Ethical Challenges in Health Care Policy during COVID-19 Pandemic in Italy.

Since the outbreak of the coronavirus disease 2019 (COVID-19) pandemic, Italy has proven to be one of the countries with the highest coronavirus-linked death rate. To reduce the impact of SARS-CoV-2 coronavirus, the Italian Government decision-makers issued a series of law decrees that imposed measures limiting social contacts, stopped non-essential production activities, and restructured public health care in order to privilege assistance to patients infected with SARS-CoV-2. Health care services were substantially limited including planned hospitalization and elective surgeries. These substantial measures were criticized due to their impact on individual rights including freedom and autonomy, but were justified by the awareness that hospitals would have been unable to cope with the surge of infected people who needed treatment for COVID-19. The imbalance between the need to guarantee ordinary care and to deal with the pandemic, in a context of limited health resources, raises ethical concerns as well as clinical management issues. The emergency scenario caused by the COVID-19 pandemic, especially in the lockdown phase, led the Government and health care decision-makers to prioritize community safety above the individuals' rights. This new community-centered approach to clinical care has created tension among the practitioners and exposed health workers to malpractice claims. Reducing the morbidity and mortality rates of the COVID-19 pandemic is the priority of every government, but the legitimate question remains whether the policy that supports this measure could be less harmful for the health care system.

Ethical Issues in COVID-19 Communication to Mitigate the Pandemic: Dilemmas and Practical Implications.

Communication plays a critical role in all stages of a pandemic. From the moment it is officially declared governments and public health organizations aim to inform the public about the risk from the disease and to encourage people to adopt mitigation practices. The purpose of this article is to call attention to the multiple types and the complexity of ethical challenges in COVID-19 communication. Different types of ethical issues in COVID-19 communication are presented in four main sections. The first deals with ethical issues in informing the public about the risk of the pandemic and dilemmas regarding communicating uncertainty, using threats and scare tactics, and framing the pandemic as a war. The second concerns unintended consequences that relate to increasing inequities, stigmatization, ageism, and delaying medical care. The third raises ethical issues in communicating about specific mitigation practices: contact tracing, wearing face masks, spatial (also referred to as social) distancing, and handwashing or sanitizing. The fourth concerns appealing to positive social values associated with solidarity and personal responsibility, and ethical challenges when using these appeals. The article concludes with a list of practical implications and the importance of identifying ethical concerns, which necessitate interdisciplinary knowledge, cross-disciplinary collaborations, public discourse and advocacy.

Restarting Orthopaedic Care in a Pandemic: Ethical Framework and Case Examples.

The question about how to resume typical orthopaedic care during a pandemic, such as coronavirus disease 2019, should be framed not only as a logistic or safety question but also as an ethical question. The current published guidelines from surgical societies do not explicitly address ethical dilemmas, such as why public health ethics requires a cessation of nonemergency surgery or how to fairly allocate limited resources for delayed surgical care. We propose ethical guidance for the resumption of care on the basis of public health ethics with a focus on clinical equipoise, triage tiers, and flexibility. We then provide orthopaedic surgery examples to guide physicians in the ethical resumption of care.