Ethical considerations of the vaccine development process and vaccination: a scoping review.

BACKGROUND: Various vaccines have been developed and distributed worldwide to control and cope with COVID-19 disease. To ensure vaccines benefit the global community, the ethical principles of beneficence, justice, non-maleficence, and autonomy should be examined and adhered to in the process of development, distribution, and implementation. This study, therefore, aimed to examine ethical considerations of vaccine development and vaccination processes. METHODS: A scoping review of the literature was conducted based on the Arkesy and O'Malley protocol to identify eligible studies published until November 2021. We searched Web of Science, PubMed, Scopus, and SciELO databases. The search was conducted using combinations of Medical Subject Heading (MeSH) search terms and keywords for Ethics, COVID-19, and vaccines in abstract, keywords, and title fields to retrieve potentially relevant publications. We included any study that reported one of the four principles of medical ethics: autonomy, justice, non-maleficence, and beneficence in the COVID-19 vaccine development and distribution and implementation of vaccinations. Letters, notes, protocols, and brief communications were excluded. In addition, we searched gray literature to include relevant studies (ProQuest database, conferences, and reports). Data were analyzed using framework analysis. RESULTS: In total, 43 studies were included. Ethical considerations concluded two themes: (1) production and (2) distribution and vaccination. The production process consisted of 16 codes and 4 main Categories, distribution and vaccination process consisted of 12 codes and 4 main Categories. Moreover, the ethical considerations of special groups were divided into four main groups: health care workers (HCWs) (five codes), children and adolescents (five codes), the elderly (one code), and ethnic and racial minorities (three codes). CONCLUSION: Due to the externalities of pandemics and the public and social benefits and harms of vaccination, it is not feasible to adhere to all four principles of medical ethics simultaneously and perfectly. This issue confronts individuals and policymakers with several moral dilemmas. It seems that decision-making based on the balance between social benefit and social harm is a better criterion in this regard, and the final decision should be made based on maximizing the public benefit and minimizing the public harm.

Practising in a post-truth world: Pandemic ethics can inform patient autonomy and clinical communication.

The COVID-19 pandemic posed an unprecedented challenge to modern bioethical frameworks in the clinical setting. Now, as the pandemic stabilises and we learn to 'live with COVID', the medical community has a duty to evaluate its response to the challenge, and reassess our ethical reasoning, considering how we practise in the future. This article considers a number of clinical and bioethical challenges encountered by the author team and colleagues during the most severe waves of the pandemic. We argue that the changed clinical context may require reframing our ethical thought in such a manner as to adequately accommodate all parties in the clinical interaction. We argue that clinicians have become relatively disempowered by the 'infodemic', and do not necessarily have adequate skills or training to assess the scientific literature being published at an unprecedented rate. Conversely, we acknowledge that patients and families are more empowered by the infodemic, and bring this empowerment to bear on the clinical consultation. Sometimes these interactions can be unpleasant and threatening, and involve inviting clinicians to practise against best evidence or even illegally. Generally, these requests are framed within 'patient autonomy' (which some patients or families perceive to be unlimited), and several factors may prevent clinicians from adequately navigating these requests. In this article, we conclude that embracing a framework of shared decision-making (SDM), which openly acknowledges clinical expertise and in which patient and family autonomy is carefully balanced against other bioethics principles, could serve us well going forward. One such principle is the recognition of clinician expertise as holding weight in the clinical encounter, when framed in terms of non-maleficence and beneficence. Such a framework incorporates much of our learning and experience from advising and treating patients during the pandemic.

Evolution of basic human values orientations: An application of monitoring changes in cluster solutions.

This study enumerates the evolution of basic human values orientations and the dynamic relationship between them, computed from Schwartz's value survey conducted in European nations. For this purpose, eight datasets related to the human value scale were extracted from the European Social Survey; each corresponds to a single round conducted cross-sectionally every two years since 2001. Change detection algorithm was implemented to the cluster solutions of temporal datasets, and the evolution of important clusters was traced. Finding of the study reveals that Universalism and Benevolence values are on the rise in European societies in the last couple of decades. Most of the European inhabitants believe in the smooth group functioning and form the organismic needs of cooperation. The people prefer anxiety-free life, and love for nature, environment, humanity, and kindness to other beings in society are essential constructs for them. They avoid self-centred behaviour and prefer social physiognomies.

Relationship between moral sensitivity and the quality of nursing care for the elderly with Covid-19 in Iranian hospitals.

BACKGROUND: The quality of care has a significant impact on the condition of elderly patients. Many factors affect the quality of care, including ethical considerations. Ethical considerations, such as moral sensitivity, change in times of crisis. The present study was conducted to assess the relationship between moral sensitivity and the quality of nursing care for the elderly with Covid-19 in Iranian hospitals. METHODS: This was a cross-sectional descriptive correlational study. The participants included 445 nurses that were selected by quota sampling method from hospitals admitting COVID-19 patients. The data were collected using the Moral Sensitivity Questionnaire (MSQ) and Quality Patient Care Scale (QUALPAC) as self-reports. We used the SPSS software v.16 for statistical analysis. RESULTS: The total score of moral sensitivity and quality of care was 52.29 ± 16.44 and 2.83 ± 0.23, respectively. Moral sensitivity negatively correlates with psychological, social, and physical aspects (P < 0.05). Modifying autonomy, interpersonal orientation, and experiencing moral conflict predicted ß = 0.10 of the psychosocial aspect of quality of care. Structural moral meaning and expressing benevolence predicted the changes in the physical dimension of quality of care (ß = 0.02). CONCLUSION: The quality of care had a significant inverse correlation with moral sensitivity. Multiple regression analysis showed that modifying autonomy, interpersonal orientation, and experiencing moral conflict could predict the psychosocial dimensions. Structuring moral meaning could predict the physical dimension. The communication aspects were not related to any of the dimensions of moral sensitivity.

Representation of Ethics in COVID-19 Research: A Systematic Review.

BACKGROUND: Ethical discourse in the scientific community facilitates the humane conduct of research. The urgent response to COVID-19 has rapidly generated a large body of literature to help policymakers and physicians address novel pandemic challenges. Plastic surgeons, in particular, have to manage the postponement of elective procedures and safely provide care for non-COVID-19 patients. Although COVID-19 research may provide guidance on these challenges, the extent to which ethical discussions are present in these publications remains unknown. METHODS: Articles were identified systematically by searching the PubMed, Embase, Central, and Scopus databases using search terms related to ethics and COVID-19. The search included articles published during the first 9 months of the COVID-19 pandemic. The following data were extracted: presence of an ethical discussion, date of publication, topic of ethical discussion, and scientific discipline of the article. RESULTS: One thousand seven hundred fifty-three articles were included, of which seven were related to plastic surgery. The ethical principle with the greatest representation was nonmaleficence, whereas autonomy had the least representation. Equity and access to care was the most common topic of ethical discussion; the mental health effects of COVID-19 were the least common. The principle of justice had the greatest variation in representation. CONCLUSIONS: In a systematic review of COVID-19-related articles that were published during the first 9 months of the pandemic, the ethical principles of autonomy and justice are neglected in ethical discussions. As ethical dilemmas related to COVID-19 remain prevalent in plastic surgery, attention to ethical discourse should remain a top priority for leaders in the field.

Deontological or Utilitarian? An Eternal Ethical Dilemma in Outbreak.

Both deontological ethics and utilitarian ethics are important theories that affect decision making in medical and health care. However, it has been challenging to reach a balance between these two ethical theories. When there is a conflict between these two ethical principles in the medical context, the conflict must be addressed in order to reach an appropriate solution for patients and others involved. To demonstrate decisions made in terms of deontological ethics and utilitarian ethics, the study will use the film Outbreak as example to further understand these two ethics in relation to epidemiology and public health. The paper will also analyze film scenarios to examine how deontological ethics and utilitarian ethics are involved and strike a balance with different pearspectives to reach an appropriate public health solution. To reach more just solutions, it is essential to determine how to make wise decisions by balancing deontological ethics and utilitarian ethics. However, the decision-making process is complicated because any solution must consider not only medical ethics but also political, environmental, and military issues. In order to reach an appropriate public health decision, those involved should be inclined toward empathy and contemplate things from different ethical perspectives to deal with ethical/moral dilemmas and create greater beneficence and justice for patients and humanity at large.

Caring for their own: How firm actions to protect essential workers and CEO benevolence influenced stakeholder sentiment during the COVID-19 pandemic.

Whereas many workplaces shut down following the onset of the COVID-19 pandemic, many others in essential industries had to remain operational, thus exposing their employees to COVID-19's inherent dangers. These firms were pressed to take immediate action to protect their employees' safety and financial well-being. However, firms varied considerably in the degree to which they took action, and stakeholders appeared to take notice. Leveraging attribution theory, we build theory around the impact of firm actions to protect employee safety and compensation on stakeholder sentiment toward the firm. We further examined how firm leadership helped shape stakeholder sentiment by theorizing about the joint impact of actions with Chief Executive Officer (CEO) benevolence. We built a unique, multisourced data set and tested our theory on a sample of public firms in the consumer staples sector. Our longitudinal analysis of positive stakeholder sentiment expressed on social media demonstrated the importance of these immediate firm actions on sentiment in the initial months of the pandemic. Specifically, firm compensation actions were associated with a growth in positive sentiment over these months, particularly when made by CEOs with high benevolence, whereas firm safety actions led to growth in positive sentiment but only when made by CEOs with low benevolence. We discuss the implications of these findings for our understanding of firm actions and leadership at the onset of the COVID-19 pandemic. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Utilitarian Principlism as a Framework for Crisis Healthcare Ethics.

This paper introduces the model of Utilitarian Principlism as a framework for crisis healthcare ethics. In modern Western medicine, during non-crisis times, principlism provides the four guiding principles in biomedical ethics-autonomy, nonmaleficence, beneficence, and justice; autonomy typically emerges as the decisive principle. The physician-patient relationship is a deontological construct in which the physician's primary duty is to the individual patient and the individual patient is paramount. For this reason, we term the non-crisis ethical framework that guides modern medicine Deontological Principlism. During times of crisis, resources become scarce, standards of care become dynamic, and public health ethics move to the forefront. Healthcare providers are forced to work in non-ideal conditions, and interactions with individual patients must be considered in the context of the crisis. The COVID-19 pandemic has forced healthcare to shift to a more utilitarian framework with a greater focus on promoting the health of communities and populations. This paper puts forth the notion of Utilitarian Principlism as a framework for crisis healthcare ethics. We discuss each of the four principles from a utilitarian perspective and use clinical vignettes, based on real cases from the COVID-19 pandemic, for illustrative purposes. We explore how Deontological Principlism and Utilitarian Principlism are two ends of a spectrum, and the implications to healthcare as we emerge from the pandemic.

To comfort always: Are we ignoring this duty in Covid protocols?

COVID-19 is an amplifier of serious physical suffering and emotional trauma, which together could be all-consuming. It is important for health systems to go beyond methods of prevention and treatment, and focus on the palliation of suffering, and to systematically integrate palliative care into Covid-19 management.

Further, in cases where the triage process indicates poor chances of survival, it is particularly important to respect autonomy by honest and sensitive disclosure of prognosis, and to jointly arrive at goals of care. Hooking every dying person to a ventilator would violate the ethical principles of beneficence and non-maleficence. It is also important to ensure at least electronic communication between the patient and family members.

Keywords: Covid-19, palliative care, end of life care, isolation, quarantine, intensive care, ethics of intubation, consent

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There are no in-principle ethical objections to controlled voluntary SARS-CoV-2 infection.

In response to the COVID-19 pandemic, some authors have advocated a program of controlled voluntary infection (CVI) with SARS-CoV-2. Under CVI, during periods where the medical system is under capacity, volunteers from low-risk groups would be intentionally infected after giving informed consent, and then quarantined until they have developed immunity. Proponents claim that this could have benefits for society, such as building herd immunity and ensuring that critical workers won't be incapacitated during the peak of the infection. They also claim that this could have benefits for individuals, such as being safely exempted from lockdown measures and (for individuals who are likely to be infected anyway) ensuring that the infection happens under relatively less dangerous conditions. Some respond that CVI would unethical. Here, I argue that, while CVI may or may not be ill-advised for empirical reasons, there are no in-principle ethical objections to it (i.e., if CVI would work as well as its proponents think, it would be ethical to implement it). I present three arguments for this conclusion. The first is an argument from informed consent: informed consent to relevantly similar medical procedures renders performing these procedures permissible, so informed consent to CVI would render it permissible. The second is an argument from reasonable beneficence: it draws on recent work by Caspar Hare on relevantly similar choices to argue that CVI is permissible. The third is an argument from precedent: smallpox variolation was permissible, and CVI is relevantly similar to that, so CVI is permissible.

Parental manual ventilation in resource-limited settings: an ethical controversy.

Lower respiratory tract infections are a leading cause of paediatric morbidity and mortality worldwide. Children in low-income countries are disproportionately affected. This is in large part due to limitations in healthcare resources and medical technologies. Mechanical ventilation can be a life-saving therapy for many children with acute respiratory failure. The scarcity of functioning ventilators in low-income countries results in countless preventable deaths. Some hospitals have attempted to adapt to this scarcity by using hand-bag ventilation, as either a bridge to a mechanical ventilator, or until clinical improvement occurs rendering mechanical ventilation no longer necessary. In instances of hand-bag ventilation, an endotracheal tube is first placed. Family members are then asked to play the role of a ventilator, manually compressing a bag repeatedly to inflate the child's lungs. This approach is fraught with numerous ethical challenges. A careful examination of the data and a nuanced approach to the ethical considerations are imperative. Ethical arguments in support of and in opposition to allowing parental hand-bag ventilation are explored, including the best interests of the child, the child's right to an open future, beneficence and parental protection, legitimising substandard care, and finally, contextual concerns. An algorithmic, potentially ethically permissible approach to parental participation in manual ventilation is proposed.

COVID 19: prioritise autonomy, beneficence and conversations before score-based triage.

At the start of the COVID-19 pandemic, mounting demand overwhelmed critical care surge capacities, triggering implementation of triage protocols to determine ventilator allocation. Relying on triage scores to ration care, while relieving clinicians from making morally distressing decisions under high situational pressure, distracts clinicians from what is essentially deeply humanistic issues entrenched in this protracted public health crisis. Such an approach will become increasingly untenable as countries flatten their epidemic curves. Decisions regarding intensive care unit admission are particularly challenging in older people, who are most likely to require critical care, but for whom benefits are most uncertain. Before applying score-based triage, physicians must first discern if older people will benefit from critical care (beneficence) and second, if he wants critical care (autonomy). When deliberating beneficence, physicians should steer away from solely using age-stratified survival probabilities from epidemiological data. Instead, decisions must be based on individualised risk-stratification that encompasses evidence-based predictors of adverse outcomes specific to older adults. Survival will also need to be weighed against burden of treatment, as well as longer term functional deficits and quality-of-life. By identifying the robust older people who may benefit from critical care, clinicians should proceed to elicit his values and preferences that would determine the treatment most aligned with his best interest. During these dialogues, physicians must truthfully convey the emergent clinical reality, discern the older person's therapeutic goals and discuss the feasibility of achieving them. Given that COVID-19 is here to stay, these conversations aimed at achieving goal-cordant care must become a new clinical norm.

Ethics of sharing medical knowledge with the community: is the physician responsible for medical outreach during a pandemic?

A recent update to the Geneva Declaration's 'Physician Pledge' involves the ethical requirement of physicians to share medical knowledge for the benefit of patients and healthcare. With the spread of COVID-19, pockets exist in every country with different viral expressions. In the Chareidi ('ultra-orthodox') religious community, for example, rates of COVID-19 transmission and dissemination are above average compared with other communities within the same countries. While viral spread in densely populated communities is common during pandemics, several reasons have been suggested to explain the blatant flouting of public health regulations. It is easy to fault the Chareidi population for their proliferation of COVID-19, partly due to their avoidance of social media and internet aversion. However, the question remains: who is to blame for their community crisis? The ethical argument suggests that from a public health perspective, the physician needs to reach out and share medical knowledge with the community. The public's best interests are critical in a pandemic and should supersede any considerations of cultural differences. By all indications, therefore, the physician has an ethical obligation to promote population healthcare and share medical knowledge based on ethical concepts of beneficence, non-maleficence, utilitarian ethics as well as social, procedural and distributive justice. This includes the ethical duty to reduce health disparities and convey the message that individual responsibility for health has repercussions within the context of broader social accountability. Creative channels are clearly demanded for this ethical challenge, including measured medical paternalism with appropriate cultural sensitivity in physician community outreach.

Breath Is Life.

This painting memorializes the lives of people who died in the COVID-19 pandemic and people who have died from police brutality.

Understanding Ethical and Legal Obligations in a Pandemic: A Taxonomy of "Duty" for Health Practitioners.

From the ethics perspective, "duty of care" is a difficult and contested term, fraught with misconceptions and apparent misappropriations. However, it is a term that clinicians use frequently as they navigate COVID-19, somehow core to their understanding of themselves and their obligations, but with uncertainty as to how to translate or operationalize this in the context of a pandemic. This paper explores the "duty of care" from a legal perspective, distinguishes it from broader notions of duty on professional and personal levels, and proposes a working taxonomy for practitioners to better understand the concept of "duty" in their response to COVID-19.