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1.
Acad Med ; 96(12): 1682, 2021 12 01.
Article in English | MEDLINE | ID: covidwho-1684826
6.
Am Soc Clin Oncol Educ Book ; 41: e13-e19, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1249567

ABSTRACT

The COVID-19 pandemic and the simultaneous increased focus on structural racism and racial/ethnic disparities across the United States have shed light on glaring inequities in U.S. health care, both in oncology and more generally. In this article, we describe how, through the lens of fundamental ethical principles, an ethical imperative exists for the oncology community to overcome these inequities in cancer care, research, and the oncology workforce. We first explain why this is an ethical imperative, centering the discussion on lessons learned during 2020. We continue by describing ongoing equity-focused efforts by ASCO and other related professional medical organizations. We end with a call to action-all members of the oncology community have an ethical responsibility to take steps to address inequities in their clinical and academic work-and with guidance to practicing oncologists looking to optimize equity in their research and clinical practice.


Subject(s)
Health Equity/statistics & numerical data , Health Status Disparities , Healthcare Disparities/statistics & numerical data , Medical Oncology/methods , Neoplasms/therapy , Racism/prevention & control , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/virology , Health Equity/ethics , Healthcare Disparities/ethics , Humans , Medical Oncology/ethics , Medical Oncology/organization & administration , Neoplasms/diagnosis , Pandemics , Public Health/ethics , Public Health/methods , Public Health/statistics & numerical data , Racism/ethics , SARS-CoV-2/isolation & purification , SARS-CoV-2/physiology , United States
8.
Hastings Cent Rep ; 51(3): 3-4, 2021 May.
Article in English | MEDLINE | ID: covidwho-1239985

ABSTRACT

The Covid-19 pandemic has exposed four myths in bioethics. First, the flood of bioethics publications on how to allocate scarce resources in crisis conditions has assumed authorities would declare the onset of crisis standards of care, yet few have done so. This leaves guidelines in limbo and patients unprotected. Second, the pandemic's realities have exploded traditional boundaries between clinical, research, and public health ethics, requiring bioethics to face the interdigitation of learning, doing, and allocating. Third, without empirical research, the success or failure of ethics guidelines remains unknown, demonstrating that crafting ethics guidance is only the start. And fourth, the pandemic's glaring health inequities require new commitment to learn from communities facing extraordinary challenges. Without that new learning, bioethics methods cannot succeed. The pandemic is a wake-up call, and bioethics must rise to the challenge.


Subject(s)
Bioethical Issues/standards , COVID-19/epidemiology , Health Care Rationing/organization & administration , Biomedical Research/ethics , Biomedical Research/organization & administration , Health Care Rationing/ethics , Health Care Rationing/standards , Health Status Disparities , Healthcare Disparities/ethics , Healthcare Disparities/standards , Humans , Pandemics , Public Health , SARS-CoV-2
9.
Ann Glob Health ; 87(1): 34, 2021 04 01.
Article in English | MEDLINE | ID: covidwho-1173034

ABSTRACT

Background: Incidence and mortality from COVID-19 are starkly elevated in poor, minority and marginalized communities. These differences reflect longstanding disparities in income, housing, air quality, preexisting health status, legal protections, and access to health care. The COVID-19 pandemic and its economic consequences have made these ancient disparities plainly visible. Methodology: As scholars in Catholic research universities committed to advancing both scientific knowledge and social justice, we examined these disparities through the lenses of both epidemiology and ethics. Findings: We see these widening disparities as not only as threats to human health, societal stability, and planetary health, but also as moral wrongs - outward manifestations of unrecognized privilege and greed. They are the concrete consequences of policies that promote structural violence and institutionalize racism. Recommendations: We encourage governments to take the following three scientific and ethical justified actions to reduce disparities, prevent future pandemics, and advance the common good: (1) Invest in public health systems; (2) Reduce economic inequities by making health care affordable to all; providing education, including early education, to all children; strengthening environmental and occupational safeguards; and creating more just tax structures; and (3) Preserve our Common Home, the small blue planet on which we all live.


Subject(s)
COVID-19 , Health Status Disparities , Healthcare Disparities , Minority Health , Quality of Life , Social Justice/standards , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/psychology , Global Health , Healthcare Disparities/ethics , Healthcare Disparities/standards , Healthcare Disparities/statistics & numerical data , Humans , Minority Health/ethics , Minority Health/standards , Minority Health/statistics & numerical data , Quality Improvement , Social Determinants of Health
10.
OMICS ; 25(4): 249-254, 2021 04.
Article in English | MEDLINE | ID: covidwho-1165315

ABSTRACT

Digital health is a rapidly emerging field that offers several promising potentials: health care delivery remotely, in urban and rural areas, in any time zone, and in times of pandemics and ecological crises. Digital health encompasses electronic health, computing science, big data, artificial intelligence, and the Internet of Things, to name but a few technical components. Digital health is part of a vision for systems medicine. The advances in digital health have been, however, uneven and highly variable across communities, countries, medical specialties, and societal contexts. This article critically examines the determinants of digital health (DDH). DDH describes and critically responds to inequities and differences in digital health theory and practice across people, places, spaces, and time. DDH is not limited to studying variability in design and access to digital technologies. DDH is situated within a larger context of the political determinants of health. Hence, this article presents an analysis of DDH, as seen through political science, and the feminist studies of technology and society. A feminist lens would strengthen systems-driven, historically and critically informed governance for DDH. This would be a timely antidote against unchecked destructive/extractive governance narratives (e.g., technocracy and patriarchy) that produce and reproduce the health inequities. Moreover, feminist framing of DDH can help cultivate epistemic competence to detect and reject false equivalences in how we understand the emerging digital world(s). False equivalence, very common in the current pandemic and post-truth era, is a type of flawed reasoning in decision-making where equal weight is given to arguments with concrete material evidence, and those that are conjecture, untrue, or unjust. A feminist conceptual lens on DDH would help remedy what I refer to in this article as "the normative deficits" in science and technology policy that became endemic with the rise of neoliberal governance since the 1980s in particular. In this context, it is helpful to recall the feminist writer Ursula K. Le Guin. Le Guin posed "what if?" questions, to break free from oppressive narratives such as patriarchy and re-imagine technology futures. It is time to envision an emancipated, equitable, and more democratic world by asking "what if we lived in a feminist world?" That would be truly awesome, for everyone, women and men, children, youth, and future generations, to steer digital technologies and the new field of DDH toward broadly relevant, ethical, experiential, democratic, and socially responsive health outcomes.


Subject(s)
COVID-19/epidemiology , Digital Technology/organization & administration , Feminism , Healthcare Disparities/ethics , Pandemics/prevention & control , SARS-CoV-2/pathogenicity , Artificial Intelligence/trends , Big Data , Delivery of Health Care/ethics , Female , Humans , Politics , Public Health/trends
11.
Lancet Haematol ; 8(3): e173-e174, 2021 03.
Article in English | MEDLINE | ID: covidwho-1146162
12.
Ann Surg ; 273(4): e125-e126, 2021 04 01.
Article in English | MEDLINE | ID: covidwho-1132687

ABSTRACT

The SARS-CoV-2 pandemic has highlighted existing systemic inequities that adversely affect a variety of communities in the United States. These inequities have a direct and adverse impact on the healthcare of our patient population. While civic engagement has not been cultivated in surgical and anesthesia training, we maintain that it is inherent to the core role of the role of a physician. This is supported by moral imperative, professional responsibility, and a legal obligation. We propose that such civic engagement and social justice activism is a neglected, but necessary aspect of physician training. We propose the implementation of a civic advocacy education agenda across department, community and national platforms. Surgical and anesthesiology residency training needs to evolve to the meet these increasing demands.


Subject(s)
Anesthesiology/education , Education, Medical, Graduate/methods , Health Status Disparities , Healthcare Disparities , Physician's Role , Social Justice/education , Specialties, Surgical/education , Anesthesiology/ethics , Education, Medical, Graduate/ethics , Health Policy , Healthcare Disparities/ethics , Humans , Patient Advocacy/education , Patient Advocacy/ethics , Social Justice/ethics , Specialties, Surgical/ethics , United States
13.
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
14.
J Korean Med Sci ; 36(3): e31, 2021 Jan 18.
Article in English | MEDLINE | ID: covidwho-1067644

ABSTRACT

The coronavirus disease 2019 pandemic has caused a breakdown in the healthcare system worldwide. The need to rapidly update guidelines in order to control the transmission in the population and for evidenced-based healthcare care has led to the need for timely, voluminous and valid research. Amid the quest for a vaccine and better therapies, researchers clamouring for information has led to a wide variety of ethical issues due to the unique situation. This paper aims to examine the positive and negative aspects of recent changes in the process of obtaining informed consent. The article outlines the various aspects, from history, previously described exemptions to consenting as well as those implemented during the pandemic and the current impact of virtual methods. Further, the authors make recommendations based on the outcome of suggested adjustments described in the literature. This article looks into increasing the awareness of physicians and researchers about ethical issues that need to be addressed to provide optimal care for patients while assuring their integrity and confidentiality.


Subject(s)
COVID-19 , Informed Consent/ethics , Publishing/ethics , SARS-CoV-2 , COVID-19/prevention & control , COVID-19/therapy , COVID-19/transmission , Evidence-Based Medicine , Healthcare Disparities/ethics , Humans , Pandemics , Patient Education as Topic/ethics , Physician-Patient Relations/ethics
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
17.
J Infect Dev Ctries ; 14(9): 968-970, 2020 09 30.
Article in English | MEDLINE | ID: covidwho-842091

ABSTRACT

The COVID-19 pandemic has created new challenges on multiple fronts including a few ethical concerns. Timely and appropriate access to health services and the need to protect vulnerable people are some of them. An important aspect to consider, at the global level, is the frailty of health systems in many developing countries and the constant threat of these collapsing due to shortage of resources and medical supply. Special attention should be placed towards protecting the health of care workers who are highly exposed to SARS-CoV-2 infection. Research and clinical trials involving COVID-19 patients and healthy human volunteers must be done in strict adherence to the fundamental principles of bioethics, even if finding a solution is an urgent need. Shared responsibility must be assumed as we collectively face a common problem and ethical conflicts must be resolved using, as reference, the guidelines developed by the World Health Organization and other relevant international and national organizations. This would allow responsible action in the face of the pandemic without harming human rights, the individual and collective well-being.


Subject(s)
Betacoronavirus , Global Health/ethics , Pandemics/ethics , COVID-19 , Clinical Trials as Topic/ethics , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Coronavirus Infections/therapy , Developing Countries , Health Personnel/ethics , Healthcare Disparities/ethics , Human Rights/ethics , Humans , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Pneumonia, Viral/therapy , SARS-CoV-2 , Triage/ethics
20.
Am J Trop Med Hyg ; 102(6): 1178-1180, 2020 06.
Article in English | MEDLINE | ID: covidwho-668710

ABSTRACT

The 2019 novel coronavirus disease (COVID-19) pandemic highlights the experience of communities in the global South that have grappled with vulnerability and scarcity for decades. In the global North, many frontline workers are now being similarly forced to provide and ration care in unprecedented ways, with minimal guidance. We outline six reflections gained as Western practitioners working in resource-denied settings which inform our current experience with COVID-19. The reflections include the following: managing trauma, remaining flexible in dynamic situations, and embracing discomfort to think bigger about context-specific solutions to collectively build back our systems. Through this contextualized reflection on resilience, we hope to motivate strength and solidarity for providers, patients, and health systems, while proposing critical questions for our response moving forward.


Subject(s)
Betacoronavirus/pathogenicity , Coronavirus Infections/epidemiology , Health Care Rationing/ethics , Health Services Accessibility/economics , Pandemics , Pneumonia, Viral/epidemiology , Public Health/economics , COVID-19 , Clinical Decision-Making/ethics , Coronavirus Infections/diagnosis , Coronavirus Infections/economics , Coronavirus Infections/therapy , Health Care Rationing/economics , Healthcare Disparities/ethics , Humans , Interpersonal Relations , North America/epidemiology , Pandemics/economics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/economics , Pneumonia, Viral/therapy , Practice Guidelines as Topic , Public Health/ethics , SARS-CoV-2 , Uncertainty
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