-HP), we conducted a cross-sectional online survey providing G-MISS-HP and G-SVEST-R to HP. Statistics included Pearson's interitem correlation, reliability analysis, principal axis factoring and principal components analysis with Promax rotation, confirmatory factor and ROC analyses. RESULTS: A total of 244 persons responded, of whom 156 completed the survey (33% nurses, 16% physicians, 9% geriatric nurses, 7.1% speech and language therapists). Interitem and corrected item-scale correlations did not measure for one item sufficiently. It was, therefore, excluded from further analyses. The nine-item score revealed good reliability (Guttman's lambda 2 = 0.80; Cronbach's alpha = 0.79). Factor validity was demonstrated, indicating that a three-factor model from the original study might better represent the data compared with our two-factor model. Positive correlations between G-MISS-HP and G-SVESTR subscales demonstrated convergent validity. ROC revealed sensitivity of 89% and specificity of 63% for G-MISS-HP using a nine-item scale with cutoff value of 28.5 points. Positive and negative predictive values were 62% and 69%, respectively. Subgroup analyses did not reveal any differences. CONCLUSION: G-MISS-HP with nine items is a valid and reliable testing instrument for moral injury. However, strong intercorrelations of MI and SVP indicate the need for further research on the distinction of these phenomena.

Moral injury in healthcare professionals: A scoping review and discussion.

Moral injury emerged in the healthcare discussion quite recently because of the difficulties and challenges healthcare workers and healthcare systems face in the context of the COVID-19 pandemic. Moral injury involves a deep emotional wound and is unique to those who bear witness to intense human suffering and cruelty. This article aims to synthesise the very limited evidence from empirical studies on moral injury and to discuss a better understanding of the concept of moral injury, its importance in the healthcare context and its relation to the well-known concept of moral distress. A scoping literature review design was used to support the discussion. Systematic literature searches conducted in April 2020 in two electronic databases, PubMed/Medline and PsychInfo, produced 2044 hits but only a handful of empirical papers, from which seven well-focused articles were identified. The concept of moral injury was considered under other concepts as well such as stress of conscience, regrets for ethical situation, moral distress and ethical suffering, guilt without fault, and existential suffering with inflicting pain. Nurses had witnessed these difficult ethical situations when faced with unnecessary patient suffering and a feeling of not doing enough. Some cases of moral distress may turn into moral residue and end in moral injury with time, and in certain circumstances and contexts. The association between these concepts needs further investigation and confirmation through empirical studies; in particular, where to draw the line as to when moral distress turns into moral injury, leading to severe consequences. Given the very limited research on moral injury, discussion of moral injury in the context of the duty to care, for example, in this pandemic settings and similar situations warrants some consideration.

COVID-19, Moral Conflict, Distress, and Dying Alone.

COVID-19 has truly affected most of the world over the past many months, perhaps more than any other event in recent history. In the wake of this pandemic are patients, family members, and various types of care providers, all of whom share different levels of moral distress. Moral conflict occurs in disputes when individuals or groups have differences over, or are unable to translate to each other, deeply held beliefs, knowledge, and values. Such conflicts can seriously affect healthcare providers and cause distress during disastrous situations such as pandemics when medical and human resources are stretched to the point of exhaustion. In the current pandemic, most hospitals and healthcare institutions in the United States have not allowed visitors to come to the hospitals to see their family or loved ones, even when the patient is dying. The moral conflict and moral distress (being constrained from doing what you think is right) among care providers when they see their patients dying alone can be unbearable and lead to ongoing grief and sadness. This paper will explore the concepts of moral distress and conflict among hospital staff and how a system-wide provider wellness programme can make a difference in healing and health.