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1.
J Prev Med Public Health ; 54(5): 360-369, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1471032

ABSTRACT

OBJECTIVES: The purpose of this study was to investigate public preferences regarding allocation principles for scarce medical resources in the coronavirus disease 2019 (COVID-19) pandemic, particularly in comparison with the recommendations of ethicists. METHODS: An online survey was conducted with a nationally representative sample of 1509 adults residing in Korea, from November 2 to 5, 2020. The degree of agreement with resource allocation principles in the context of the medical resource constraints precipitated by the COVID-19 pandemic was examined. The results were then compared with ethicists' recommendations. We also examined whether the perceived severity of COVID-19 explained differences in individual preferences, and by doing so, whether perceived severity helps explain discrepancies between public preferences and ethicists' recommendations. RESULTS: Overall, the public of Korea agreed strongly with the principles of "save the most lives," "Koreans first," and "sickest first," but less with "random selection," in contrast to the recommendations of ethicists. "Save the most lives" was given the highest priority by both the public and ethicists. Higher perceived severity of the pandemic was associated with a greater likelihood of agreeing with allocation principles based on utilitarianism, as well as those promoting and rewarding social usefulness, in line with the opinions of expert ethicists. CONCLUSIONS: The general public of Korea preferred rationing scarce medical resources in the COVID-19 pandemic predominantly based on utilitarianism, identity and prioritarianism, rather than egalitarianism. Further research is needed to explore the reasons for discrepancies between public preferences and ethicists' recommendations.


Subject(s)
COVID-19 , Health Resources/supply & distribution , Pandemics , Public Opinion , Adult , Aged , Ethicists , Female , Health Care Rationing/ethics , Health Resources/ethics , Humans , Male , Middle Aged , Republic of Korea , Surveys and Questionnaires , Young Adult
2.
Ann Ist Super Sanita ; 57(2): 113-120, 2021.
Article in English | MEDLINE | ID: covidwho-1271020

ABSTRACT

The issue of political, institutional and professional liability in the context of the SARS-COV-2 pandemic is currently widely debated and involves several levels of investigation. One crucial aspect relates to the allocation of life-saving resources in situations where there is an imbalance between need and availability and the associated questions of ethical and legal liability. This work looks at the implications of the criteria applied to rationing under extraordinary conditions and the issue of their legitimacy. Considering the European scenario, we describe the approach taken by Italy in proposing criteria for pandemic triage of intensive treatment and highlight certain problems and critical issues. We emphasise that the decision, based on a comparative assessment, to deny treatment to a patient in critical condition, compromising that patient's right to care, exceeds the scope of decision-making autonomy of the professional concerned and requires a theoretical and procedural definition shared at multiple levels of society.


Subject(s)
COVID-19 , Health Resources/ethics , Health Resources/legislation & jurisprudence , Liability, Legal , Pandemics , Humans , Intensive Care Units , Italy
3.
Rev Esp Anestesiol Reanim (Engl Ed) ; 68(1): 28-36, 2021 Jan.
Article in English, Spanish | MEDLINE | ID: covidwho-915684

ABSTRACT

The entire world has suffered the devastating action of the SARS-CoV-2/COVID-19 pandemic. This is the ideal moment to stop and ask ourselves what happened and how we acted; to reflect on what we have learned not only for similar situations but for all of our clinical practice. This work is an ethical reflection via the clinical experience of professionals dedicated to the care of critical patients in one of the countries most affected by the SARS-CoV-2/COVID-19 pandemic in the world. Some of the moral values and categories involved in decision-making in situations of limited resources are analysed, and the need for bioethics to be a part of daily practice is proposed, along with some strategies for doing so, thus facilitating decision-making by the health professional and fair and appropriate care for the patient in situations of particular vulnerability such as those experienced in this health and social crisis.


Subject(s)
Bioethical Issues , COVID-19 , Delivery of Health Care/ethics , Health Resources/ethics , Humans
4.
Bioethics ; 35(3): 229-236, 2021 03.
Article in English | MEDLINE | ID: covidwho-868047

ABSTRACT

Age rationing is a central issue in the health care priority-setting literature, but it has become ever more salient in the light of the Covid-19 outbreak, where health authorities in several countries have given higher priority to younger over older patients. But how is age rationing different under outbreak circumstances than under normal circumstances, and what does this difference imply for ethical theories? This is the topic of this paper. The paper argues that outbreaks such as that of Covid-19 involve special circumstances that change how age should influence our prioritization decisions, and that while this shift in circumstances poses a problem for consequentialist views such as utilitarianism and age-weighted consequentialism, contractualism is better equipped to cope with it. The paper then offers a contractualist prudential account of age rationing under outbreak circumstances.


Subject(s)
Disease Outbreaks/ethics , Ethical Analysis , Ethical Theory , Health Care Rationing/ethics , Health Priorities/ethics , Health Resources/ethics , Age Factors , COVID-19/epidemiology , Humans
7.
Cuad Bioet ; 31(102): 231-243, 2020.
Article in Spanish | MEDLINE | ID: covidwho-761287

ABSTRACT

The crisis in the health system caused by COVID-19 has left some important humanitarian deficits on how to care for the sick in their last days of life. The humanization of the dying process has been affected in three fundamental aspects, each of which constitutes a medical and ethical duty necessary. In this study, I analyze why dying accompanied, with the possibility of saying goodbye and receiving spiritual assistance, constitutes a specific triad of care and natural obligations that should not be overlooked - even in times of health crisis - if we do not want to see human dignity violated and violated some fundamental rights derived from it.


Subject(s)
Betacoronavirus , Nursing Homes/ethics , Pandemics/ethics , Aged , COVID-19 , Coronavirus Infections/prevention & control , Ethics Committees , Health Policy , Health Resources/ethics , Health Resources/supply & distribution , Humans , Information Dissemination , Pandemics/prevention & control , Personhood , Pneumonia, Viral/prevention & control , Practice Guidelines as Topic , Resource Allocation/ethics , SARS-CoV-2 , Social Justice , UNESCO , Vulnerable Populations
8.
Cuad Bioet ; 31(102): 183-202, 2020.
Article in Spanish | MEDLINE | ID: covidwho-761284

ABSTRACT

The article deals with the analysis of the criteria for the allocation of scarce health resources during the pandemic produced by the COVID 19 virus in Spain. It critically analyses the absence of a legal-constitutional perspective in the elaboration of such criteria and suggests the incorporation of the criterion of equity as a guarantee of the effective exercise of the constitutional right to health protection by vulnerable persons.


Subject(s)
Betacoronavirus , Health Resources/ethics , Pandemics/ethics , Resource Allocation/ethics , COVID-19 , Constitution and Bylaws , Coronavirus Infections/prevention & control , Ethical Theory , Government Agencies , Health Priorities , Health Resources/legislation & jurisprudence , Health Resources/supply & distribution , Health Services Accessibility/ethics , Health Services Accessibility/legislation & jurisprudence , Human Rights/legislation & jurisprudence , Humans , Minority Groups , Pandemics/legislation & jurisprudence , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Publications , Resource Allocation/legislation & jurisprudence , Role , SARS-CoV-2 , Social Justice , Societies, Medical , Spain/epidemiology , Triage/ethics , Vulnerable Populations
9.
Cuad Bioet ; 31(102): 167-182, 2020.
Article in Spanish | MEDLINE | ID: covidwho-761283

ABSTRACT

In this paper present, from a bioethical perspective, a reflection on how to reconcile efforts to combat the COVID-19 pandemic with the safeguard of human rights. To do this, I develop three points. First, the regulatory framework that justifies the restriction or suspension of rights in the face of serious threats to public health. Second, the declarations of the international bioethics committees on the way in which human rights should be protected during public health crisis. And third, a review of the main rights threatened both by the public health crisis and by the means adopted to combat it. Before going into each of these points, I offer a preliminary note to clarify certain legal concepts and underline the need to overcome disjunctive approaches in considering human rights.


Subject(s)
Betacoronavirus , Communicable Disease Control/legislation & jurisprudence , Human Rights/ethics , Pandemics/prevention & control , Public Health/ethics , COVID-19 , Communicable Disease Control/methods , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Ethics Committees , European Union , Freedom , Health Resources/ethics , Health Resources/supply & distribution , Health Services Accessibility/ethics , Human Rights/legislation & jurisprudence , Humans , Pandemics/ethics , Pandemics/legislation & jurisprudence , Patient Rights/ethics , Patient Rights/legislation & jurisprudence , Personal Autonomy , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Practice Guidelines as Topic , Public Health/legislation & jurisprudence , Quarantine/ethics , Quarantine/legislation & jurisprudence , Research Subjects , Resource Allocation/ethics , SARS-CoV-2 , Spain , UNESCO
10.
Dev World Bioeth ; 21(1): 36-43, 2021 03.
Article in English | MEDLINE | ID: covidwho-730401

ABSTRACT

The COVID-19 pandemic has raised important universal public health challenges. Conceiving ethical responses to these challenges is a public health imperative but must take context into account. This is particularly important in sub-Saharan Africa (SSA). In this paper, we examine how some of the ethical recommendations offered so far in high-income countries might appear from a SSA perspective. We also reflect on some of the key ethical challenges raised by the COVID-19 pandemic in low-income countries suffering from chronic shortages in health care resources, and chronic high morbidity and mortality from non-COVID-19 causes. A parallel is drawn between the distribution of severity of COVID-19 disease and the classic "Fortune at the bottom of the pyramid" model that is relevant in SSA. Focusing allocation of resources during COVID-19 on the 'thick' part of the pyramid in Low-to-Middle Income Countries (LMICs) could be ethically justified on utilitarian and social justice grounds, since it prioritizes a large number of persons who have been economically and socially marginalized. During the pandemic, importing allocation frameworks focused on the apex of the pyramid from the global north may therefore not always be appropriate. In a post-COVID-19 world, we need to think strategically about how health care systems can be financed and structured to ensure broad access to adequate health care for all who need it. The root problems underlying health inequity, exposed by COVID-19, must be addressed, not just to prepare for the next pandemic, but to care for people in resource poor settings in non-pandemic times.


Subject(s)
COVID-19/prevention & control , Decision Making , Developing Countries , Ethical Theory , Health Care Rationing/ethics , Health Resources/ethics , Africa South of the Sahara/epidemiology , Health Personnel/ethics , Humans , Social Justice
14.
Recenti Prog Med ; 111(4): 207-211, 2020 Apr.
Article in Italian | MEDLINE | ID: covidwho-110237

ABSTRACT

On February 21st, 2020 the first case of severe acute respiratory syndrome due to the coronavirus 2 (SARS-CoV-2) causing the CoViD-19 disease, was identified in Italy. In the following days, despite the restrictive public health measures aimed to avoid the infection's spread, the number of cases increased. As of March 8th, 2020, Italy is the 2nd most affected country in the world. As of March 6th, 2020, the Italian Society of Anesthesia Analgesia Resuscitation and Intensive Care (SIAARTI) published operational recommendations and ethical considerations to support the clinicians involved in the care of critically-ill CoViD-19 patients, in regard a probable scenario where an imbalance between supply and demand of ICU beds, is put in place by a steadily rising number of these patients.


Subject(s)
Coronavirus Infections , Critical Care , Decision Making/ethics , Health Resources , Hospital Bed Capacity , Pandemics , Pneumonia, Viral , Resource Allocation , Betacoronavirus , COVID-19 , Coronavirus Infections/epidemiology , Critical Care/statistics & numerical data , Health Resources/ethics , Humans , Italy , Pneumonia, Viral/epidemiology , Resource Allocation/ethics , SARS-CoV-2
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