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6.
Indian J Med Ethics ; VI(2): 1-14, 2021.
Article in English | MEDLINE | ID: covidwho-1206595

ABSTRACT

The world is currently facing another severe pandemic, Covid-19, just four decades after the start of AIDS, and the still increasing incidence of HIV infection continues to be one of the greatest global health challenges. The way the latter was confronted is of fundamental importance for a serious discussion on global health, ethics and human rights, and this experience could and can still be applied to Covid-19. The Covid-19 pandemic has specific characteristics and these will be discussed, in relation to vaccine research and especially to the global right to equal access to products proven to be safe and effective. The article focusses primarily on issues related to Covid-19 vaccines, especially the appropriate use and limits on placebo, the right to post-trial access to placebo arm participants, and the use of an active control for subsequent Phase-3 trials after the approval of other safe and efficacious vaccines. Most importantly, it will emphasise that access to Covid-19 vaccines is a human right, which presupposes the establishment of appropriate ethical standards to ensure universal, equal, and affordable access to healthcare and to vaccines for all, and the imperative need for suspension of patents for products developed for Covid-19. It will consider the role of social determinants that contribute to the severity of Covid-19 and that must be addressed to effectively curb the current syndemic.


Subject(s)
Biomedical Research/standards , COVID-19 Vaccines/standards , COVID-19/prevention & control , Guidelines as Topic , Health Services Accessibility/ethics , Health Services Accessibility/standards , Placebos/standards , Ethics, Medical , Human Rights , Humans , Pandemics , SARS-CoV-2
7.
Clin Obstet Gynecol ; 64(2): 392-397, 2021 06 01.
Article in English | MEDLINE | ID: covidwho-1203758

ABSTRACT

While telemedicine had been utilized in varying ways over the last several years, it has dramatically accelerated in the era of the COVID-19 pandemic. In this article we describe the privacy issues, in relation to the barriers to care for health care providers and barriers to the obstetric patient, licensing and payments for telehealth services, technological issues and language barriers. While there may be barriers to the use of telehealth services this type of care is feasible and the barriers are surmountable.


Subject(s)
Communication Barriers , Health Services Accessibility , Obstetrics , Privacy , Telemedicine , Female , Health Insurance Portability and Accountability Act , Health Services Accessibility/ethics , Health Services Accessibility/legislation & jurisprudence , Health Services Accessibility/organization & administration , Humans , Internet , Licensure , Obstetrics/ethics , Obstetrics/legislation & jurisprudence , Obstetrics/methods , Obstetrics/organization & administration , Pregnancy , Privacy/legislation & jurisprudence , Technology , Telemedicine/ethics , Telemedicine/legislation & jurisprudence , Telemedicine/methods , Telemedicine/organization & administration , United States
12.
J Diabetes Sci Technol ; 15(5): 1005-1009, 2021 09.
Article in English | MEDLINE | ID: covidwho-1085175

ABSTRACT

The COVID-19 pandemic raised distinct challenges in the field of scarce resource allocation, a long-standing area of inquiry in the field of bioethics. Policymakers and states developed crisis guidelines for ventilator triage that incorporated such factors as immediate prognosis, long-term life expectancy, and current stage of life. Often these depend upon existing risk factors for severe illness, including diabetes. However, these algorithms generally failed to account for the underlying structural biases, including systematic racism and economic disparity, that rendered some patients more vulnerable to these conditions. This paper discusses this unique ethical challenge in resource allocation through the lens of care for patients with severe COVID-19 and diabetes.


Subject(s)
COVID-19/therapy , Diabetes Complications/therapy , Diabetes Mellitus/therapy , Resource Allocation , COVID-19/complications , COVID-19/epidemiology , Diabetes Complications/economics , Diabetes Complications/epidemiology , Diabetes Mellitus/economics , Diabetes Mellitus/epidemiology , Health Services Accessibility/economics , Health Services Accessibility/ethics , Health Services Accessibility/standards , Health Services Accessibility/statistics & numerical data , Health Status Disparities , Healthcare Disparities/economics , Healthcare Disparities/ethics , Healthcare Disparities/organization & administration , Healthcare Disparities/statistics & numerical data , Humans , Pandemics , Racism/ethics , Racism/statistics & numerical data , Resource Allocation/economics , Resource Allocation/ethics , Resource Allocation/organization & administration , Resource Allocation/statistics & numerical data , Triage/economics , Triage/ethics , United States/epidemiology , Ventilators, Mechanical/economics , Ventilators, Mechanical/statistics & numerical data , Ventilators, Mechanical/supply & distribution
16.
HEC Forum ; 33(1-2): 157-164, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1030730

ABSTRACT

Oral health is a critical part of overall health. The current COVID-19 pandemic has highlighted the importance of oral health. In this article, we describe how dental practice has been impacted by COVID-19, identify the public health response to COVID-19, and explain the gradual resumption of dental care after the initial disruption due to the pandemic. Finally, we discuss how long-standing health disparities in oral health have been exacerbated by the current pandemic.


Subject(s)
COVID-19/epidemiology , Delivery of Health Care/ethics , Ethics, Dental , Health Services Accessibility/ethics , Healthcare Disparities/ethics , Oral Health/ethics , Humans , Pandemics , Public Health/ethics , SARS-CoV-2
18.
BMC Med Ethics ; 21(1): 40, 2020 05 14.
Article in English | MEDLINE | ID: covidwho-762353

ABSTRACT

BACKGROUND: The world is threatened by future pandemics. Vaccines can play a key role in preventing harm, but there will inevitably be shortages because there is no possibility of advance stockpiling. We therefore need some method of prioritising access. MAIN TEXT: This paper reports a critical interpretative review of the published literature that discusses ethical arguments used to justify how we could prioritise vaccine during an influenza pandemic. We found that the focus of the literature was often on proposing different groups as priorities (e.g. those with pre-existing health conditions, the young, the old, health care workers etc.). Different reasons were often suggested as a means of justifying such priority groupings (e.g. appeal to best overall outcomes, fairness, belonging to a vulnerable or 'at risk' group etc.). We suggest that much of the literature, wrongly, assumes that we are able to plan priority groups prior to the time of a particular pandemic and development of a particular vaccine. We also point out the surprising absence of various issues from the literature (e.g. how vaccines fit within overall pandemic planning, a lack of specificity about place, issues of global justice etc.). CONCLUSIONS: The literature proposes a wide range of ways to prioritise vaccines, focusing on different groups and 'principles'. Any plan to use pandemic vaccine must provide justifications for its prioritisation. The focus of this review was influenza pandemic vaccines, but lessons can be learnt for future allocations of coronavirus vaccine, if one becomes available.


Subject(s)
Disease Outbreaks/prevention & control , Health Priorities/ethics , Health Services Accessibility/ethics , Influenza Vaccines/supply & distribution , Influenza, Human/prevention & control , Humans , Pandemics
19.
J Neurovirol ; 27(1): 168-170, 2021 02.
Article in English | MEDLINE | ID: covidwho-1009224

ABSTRACT

People living with HIV (PLWH) may be at higher risk for adverse outcomes indirectly associated with the severe acute respiratory syndrome coronavirus (SARS-CoV-2). When comparing responses to questionnaires administered when social distancing and quarantine guidelines were first implemented, we found that PLWH were more likely to have restricted access to medical care, increased financial stress, increased symptoms of anxiety and depression, and increased substance use compared to demographically-similar people without HIV.


Subject(s)
Anxiety/epidemiology , COVID-19/epidemiology , Depression/epidemiology , HIV Infections/epidemiology , Pandemics , Stress, Psychological/epidemiology , Substance-Related Disorders/epidemiology , Adult , Aged , Anxiety/economics , Anxiety/psychology , Anxiety/virology , COVID-19/economics , COVID-19/psychology , COVID-19/virology , Comorbidity , Depression/economics , Depression/psychology , Depression/virology , Female , HIV Infections/economics , HIV Infections/psychology , HIV Infections/virology , HIV-1/pathogenicity , Health Services Accessibility/economics , Health Services Accessibility/ethics , Humans , Male , Middle Aged , Missouri/epidemiology , Physical Distancing , Quarantine/economics , Quarantine/psychology , SARS-CoV-2/pathogenicity , Stress, Psychological/economics , Stress, Psychological/virology , Substance-Related Disorders/economics , Substance-Related Disorders/psychology , Substance-Related Disorders/virology , Surveys and Questionnaires
20.
Semergen ; 47(2): 122-130, 2021 Mar.
Article in Spanish | MEDLINE | ID: covidwho-997527

ABSTRACT

Public health emergencies, such as the current SARS-CoV-2 coronavirus pandemic, have led to tragic resource constraints that prevent lives from being saved. This has led to tensions in patient-centered care as the backbone of the system in normal conditions and the same care in emergencies originating in the COVID-19. In this review we address some of the healthcare, organizational and ethical problems that this scenario has caused in primary care such as: cancellation of programmed activities; scarce home care and follow-up of elderly, chronically ill and immobilized patients; shortage of PPE and the exposure to risk of healthcare professionals, and finally the problems associated with telemedicine and telephone attention to patients.


Subject(s)
COVID-19/prevention & control , Health Care Rationing/ethics , Health Services Accessibility/ethics , Infection Control/methods , Primary Health Care/ethics , Telemedicine/ethics , COVID-19/epidemiology , Health Care Rationing/methods , Health Care Rationing/organization & administration , Health Services Accessibility/organization & administration , Health Services for the Aged/ethics , Health Services for the Aged/organization & administration , Humans , Infection Control/instrumentation , Infection Control/organization & administration , Pandemics , Personal Protective Equipment/supply & distribution , Primary Health Care/methods , Primary Health Care/organization & administration , Quality of Health Care/ethics , Quality of Health Care/organization & administration , Spain/epidemiology , Telemedicine/methods , Telemedicine/organization & administration
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