Attitudes among physicians toward vaccine mandates for emerging infectious disease: the case of the COVID-19 vaccine

Objectives: The outbreak of SARS-CoV-2 resulted in a global pandemic. Vaccine mandates were implemented in several countries, including in Taiwan, and often targeted health-care workers in particular. This study investigated attitudes among Taiwanese physicians toward such policies and how ethical beliefs and logic influenced attitudes. Methods: A total of 16 physicians were recruited by using the snowball method from hospitals in northern Taiwan. Data were collected through semi-structured interviews. Results: Physicians tended not to support mandatory vaccination. Five themes emerged: (1) Individual rights, including violation of autonomy and labor rights;(2) vaccine performance, including safety and efficacy;(3) institutional norms, including the degree of relevancy of the policy-issuing unit and the employment relationship between physicians and institutions;(4) social and workplace stigma resulting from coercive policies in different job categories or departments;and (5) professional ethics of physicians. Conclusions: Autonomy and professional ethics among physicians influence attitudes toward vaccine mandates. Vaccine performance, institutional norms, and stigma also influence attitudes toward vaccine mandates and decision-making. Even with high ethical awareness, the study participants tended not to support vaccine mandates. The government should formulate mandatory vaccination policy means for healthcare workers that can be used by hospitals. Each hospital should assess their unique risks and implement policies that best suit their needs. (Taiwan J Public Health. 2023;42(1):75-87)

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)

Vaccine ethics: An ethical framework for global distribution of COVID-19 vaccines

This paper addresses the just distribution of vaccines against the SARS-CoV- 2 virus and sets forth an ethical framework that prioritises frontline and essential workers, people at high risk of severe disease or death, and people at high risk of infection. Section I makes the case that vaccine distribution should occur at a global level in order to accelerate development and fair, efficient vaccine allocation. Section II puts forth ethical values to guide vaccine distribution including helping people with the greatest need, reducing health disparity, saving the most lives and promoting narrow social utility. It also responds to objections which claim that earlier years have more value than later years. Section III puts forth a practical ethical framework to aid decision-makers and compares it with alternatives. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Ethical considerations for protecting the options of subjects in primary epidemic vaccine trials

Comments on an article by J. T. Monrad (see record 2020-61038-012). Monrad presented several issues about secondary vaccine trials. It lays out the case in which a vaccine has been tested through phases I-III and is being deployed. Subsequently, consideration is being given to conducting 'trials for another vaccine for the pathogen'. Monrad stated: 'In summary, we may say that researchers have strong prima facie reasons not to conduct a secondary vaccine trial.' Monrad discusses several factors meriting careful consideration about the need for developing and testing more than one vaccine: relative efficacy, length of immunity, adverse reactions (reactogenicity), ease of storage and administration, economic and logistical factors. What is not addressed are the ethical duties that exist when there are competing phase III vaccine candidates for COVID- 19. Ethically, a subject is allowed to quit a trial at any time. But how might this work in a vaccine trial with multiple candidates? If someone has received an experimental vaccine, they need to be informed of what to do should they wish to subsequently try an approved vaccine. But will companies and researchers with financial stakes in one vaccine readily disclose other options either initially or mid-trial? If a subject got experimental vaccine, there may be more of a chance of having an adverse immune reaction to an additional vaccine that is approved. So they may not wish to do anything. Thus, as part of all informed consents for phase three trials, participants need to be told that at the time some vaccine is approved, they will be told whether or not they received the test vaccine or the placebo so as to help participants make their decision as to whether to get another approved vaccine or not. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

New development: Ethical dilemmas and emotional labour—what can we learn from the shared Covid-19 crisis?

IMPACTThis article will be of value to public officials and managers who are grappling with the ethical questions arising from public sector work and service delivery. This is especially relevant in the context of Covid-19 where new forms of emotional labour are emerging. Procurement officers and politicians are encouraged to consider the possibilities of unethical behaviour and the consequences.

Lifestyle audits in South Africa – overrated or X-factor?

PurposePresident Cyril Ramaphosa, in his 2018 State of the Nation Address, stated that "Thieves who are stealing public funds should be arrested and prosecuted”, and called for lifestyle audits of public-sector employees. The gross misuse of COVID-19 relief funds by public officials indicated the urgent need to execute these audits as an anti-corruption measure. This paper aims to provide a review of the existing state of affairs with regard to the application of lifestyle audits in South Africa.Design/methodology/approachThis paper critically analyses the literature available on the current position of South Africa concerning lifestyle audits in the public sector, based on the mandates of some of the anti-corruption agencies that could be responsible for the conducting and processing of such audits.FindingsSouth Africa has only recently seen a framework for applying lifestyle audits, developed by the Department of Public Service and Administration. Although these first steps in developing a standard practice are laudable, the practical process of dealing with misconduct and/or criminal matters remains to be seen. It is recommended that South Africa consider a legislative approach to dealing with unlawfully obtained wealth by either criminalising the act of illicit enrichment (per the United Nations Convention Against Corruption) or creating an Unexplained Wealth Order, as seen, for example, in the UK.Originality/valueSouth Africa is in dire need of addressing corruption in the public sector. Despite lifestyle audits being called for, the lack of proper implementation is negating any positive outcomes. Therefore, alternative solutions should be investigated.

Inclusive Community Aquatics Programming for Children with Developmental Challenges: A Community Participatory Action Research

Background: Children who are neurodiverse have traditionally been segregated from their peers in community-based programs, despite evidence of health benefits of inclusive education. Objectives: This community-initiated project aims to explore barriers and facilitators to inclusive aquatics programming for children with developmental and/or mental health challenges. Methods: Using a participatory-action research methodology, semi-structured interviews and focus groups were conducted with 14 participants from various stakeholder groups, including parents of children who are neurodiverse, helping professionals, and community programmers. Results: Participants described unique definitions of inclusion, from integration with neurotypical peers, to individualized goal-setting and achievement. Major facilitators include adequate resources, flexibility around accommodations, and motivated staff. Major barriers include social stigma, financial limitations, and lack of communication between caregivers and service providers. Conclusions: Participants felt strongly about the need to improve inclusion practices within aquatics—and other community-based—programs. Increased collaboration between families, community programmers, and helping professionals can foster better inclusion and outcomes for children who are neurodiverse. By incorporating various perspectives into the design of future programs, program administrators can ensure more equitable access such that all children are able to participate.

The Employee Moonlighting - A Paradigm Shift in Socioeconomic Context

The global economy perhaps suffered the worst-ever disaster since the eruption of the COVID-19 pandemic. It hits badly both life and livelihood leaving away the mark of catastrophe across the labor market by causing harm to both employment and employ ability. The badly damaged sectors like airlines, hospitality, and retail chains fueled the crisis of loss in employment opportunities due to the total collapse of the tourism industry. However, within these bleak business situations, healthcare, and pharmaceutical (thanks to the COVID vaccine invention) sectors recorded robust growth despite huge fatalities of healthcare professionals across the globe. Despite the recessionary trend across the sectors, business growth in e-commerce was phenomenal;because the series of lockdowns, compelled households to satisfy demands at the doorstep, by using e-commerce platforms. Even after the pandemic, there was an explosion of e-commerce businesses creating value for the customers and satisfying it at their doorsteps;from trimming of hair to fumigation at households or from arranging Pandits for performing Pujas to booking accommodation for a cozy stay at remote holiday destinations made available at fingertips. The introduction of Work from Home (WFH) or Remote Working which was earlier practiced widely by IT or IT-enabled services and adopted subsequently by other businesses in the form of virtual or hybrid working has opened opportunities for individuals to explore newer sources of income to balance their financial liabilities threatened by the erosion of permanent employment, wage cut, and frizzing of increments. So, when maintaining a livelihood is important, financial insecurity created the center stage for exploring alternatives for sustenance. Therefore, the concept of moonlighting is an offshoot of changing organizational commitments and outlook toward the individual employee during and the post-pandemic period evidenced in the changes in people management policies of talent acquisition, management, and retention. The policy changes though promulgated for business continuity, negatively impacted employee morale causing the workforce, particularly the millennial and gen Z start shifting mindsets toward the workplace by leveraging expertise elsewhere without hampering primary employment. It will be the objective of the article to deep dive to understand the recent socioeconomic shifts which possibly act as an agent for the occurrence of moonlighting.

A qualitative study of moral distress in physicians during the COVID-19 pandemic

The spread of Coronavirus (COVID-19) created a pandemic and had a world-shattering effect on healthcare organizations. As a result, many healthcare professionals were exposed to health situations that stretched them beyond their professional ethics, mental health, and emotional capacity. Throughout the last 30 years, moral distress has been understood as the type of stress that medical professionals experience. Research has substantially grown regarding COVID-19 and moral distress, exposing gaps in the ability of experts to care as they should. Moral distress was a term created to define the emotional disruption that occurs when a professional cannot work within their ethical duty due to organizational or policy constrictions but know the needed moral action. The purpose of this generic qualitative study was to understand eight physicians' perceptions of moral distress during the pandemic. Jameton's concept of moral distress was the framework for understanding physicians' perceptions. The generic qualitative approach explored physicians' treatment during the pandemic for this study. Interviews were conducted using semi-structured interview questions via videoconferencing (Google Meet). Braun and Clark's thematic six-step analysis was used to analyze and code the data. The results of the eight semi-structured interviews demonstrated that moral distress was a cyclic effect. Four themes that emerged as a result of understanding the perception of moral distress during the pandemic included that the system was reactive, causing maladaptive behaviors. The research explored physicians' perceptions while promoting positive social change by improving self-awareness to educate pandemic-related barriers or constraints professionally faced daily. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

The Disease Management Experiences of Patients with Stroke during the Covid-19 Pandemic: A Qualitative Study

Background: The pandemic, COVID-19, has disrupted the delivery of healthcare services. The admissions of patients with stroke to hospitals decreased during the pandemic. There is considerable uncertainty about how patients with stroke manage their illnesses beyond the control of healthcare professionals during the pandemic period. Aim: Our study aimed to determine the experiences of patients with stroke regarding disease management during the pandemic period. Methods: This study had a descriptive qualitative design. The study was conducted with 18 patients with stroke registered in the Stroke Outpatient Clinic of Hospital X. A patient information form and a semi-structured interview form were used, and video-online in-depth interviews were conducted with each patient and recorded. After the interviews, the records were directly transcribed and analyzed. The transcripts were analyzed using thematic content analysis. Results: As a result of our study, five main themes were reached. These themes are;difficulty in access to healthcare, fear, change in the flow of daily life, inability to access sufficient information, and adaptation. Conclusion: As a result of our study, it is seen that patients with stroke have difficulties due to pandemic conditions, and individual and institutional solutions have been developed for these difficulties over time. It is recommended to create accessible health systems, increase online health services, and implement initiatives that support patients with stroke in bio-psycho-social aspects, for all extraordinary conditions that may be experienced.

Domestic Abuse in the Context of Life-Limiting Illness: A Systematic Scoping Review

Domestic abuse is a worldwide public health and social issue which impacts the health and wellbeing of those experiencing abuse and their families. People living with a life-limiting illness are at increased risk of domestic abuse because they are often frail, isolated, and dependent on others. Little is known about domestic abuse and the coexistence of life-limiting illness and existing support for those experiencing or at risk of abuse. A scoping review was conducted to identify factors that shape and characterise experiences of adults with a life-limiting illness affected by domestic abuse and the health and social care practitioners and other organisations that support them. The Joanna Briggs Institute (JBI) methodology and checklist for Preferred Reporting Items for Systematic Reviews and Meta Analyses-Extension for Scoping Reviews (PRISMA-ScR) were applied. Five databases were systematically searched from 2000 to 2021: MEDLINE;CINAHL;PsycINFO;Social Sciences Citation Index (Web of Science);and ProQuest Dissertations and Global. Twenty-one papers met the inclusion criteria. Most studies were conducted in North America, with female participants living with cancer, and conducted in health and community settings. There were no studies involving third sector organisations. A range of abusive behaviours was reported resulting in missed medical appointments, delays in screening leading to late diagnosis, and palliative rather than curable treatment. Abuse also impacted on the physical, emotional, and psychological wellbeing of the person experiencing the abuse, which increased stress levels and could have a detrimental effect on their health. Identifying domestic abuse within the context of life-limiting illness was reported to be challenging for health and social care professionals, as was responding to and managing a disclosure. Further research is needed to address existing knowledge in order to inform policy and practice to identify and manage domestic abuse where it coexists with life-limiting illness.

Doctors' professional ethics in the perspective of marx's "industrial pathology”

In Das Kapital, Marx cited the Public Health Report of Dr. Simon, the promoter of the British public health reform? and developed Marx's "industrial pathology", which not only directly demonstrated the oppression and exploitation of capitalism on the working class, but also indirectly raised expectations and construction of doctors' professional ethics and social values. Marx believed that the doctors should have professional, fair and resolute ethic, and only by placing their value in the working people and putting the health and interests of the people first, can they better save the dying, heal the wounded, and play a greater role of value and advantage. Reviewing the professional ethics and social values of doctors from the perspective of Marx's "industrial pathology" not only enlightens people on how to better respond to the COVID-19, but also has important reference significance for the construction of contemporary medical ethics. © 2023, Editorial department of Chinese Medical Ethics. All rights reserved.

The Impacts and Vulnerabilities for People Living with Spinal Cord Injury and Their Service Systems of the COVID-19 Pandemic in Queensland, Australia

As part of a larger study examining the perceived impacts of health system stress in Queensland, Australia, caused by the COVID-19 pandemic, this study explored the experiences and perspectives of a sample of people with spinal cord injury (SCI) and critical stakeholders to identify secondary complications, access concerns, and potential solutions in the context of the pandemic. This study utilised a multimethods qualitative design. Thirty-four people with SCI completed an online survey between August and November 2021, recruited from an online Spinal Life Australia Peer Support Group. Sixteen SCI expert stakeholders, recruited from the Queensland Spinal Cord Injuries Services, consumer support organisations, and funding agencies, participated in one of two expert stakeholder forums in September 2021, focusing on impacts of the pandemic on the services they provided. Survey and forum results were analysed thematically. Results highlighted service disruption wherein people with SCI faced difficulty accessing health and community services (including rehabilitation) and personal supports. Reduced access led to secondary complications in physical health, psychosocial, and occupational domains. Solutions for safeguarding access to care, including action-ready back-up plans, effective technology and training, collaboration of service networks, and forward planning for system disruption, consumables access, staff support, and advocacy are required to best support vulnerable populations and the supporting staff in times of crisis. In conclusion, COVID-19 disrupted access to specialist SCI and mainstream health, rehabilitation, and social care services, resulting in functional decline and physical and psychosocial complications. While people with SCI and their service providers attempted to innovate and solve problems to overcome service access barriers, this is not possible in all situations. Improved planning and preparation for future system disruptions mitigates risks and better protects vulnerable populations and service providers in times of severe system stress.

Digital skills and ethical knowledge of teachers with TPACK in higher education

This paper analyzes the professional ethical knowledge of teachers in the use of technologies by teachers in training. Based on the disciplinary pedagogical technological knowledge (TPACK) model, it is intended to measure the correct inclusion of technologies in the classroom. For this, a descriptive exploratory methodological design study was carried out. The instruments used have been the Likert scale questionnaire and the personal interview, organized into four dimensions in which the self-perception of professional ethical knowledge, ethical knowledge of technology, pedagogical technological ethical knowledge and disciplinary technological ethical knowledge of the future teachers. The questionnaire has been applied to a sample of 1.051 trainee teachers from a European university in the context of COVID-19 and 822 students participated in the interview. The results show the scarce training in professional ethical knowledge of teachers in training and the importance of addressing this knowledge in the 21st century, a post-pandemic context. Another of the conclusions is the need to include the ethical component in the TPACK model to achieve a correct and ethical use of digital resources in the classroom. © 2023 by authors;licensee CEDTECH by Bastas, CY.

The Office of Legal Counsel's Client is the President: Why the Model Rules Demand a Secretive Agency Identify its Boss

This Note argues that the Model Rules of Professional Conduct require the Office of Legal Counsel to identify President Biden as its client. Had the agency done so when Biden first took office, it could have immediately implemented Biden's policy preference: keeping former prisoners home during the coronavirus pandemic.

COVID-19: Comparison of Vaccination Coverage between Oral Health Care Practitioners and Other Health Care Personnel in Yaounde

Introduction: COVID-19 is a global pandemic for which vaccination coverage is still low in our environment. Health care workers and particularly those in the oral sphere are at high risk of contracting it. General objective: To evaluate the COVID-19 vaccination coverage among oral health care workers in comparison with other health care workers in Yaounde. Materials and methods: We conducted a cross-sectional study on 360 individuals in three hospitals in Yaounde, from February to April 2022, i.e., 3 months. All health personnel who gave their free consent consecutively were included. Statistical analysis was performed using SPSS 26.0 software with a statistical significance level of p<0.05. Results: The coverage rate of the COVID-19 vaccine was 34.2%. The rates of vaccination against COVID-19 were 43.3% and 32.2% in oral sphere practitioners and others respectively (p=0.135). There was no statistically significant difference in the distribution of vaccine received, adverse events and post-vaccination infection rate against SARS-CoV-2 between our two groups (p≥0.05). Conclusion: A similar distribution was found between oral health professionals and other health personnel in terms of vaccination rate, type of vaccine received, and post-vaccination adverse events against SARS-CoV-2. Education seems to be a priority action to target the most at-risk populations.

Doctors' professional ethics in the perspective of marx's "industrial pathology”

In Das Kapital, Marx cited the Public Health Report of Dr. Simon, the promoter of the British public health reform? and developed Marx's "industrial pathology", which not only directly demonstrated the oppression and exploitation of capitalism on the working class, but also indirectly raised expectations and construction of doctors' professional ethics and social values. Marx believed that the doctors should have professional, fair and resolute ethic, and only by placing their value in the working people and putting the health and interests of the people first, can they better save the dying, heal the wounded, and play a greater role of value and advantage. Reviewing the professional ethics and social values of doctors from the perspective of Marx's "industrial pathology" not only enlightens people on how to better respond to the COVID-19, but also has important reference significance for the construction of contemporary medical ethics. © 2023, Editorial department of Chinese Medical Ethics. All rights reserved.

The Overdose Conundrum

The article discusses the impact of patients' overdose on psychiatrists. It discusses the case of a 45-year-old woman with an opioid addiction and anxiety who was enrolled in an addictions treatment program. Topics covered include how the psychiatrists cope with patient suicide or overdose, how to promote honesty about recurrence of substance use and how psychiatrists can find the right balance in setting boundaries.

Exploring Clinician Attitudes Towards Treating Eating Disorders: Bridging Counselor Training Gaps

Eating disorder (ED) clinicians may face various challenges in practice, including burnout and feelings of incompetence. Several deficits may contribute to these challenges, such as graduate education and treatment gaps. In this study, 109 interdisciplinary clinicians were surveyed regarding their personal attitudes, experiences, and challenges in treating EDs. Among the various results, quantitative and qualitative findings highlighted the lack of graduate education as the primary challenge to effectively treating EDs, as well as the need for more ED research and culturally responsive care. Recommendations to enhance ED education and counselor training are provided, including managing countertransference and advocating for specialized coursework. Lastly, critical directions for future research are discussed.

Telepsychiatry

The use of communication technologies to provide psychiatric services is broadly termed telepsychiatry. While telehealth is not new and has been in existence for over 50 years, the COVID-19 pandemic accelerated the use of this modality and demonstrated its advantages in healthcare delivery. Although on the surface telepsychiatry may simply appear to be the practice of psychiatry through videoconference, like any innovation it presents nuanced regulatory, liability, and practice considerations. Familiarity with relevant rules regarding licensure, prescribing, credentialing, malpractice coverage, and privacy and security is important prior to getting involved with providing virtual services. Clinical issues such as informed consent, establishing a physician-patient relationship, documentation, and standard of care must also be considered. In this chapter, we will review these key issues through the lens of enhancing clinical practices and reducing the risk of medical malpractice and licensure violation when providing these services. (PsycInfo Database Record (c) 2022 APA, all rights reserved)