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J Law Med Ethics ; 49(4): 633-640, 2021.
Article in English | MEDLINE | ID: covidwho-1616891


This paper examines several decision-making models that have been proposed to limit the use of CPR for COVID-19 patients. My main concern will be to assess proposals for the implementation of unilateral DNRs - i.e., orders to withhold CPR without the agreement of patients or their surrogates.

COVID-19 , Cardiopulmonary Resuscitation , Decision Making , Ethics, Medical , Humans , Resuscitation Orders , SARS-CoV-2
Med Educ Online ; 26(1): 1891610, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1574778


Multiple mini-interview (MMI) is a 'multiple sample-based' approach comprising multiple focused encounters intended to access and assess a range of attributes in order to gain more objectively multiple impressions of an applicant's interpersonal skills, thoughtfulness and general demeanour. It is designed to focus on four domains that are not considered to be comprehensive, but are considered to be vital for a successful career in the health sciences: critical thinking, ethical decision making, communication and knowledge of the healthcare system. Traditionally, the MMI is conducted face-to-face, but with COVID-19 pandemic and the implementation of social distancing measures, no onsite or campus teaching, banning of mass gatherings and cancellation of face-to-face interviews, Pengiran Anak Puteri Rashidah Sa'adatul Bolkiah Institute of Health Sciences at Universiti Brunei Darussalam explored the feasibility of conducting MMI through virtual means. This report provides an account of our experience in conducting internet-MMI for the selection of new applicants into the August 2020 cohort of the Medicine programme. We also aimed to determine whether the scores derived from internet-MMI were reliable and equivalent to the scores derived from traditional MMI.

COVID-19/epidemiology , Interviews as Topic/methods , School Admission Criteria , Schools, Medical/organization & administration , Communication , Decision Making , Ethics, Medical , Health Knowledge, Attitudes, Practice , Humans , Pandemics , SARS-CoV-2 , Thinking
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
Rev. gaúch. enferm ; 42(spe): e20200172, 2021.
Article in English | LILACS (Americas) | ID: covidwho-1410822


ABSTRACT Objective: To reflect about the do-not-resuscitation order at COVID-19 in Brazil, under bioethical focus and medical and nursing professional ethics. Method: Reflection study based on the principlist bioethics of Beauchamps and Childress and in professional ethics, problematizing actions, and decisions of non-resuscitation in the pandemic. Results: It is important to consider the patient's clinic, appropriation of treatment goals for people with comorbidities, elderly people, with less chance of surviving to resuscitation, or less quality of life, with the palliative care team, to avoid dysthanasia, use of scarce resources and greater exposure of professionals to contamination. Conclusion: COVID-19 increased the vulnerabilities of professionals and patients, impacting professional decisions and conduct more widely than important values ​​such as the restriction of freedom. It propelled the population in general to rethink ethical and bioethical values ​​regarding life and death, interfering in decisions about them, supported by human dignity.

RESUMEN Objetivo: Reflexionar sobre el orden de no reanimación en COVID-19 en Brasil, bajo enfoque bioético y ética profesional médica y de enfermería. Método: Estudio de reflexión basado en la bioética principialista de Beauchamps y Childress y ética profesional, acciones problemáticas y decisiones de no reanimación en la pandemia. Resultados: Considerar la clínica del paciente, con un esquema apropiado de los objetivos del tratamiento, especialmente en los ancianos y las personas con comorbilidades y contar con el apoyo del equipo de cuidados paliativos, para evitar la distanasia, así como el mal uso de los recursos y la exposición de los profesionales a la contaminación. Conclusión: COVID-19 aumentó las vulnerabilidades de profesionales y pacientes, impactando decisiones profesionales y conductas más amplias que valores importantes como la restricción de la libertad, pero especialmente haciendo que la población en general reconsidere los valores éticos y bioéticos con respecto a la vida y la muerte, interferir en las decisiones sobre ellos apoyadas por la dignidad humana.

RESUMO Objetivo: Refletir sobre ordem de não reanimação na COVID-19 no Brasil, sob foco bioético e da ética profissional médica e de enfermagem. Método: Estudo de reflexão embasado na bioética principialista de Beauchamps e Childress e na ética profissional, problematizando ações e decisões de não reanimação na pandemia. Resultados: Importa considerar a clínica do paciente, apropriação das metas dos tratamentos de pessoas com comorbidades, idosas, com menores chances de sobreviver à reanimação, ou menor qualidade de vida, junto à equipe de cuidados paliativos, para evitar distanásia, uso dos recursos escassos e maior exposição dos profissionais à contaminação. Conclusão: A COVID-19 ampliou as vulnerabilidades de profissionais e pacientes, impactando nas decisões e condutas profissionais mais amplamente do que nos valores importantes como a restrição da liberdade. Impulsionou a população em geral a repensar valores éticos e bioéticos referentes à vida e à morte, interferindo nas decisões sobre elas, respaldas na dignidade humana.

Humans , Bioethics , Critical Care , Ethics, Nursing , Decision , COVID-19 , Palliative Care/ethics , Brazil , Cardiopulmonary Resuscitation/ethics , Ethics, Medical
Am J Law Med ; 47(2-3): 264-290, 2021 07.
Article in English | MEDLINE | ID: covidwho-1361584


As the coronavirus pandemic intensified, many communities in the United States experienced shortages of ventilators, intensive care beds, and other medical supplies and treatments. Currently, there is no single national response to provide guidance on allocation of scarce health care resources. Accordingly, states have formulated various "triage protocols" to prioritize those who will receive care and those who may not have the same access to health care services when the population demand exceeds the supply. Triage protocols address general concepts of "fairness" under accepted medical ethics rules and the consensus is that limited medical resources "should be allocated to do the greatest good for the greatest number of people."1 The actual utility of this utilitarian ethics approach is questionable, however, leaving many questions about what is "fair" unanswered. Saving as many people as possible during a health care crisis is a laudable goal but not at the expense of ignoring patients's legal rights, which are not suspended during the crisis. This Article examines the triage protocols from six states to determine whose rights are being recognized and whose rights are being denied, answering the pivotal question: If there is potential for disparate impact of facially neutral state triage protocols against Black Americans and other ethnic groups, is this legally actionable discrimination? This may be a case of first impression for the courts to resolve."[B]lack Americans are 3.5 times more likely to die of COVID-19 than [W]hite Americans … . Latinx people are almost twice as likely to die of the disease, compared with [W]hite people." 2 "Our civil rights laws protect the equal dignity of every human life from ruthless utilitarianism … . HHS is committed to leaving no one behind during an emergency, and this guidance is designed to help health care providers meet that goal." - Roger Severino, Office of Civil Rights Director, U.S. Department of Health and Human Services. 3.

COVID-19/ethnology , Civil Rights/legislation & jurisprudence , Ethics, Medical , Health Care Rationing/legislation & jurisprudence , Liability, Legal , Triage/legislation & jurisprudence , Ethical Theory , Humans , Organ Dysfunction Scores , Racism , SARS-CoV-2 , Social Discrimination , United States/epidemiology
Bull Cancer ; 108(9): 787-797, 2021 Sep.
Article in French | MEDLINE | ID: covidwho-1336273


The Curie Institute exclusively cares for cancer patients, who were considered particularly "vulnerable" from the start of the SARS-CoV 2 pandemic. This pandemic, which took the medical world by surprise, suddenly required the Institute's hospital to undergo rapid and multimodal restructuring, while having an impact on everyone to varying degrees. We will examine here how this hospital has coped, with the concern for a new benefit-risk balance, in times of greater medical uncertainty and scarcity of certain resources, for these "vulnerable" patients but also for their relatives and staff. We will highlight by theme the positive aspects and difficulties encountered, and then what could be useful for other hospitals as the pandemic is ongoing.

COVID-19/epidemiology , Cancer Care Facilities/organization & administration , Pandemics , SARS-CoV-2 , Delivery of Health Care/organization & administration , Ethics, Medical , Family , Guidelines as Topic , Health Resources/supply & distribution , Humans , Personnel Administration, Hospital , Pilot Projects , Psychotherapy/organization & administration , Remote Consultation , Research/organization & administration , Risk Assessment/methods , Teleworking , Videoconferencing/organization & administration
J Med Ethics ; 47(8): 529-530, 2021 08.
Article in English | MEDLINE | ID: covidwho-1327703
Postgrad Med J ; 97(1150): 498-500, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1322840


BACKGROUND: Healthcare workers often use terms such as Apgar, Babinski or Glasgow in their routine duties. These terms are used worldwide; they are universal and recognised in various languages. Medical eponyms are immutable by the nature; they save valuable time by streamlining communication among health professionals. However, some of these terms lack accuracy and lead to confusion. OBJECTIVE AND METHODS: This perspective article aims to analyse the current status of the divergent trends about redeeming (or not) the long-standing tradition of using medical eponyms. Multiple positions regarding the use of these terms have been expressed in the medical literature, and these are summarised in the manuscript. Although, this compilation is based primarily on the author's medical background and experience. RESULTS: There is an interesting debate in the scientific community about the suitability of certain eponyms. Defenders and detractors argue a broad spectrum of points, but there is still no international consensus. The use of classical, ethical and well-recognised medical eponyms will remain a cornerstone in daily clinical settings, textbooks and medical journals. However, their use can be inconsistent or confused in specific conditions, and they can be influenced by local geography and culture. CONCLUSIONS: There is a need to refrain from using unethical and controversial eponyms throughout the whole of science. Further academic and scientific efforts should be addressed to provide a structural systematisation, semantic classification and etymological categorisation on the use of medical eponyms.

Eponyms , Ethics, Medical , Health Personnel , Humans
Acta Paediatr ; 110(11): 2964-2967, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1299091
JAMA Intern Med ; 181(8): 1031-1032, 2021 08 01.
Article in English | MEDLINE | ID: covidwho-1258011