The promises and limitations of codes of medical ethics as instruments of policy change.

Codes of medical ethics (codes) are part of a longstanding tradition in which physicians publicly state their core values and commitments to patients, peers, and the public. However, codes are not static. Using the historical evolution of the Canadian Medical Association's Code of Ethics as an illustrative case, we argue that codes are living, socio-historically situated documents that comprise a mix of prescriptive and aspirational content. Reflecting their socio-historical situation, we can expect the upheaval of the COVID-19 pandemic to prompt calls to revise codes. Indeed, Alex John London has argued in favour of specific modifications to the World Medical Association's International Code of Medical Ethics (which has since been revised) in light of moral and scientific failures that occurred during the COVID-19 pandemic. Responding to London, we address the more general question: should codes be modified to reflect lessons drawn from the COVID-19 pandemic or future such upheavals? We caution that codes face limitations as instruments of policy change because they are inherently interpretive and 'multivocal', that is, they usually underdetermine or provide more than one answer to the question, 'What should I do now?' Nonetheless, as both prescriptive and aspirational documents, codes also serve as tools for reflection and deliberation-collective practices that are necessary to engaging with and addressing the moral and scientific uncertainties inherent to medicine.

Children First, a Debate on the Restrictions to Tackle COVID-19.

Sometimes, when a public health disaster strikes, mandatory freedom-limiting restrictions must be enforced in order to save lives. During the first waves of the COVID-19 pandemic, the customary and necessary exchange of ideas in academia drastically changed in most countries, and the absence of debate on the restrictions enforced became evident. Now that the pandemic seems to be drawing to an end, the aim of this article is to spark clinical and public debate on the ethical issues concerning pediatric COVID-19 mandates in an attempt to analyze what happened. With theoretical reflection, and not empirical inquiry, we address the mitigation measures which proved detrimental to children despite being beneficial to other segments of the population. We focus on three key points: (i) the sacrifice of fundamental children's rights for the greater good, (ii) the feasibility of cost-benefit analyses to make public health decisions and restrictions which affect children, and (iii) to analyze the impediments to allowing children's voices to be heard concerning their medical treatment.

Guaranteeing dignity and decent work for migrant nurses and health care workers beyond the COVID-19 pandemic.

AIM(S): The main aim of this article is to outline the devastating aftereffects of COVID-19 in terms of ethical recruitment and the respect of dignity of nurses and health care professionals. BACKGROUND: Nations experience the ominous impacts of the COVID-19 pandemic in terms of an exacerbated shortage of nurses worldwide. In this situation, migration flows of nurses are skyrocketing and the respect of the migrant nurses' dignity as human beings should be guaranteed. EVALUATION: Data from reports elaborated by the International Centre on Nurse Migration (ICNM) were examined and outlined the central role of the respect of dignity of every nurse to prevent unethical exploitation of them. KEY ISSUE(S): The respect of human dignity is a complex concept. Human dignity denotes the inner nature of human beings but also their rights at work. CONCLUSION(S): In a post-COVID-19 world with increased flows of nurse migration, it is crucial to guarantee dignity at work for migrant nurses. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse leaders should prioritize the ethical recruitment of health care workers and give a prominent role to the WHO 'Code of Practice on the International Recruitment of Health Personnel' which recognizes the ethical bedrocks of employment.

Media codes of ethics for health professionals and media professionals: a qualitative study

Media is an opportunity for health professionals;however, it is not free of threats. Fixing the threats requires professional systematization through developing practical guidelines, which brings us to the goal this study was designed to achieve. The study was conducted qualitatively through literature review, semi-structured interviews, and a focus group discussion with health and media experts, as a result of which 486 codes were extracted and classified into 4 groups. The first group was addressed to media professionals and contained 126 codes in 5 categories: seeking and reporting the truth, harm minimization, integrity, independence, and respect for the rights of others. The second and third groups were addressed to health professionals, the former (150 codes) dealing with formal media, and the latter (190 codes) dealing with cyberspace. These groups were both categorized into 6 categories: scientific demeanor, beneficence, harm minimization, and respect for the rights of others. The fourth group was addressed to the public audience and contained 20 codes categorized into 2 categories: ethics of belief, and ethics of (re-)publishing. Since the study was conducted during the pandemic/infodemic, the proposed codes can help reduce possible conflicts in similar future situations.

Journalistic ethics and Covid-19: an analysis of deontological codes / Ética periodística y Covid-19: análisis de contenido de los códigos deontológicos / Ética jornalística e Covid-19: análise de conteúdo de códigos deontológicos

Esta investigación realiza un análisis de contenido de 103 códigos de ética periodística de todo el mundo para comprobar su adaptación a las circunstancias derivadas de la pandemia Covid-1٩. A partir de siete recomendaciones formuladas por la Ethical Journalism Network (EJN), se analiza su presencia o ausencia en los códigos. Los resultados muestran una presencia desigual de los principios y diferencias importantes entre los códigos. Ninguno de ellos comprende las siete recomendaciones y solo uno asume seis de ellas. Por el contrario, 17 códigos contienen únicamente una recomendación y dos de ellos no recogen ninguna. Se concluye que las recomendaciones de la EJN más presentes en los códigos se relacionan con principios muy asentados en la ética periodística que dependen habitualmente de la fecha de actualización. Se propone incorporar secciones específicas sobre salud a los códigos. (AU)

This article presents the results of a content analysis of 103 journalistic codes of ethics throughout the world conducted to test the adaptation of these codes to Covid-19 pandemic. Based on seven recommendations formulated by the Ethical Journalism Network (EJN), we analyze the presence or absence of each principle. The findings show an uneven presence of the principles and important differences across the codes. None of the codes cover the seven recommendations and just one addressed six of them. In contrast, 17 codes contain only one recommendation and two do not contain any. The EJN recommendations that are most present in the codes address well-established principles in journalistic ethics. The year of the latest update of the code is also a determining factor. Specific sections on health should be incorporated into the codes. (AU)

Esse artigo desenvolve uma análise de conteúdo de 103 códigos jornalísticos de ética em todo o mundo para testar sua adaptação às circunstâncias da Covid-19. Com base nas sete recomendações formuladas pela Ethical Journalism Network (EJN), analisa a presença ou ausência de cada princípio. Os resultados mostram uma presença desigual de princípios e importantes diferenças entre os códigos. Nenhum deles entende as sete recomendações e apenas uma assume seis delas. Em contraste, 17 códigos contêm apenas uma recomendação e dois deles não contêm nenhum. Conclui-se que as recomendações da EJN mais presentes nos códigos dizem respeito a princípios muito estabelecidos na ética jornalística. O ano da última atualização do código também se torna um fator determinante. Propõe-se incorporar seções específicas de saúde nos códigos. (AU)

Covid-19, ethical nursing management and codes of conduct: An analysis.

The conduct of nurse managers, and health service managers more widely, has been subject to scrutiny and critique because of high-profile organisational failures in healthcare. This raises concerns about the practice of nursing management and the use of codes of professional and managerial conduct. Some responses to such failures seem to assume that codes of conduct will ensure or at least increase the likelihood that ethical management will be practised. Codes of conduct are general principles and rules of normative standards, including ethical standards, and guides for action of agents in particular roles. Nurse managers seem to stride two roles. Contra some accounts of the roles of a professional (nurse) and that of a manager, it is claimed that there is no intrinsic incompatibility of the roles though there is always the possibility that it could become so and likewise for codes of conduct. Codes of conduct can be used to support nurse managers in making practical decisions via an 'outside in' approach with an emphasis on the use of principles and an 'inside out' approach with an emphasis on the agent's character. It is claimed that both approaches are necessary, especially as guides to ethical action. However, neither is sufficient for action because judgement and choice will always be required (principles always underdetermine action) as will a conducive environment that positively influences good judgement by being supportive of the basic principles and values of healthcare institutions. The response to the Covid-19 pandemic has created a unique set of circumstances in which the practical judgement, including ethical judgement, of nurse managers at all levels is being tested. However, the pandemic could be a turning point because staff and institutions (temporarily) freed from managerialism have demonstrated excellent practice supportive of ethical and other practical decision making. Organisations need to learn from this post pandemic.

Ethical guidelines on cardiopulmonary resuscitation in the context of the COVID-19 pandemic in Colombia / [Pautas éticas para la reanimación cardiopulmonar en el contexto de la pandemia de COVID-19 en Colombia].

The pandemic caused by COVID19 is associated with an increase in the number of cases of cardiorespiratory arrest, which has resulted in ethical concerns regarding the enforceability of cardiopulmonary resuscitation, as well as the conditions to carry it out. The risk of aerosol transmission and the clinical uncertainties about the efficacy, the potential sequelae, and the circumstances that could justify limiting this procedure during the pandemic have multiplied the ethical doubts on how to proceed in these cases. Based on ethical and legal grounds, this paper offers a practical guide on how to proceed in the clinical setting in cases of cardiopulmonary arrest during the pandemic. The criteria of justice, benefit, no harm, respect for autonomy, precaution, integrity, and transparency are asserted in an organized and practical framework for decision-making regarding cardiopulmonary resuscitation.

La pandemia de COVID-19 se ha asociado con un incremento en el número de casos de paro cardiorrespiratorio y con ello han aumentado las inquietudes éticas en torno a la exigencia de la reanimación cardiopulmonar, así como sobre las condiciones para realizarla. El riesgo de contagio por aerosoles y las incertidumbres clínicas sobre la eficacia, las potenciales secuelas y las circunstancias que podrían justificar la limitación del procedimiento durante la pandemia, han multiplicado las dudas éticas sobre cómo proceder en estos casos. Con base en fundamentos éticos y jurídicos, en el presente artículo se ofrece una guía práctica sobre cómo proceder en los casos de paro cardiopulmonar en el contexto de la pandemia. Los criterios de justicia, beneficio, no daño, respeto a la autonomía, precaución, integridad y transparencia, se presentan de forma organizada y práctica para la adopción de decisiones en materia de reanimación cardiopulmonar.