Asunto(s)
Planificación Anticipada de Atención , Betacoronavirus , Infecciones por Coronavirus/epidemiología , Consentimiento Informado/normas , Neumonía Viral/epidemiología , Órdenes de Resucitación , Apoyo Vital Cardíaco Avanzado , Factores de Edad , COVID-19 , Reanimación Cardiopulmonar , Enfermedad Crónica , Toma de Decisiones Clínicas , Formularios de Consentimiento/normas , Infecciones por Coronavirus/transmisión , Humanos , Inutilidad Médica , Pandemias , Neumonía Viral/transmisión , SARS-CoV-2 , Consentimiento por TercerosRESUMEN
Harrowing stories reported in the media describe Covid-19 ravaging through families. This essay reports professional experiences of this phenomenon, family clustering, as encountered during the pandemic's spread across Southern California. We identify three ethical challenges following from it: Family clustering impedes shared decision-making by reducing available surrogate decision-makers for incapacitated patients, increases the emotional burdens of surrogate decision-makers, and exacerbates health disparities for and the suffering of people of color at increased likelihood of experiencing family clustering. We propose that, in response to these challenges, efforts in advance care planning be expanded, emotional support offered to surrogates and family members be increased, more robust state guidance be issued on ethical decision-making for unrepresented patients, ethics consultation be increased in the setting of conflict following from family clustering dynamics, and health care professionals pay more attention to systemic and personal racial biases and inequities that affect patient care and the surrogate experience.
Asunto(s)
Planificación Anticipada de Atención , COVID-19/epidemiología , Salud de la Familia , Familia/psicología , Salud de las Minorías , Atención al Paciente , Planificación Anticipada de Atención/ética , Planificación Anticipada de Atención/legislación & jurisprudencia , California/epidemiología , Análisis por Conglomerados , Toma de Decisiones Conjunta , Salud de la Familia/ética , Salud de la Familia/etnología , Disparidades en el Estado de Salud , Humanos , Salud de las Minorías/ética , Salud de las Minorías/etnología , Atención al Paciente/ética , Atención al Paciente/psicología , SARS-CoV-2 , Apoyo Social , Consentimiento por Terceros/éticaAsunto(s)
Vacunas contra la COVID-19/uso terapéutico , COVID-19/prevención & control , Apoderado , Consentimiento por Terceros , Vacunación/legislación & jurisprudencia , Poblaciones Vulnerables , Equidad en Salud/legislación & jurisprudencia , Equidad en Salud/normas , Disparidades en Atención de Salud , Humanos , Apoderado/legislación & jurisprudencia , SARS-CoV-2 , Consentimiento por Terceros/legislación & jurisprudencia , Estados Unidos , Vacunación/normas , Poblaciones Vulnerables/legislación & jurisprudenciaRESUMEN
Unaccompanied migrant children seeking asylum status in the United States are often forced to undergo dental radiographs, or x-rays, to verify that they are younger than 18 years.The application of third molar dental radiographs is methodologically flawed and should not be employed as a determinant of chronological age. Furthermore, the use of such tests without obtaining informed consent from either the youth or an objective advocate is unethical.Finally, the legal and health consequences of these inappropriately applied tests are severe and jeopardize the safety and security of these vulnerable minors.
Asunto(s)
Determinación de la Edad por los Dientes/métodos , Radiografía Dental/ética , Refugiados , Adolescente , Niño , Humanos , Tercer Molar/diagnóstico por imagen , Radiografía Dental/efectos adversos , Radiografía Dental/métodos , Consentimiento por Terceros/éticaRESUMEN
The current coronavirus disease 2019 (COVID-19) pandemic has triggered an intense global research effort to inform the life-saving work of frontline clinicians who need reliable information as soon as possible. Yet research done in pressured circumstances can lead to ethical dilemmas, especially for vulnerable research subjects. We present the case of a child with neurocognitive impairment who is diagnosed with COVID-19 infection after presenting with fever and a seizure. The child lives in a group home and is in the custody of the state; her parents lost parental rights many years ago. Some members of the health care team want to enroll her in a randomized clinical trial evaluating an experimental treatment of COVID-19. For minor patients to enroll in this clinical trial, the institutional review board requires assent of patients and consent of guardians. An ethics consult is called to help identify relevant concerns in enrollment. In the accompanying case discussion, we address historical perspectives on research involving people with disabilities; proper management of research participation for people with disabilities including consent by proxy, therapeutic misconception, and other threats to the ethical validity of clinical trials; and the potentially conflicting obligations of researchers and clinicians.