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Hong Kong Med J ; 26(3): 271-272, 2020 06.
Article in English | MEDLINE | ID: covidwho-1468781
J Med Ethics ; 46(8): 505-507, 2020 08.
Article in English | MEDLINE | ID: covidwho-1467731


COVID-19 is reducing the ability to perform surgical procedures worldwide, giving rise to a multitude of ethical, practical and medical dilemmas. Adapting to crisis conditions requires a rethink of traditional best practices in surgical management, delving into an area of unknown risk profiles. Key challenging areas include cancelling elective operations, modifying procedures to adapt local services and updating the consenting process. We aim to provide an ethical rationale to support change in practice and guide future decision-making. Using the four principles approach as a structure, Medline was searched for existing ethical frameworks aimed at resolving conflicting moral duties. Where insufficient data were available, best guidance was sought from educational institutions: National Health Service England and The Royal College of Surgeons. Multiple papers presenting high-quality, reasoned, ethical theory and practice guidance were collected. Using this as a basis to assess current practice, multiple requirements were generated to ensure preservation of ethical integrity when making management decisions. Careful consideration of ethical principles must guide production of local guidance ensuring consistent patient selection thus preserving equality as well as quality of clinical services. A critical issue is balancing the benefit of surgery against the unknown risk of developing COVID-19 and its associated complications. As such, the need for surgery must be sufficiently pressing to proceed with conventional or non-conventional operative management; otherwise, delaying intervention is justified. For delayed operations, it is our duty to quantify the long-term impact on patients' outcome within the constraints of pandemic management and its long-term outlook.

Coronavirus Infections/complications , Decision Making/ethics , Ethics, Medical , General Surgery/ethics , Health Equity/ethics , Pandemics/ethics , Patient Selection/ethics , Pneumonia, Viral/complications , Betacoronavirus , COVID-19 , Coronavirus Infections/virology , Cost-Benefit Analysis , England , Ethical Analysis , Ethical Theory , Humans , Informed Consent/ethics , Moral Obligations , Pneumonia, Viral/virology , Practice Guidelines as Topic , Principle-Based Ethics , Risk Assessment , SARS-CoV-2 , State Medicine , Surgeons , Surgical Procedures, Operative
J Med Ethics ; 46(8): 510-513, 2020 08.
Article in English | MEDLINE | ID: covidwho-1467730


During the COVID-19 pandemic, the media have repeatedly praised healthcare workers for their 'heroic' work. Although this gratitude is undoubtedly appreciated by many, we must be cautious about overuse of the term 'hero' in such discussions. The challenges currently faced by healthcare workers are substantially greater than those encountered in their normal work, and it is understandable that the language of heroism has been evoked to praise them for their actions. Yet such language can have potentially negative consequences. Here, I examine what heroism is and why it is being applied to the healthcare workers currently, before outlining some of the problems associated with the heroism narrative currently being employed by the media. Healthcare workers have a clear and limited duty to treat during the COVID-19 pandemic, which can be grounded in a broad social contract and is strongly associated with certain reciprocal duties that society has towards healthcare workers. I argue that the heroism narrative can be damaging, as it stifles meaningful discussion about what the limits of this duty to treat are. It fails to acknowledge the importance of reciprocity, and through its implication that all healthcare workers have to be heroic, it can have negative psychological effects on workers themselves. I conclude that rather than invoking the language of heroism to praise healthcare workers, we should examine, as a society, what duties healthcare workers have to work in this pandemic, and how we can support them in fulfilling these.

Coronavirus Infections , Courage , Delivery of Health Care , Health Personnel , Mass Media , Pandemics , Pneumonia, Viral , Public Opinion , Attitude to Health , Betacoronavirus , COVID-19 , Communication , Coronavirus Infections/virology , Humans , Moral Obligations , Pneumonia, Viral/virology , SARS-CoV-2 , Social Responsibility
J Med Ethics ; 46(8): 495-498, 2020 08.
Article in English | MEDLINE | ID: covidwho-1467727


Key ethical challenges for healthcare workers arising from the COVID-19 pandemic are identified: isolation and social distancing, duty of care and fair access to treatment. The paper argues for a relational approach to ethics which includes solidarity, relational autonomy, duty, equity, trust and reciprocity as core values. The needs of the poor and socially disadvantaged are highlighted. Relational autonomy and solidarity are explored in relation to isolation and social distancing. Reciprocity is discussed with reference to healthcare workers' duty of care and its limits. Priority setting and access to treatment raise ethical issues of utility and equity. Difficult ethical dilemmas around triage, do not resuscitate decisions, and withholding and withdrawing treatment are discussed in the light of recently published guidelines. The paper concludes with the hope for a wider discussion of relational ethics and a glimpse of a future after the pandemic has subsided.

Decision Making/ethics , Ethics, Clinical , Health Care Rationing/ethics , Health Equity/ethics , Health Personnel/ethics , Pandemics/ethics , Betacoronavirus , COVID-19 , Coronavirus Infections/virology , Disaster Planning , Humans , Moral Obligations , Pneumonia, Viral/virology , Poverty , Practice Guidelines as Topic , Professional-Patient Relations , Resuscitation Orders , SARS-CoV-2 , Social Values , Triage/ethics , Vulnerable Populations , Withholding Treatment/ethics
J Med Ethics ; 46(8): 514-525, 2020 08.
Article in English | MEDLINE | ID: covidwho-1467726


BACKGROUND: Humanitarian crises and emergencies, events often marked by high mortality, have until recently excluded palliative care-a specialty focusing on supporting people with serious or terminal illness or those nearing death. In the COVID-19 pandemic, palliative care has received unprecedented levels of societal attention. Unfortunately, this has not been enough to prevent patients dying alone, relatives not being able to say goodbye and palliative care being used instead of intensive care due to resource limitations. Yet global guidance was available. In 2018, the WHO released a guide on 'Integrating palliative care and symptom relief into the response to humanitarian emergencies and crises'-the first guidance on the topic by an international body. AIMS: This paper argues that while a landmark document, the WHO guide took a narrowly clinical bioethics perspective and missed crucial moral dilemmas. We argue for adding a population-level bioethics lens, which draws forth complex moral dilemmas arising from the fact that groups having differential innate and acquired resources in the context of social and historical determinants of health. We discuss dilemmas concerning: limitations of material and human resources; patient prioritisation; euthanasia; and legacy inequalities, discrimination and power imbalances. IMPLICATIONS: In parts of the world where opportunity for preparation still exists, and as countries emerge from COVID-19, planners must consider care for the dying. Immediate steps to support better resolutions to ethical dilemmas of the provision of palliative care in humanitarian and emergency contexts will require honest debate; concerted research effort; and international, national and local ethical guidance.

Bioethical Issues , Delivery of Health Care/ethics , Disaster Planning , Palliative Care/ethics , Pandemics/ethics , Terminal Care/ethics , Altruism , Betacoronavirus , Bioethics , COVID-19 , Coronavirus Infections/therapy , Coronavirus Infections/virology , Critical Care , Decision Making/ethics , Emergencies , Ethics, Clinical , Global Health , Health Care Rationing , Health Equity , Health Resources , Humans , Pneumonia, Viral/therapy , Pneumonia, Viral/virology , Practice Guidelines as Topic , SARS-CoV-2 , Socioeconomic Factors , Stress, Psychological
Zhongguo Xue Xi Chong Bing Fang Zhi Za Zhi ; 32(1): 7-9, 2020 Feb 27.
Article in Chinese | MEDLINE | ID: covidwho-1456574


Since the end of 2019, the coronavirus disease 2019 (COVID-19) has been extensively epidemic in China, which not only seriously threatens the safety and health of Chinese people, but also challenges the management of other infectious diseases. Currently, there are still approximately three thousand malaria cases imported into China every year. If the diagnosis and treatment of malaria cases as well as the investigation and response of the epidemic foci are not carried out timely, it may endanger patients'lives and cause the possible of secondary transmission, which threatens the achievements of malaria elimination in China. Due to the extensive spread and high transmission ability of the COVID-19, there is a possibility of virus infections among malaria cases during the medical care-seeking behaviors and among healthcare professionals during clinical diagnosis and treatment, sample collection and testing and epidemiological surveys. This paper analyzes the challenges of the COVID-19 for Chinese malaria elimination programme, and proposes the countermeasures in response to the COVID-19 outbreak, so as to provide the reference for healthcare professionals.

Coronavirus Infections/epidemiology , Disease Outbreaks , Malaria , Pneumonia, Viral/epidemiology , Betacoronavirus , COVID-19 , China , Coronavirus Infections/prevention & control , Humans , Malaria/epidemiology , Malaria/prevention & control , Malaria/transmission , National Health Programs , Pneumonia, Viral/prevention & control , SARS-CoV-2