Voluntary COVID-19 vaccination of children: a social responsibility.

Nearly 400 million adults have been vaccinated against COVID-19. Children have been excluded from the vaccination programmes owing to their lower vulnerability to COVID-19 and to the special protections that apply to children's exposure to new biological products. WHO guidelines and national laws focus on medical safety in the process of vaccine approval, and on national security in the process of emergency authorisation. Because children suffer much from social distancing, it is argued that the harms from containment measures should be factored in a broader perspective on the good of the child. Considering the available knowledge on the disease, vaccine, and coping strategies, the decision about vaccine access to children is a public responsibility. The ultimate choice is a matter of paediatric informed consent. Moreover, jurisdictions that permit non-participation in established childhood vaccination programmes should also permit choice of vaccines outside of the approved programmes. Even if vaccine supply is too short to cover the paediatric population, the a priori exclusion of children is unjust. It may also exacerbate local and global inequalities. The second part of the paper delineates a prudent and ethical scheme for gradual incorporation of minors in vaccination programmes that includes a rigorous postvaccination monitoring. This is a theoretical paper in ethics that uses the Pfizer vaccine as a stock example, without discussing possible differences among existing vaccines. The key purpose is reflection on the good of the child in emergencies and vaccine policymaking.

Allocation of Respirators in the Coronavirus Crisis in Israel: An Ethical Analysis and A Scheme for Triage.

BACKGROUND: This focus article is a theoretical reflection on the ethics of allocating respirators to patients in circumstances of shortage, especially during the coronavirus disease-2019 (COVID-19) outbreak in Israel. In this article, respirators are placeholders for similar life-saving modalities in short supply, such as extracorporeal membrane oxygenation machines and intensive care unit beds. In the article, I propose a system of triage for circumstances of scarcity of respirators. The system separates the hopeless from the curable, granting every treatable person a real chance of cure. The scarcity situation eliminates excesses of medicine, and then allocates respirators by a single scale, combining an evidence-based scoring system with risk-proportionate lottery. The triage proposed embodies continuity and consistency with the healthcare practices in ordinary times. Yet, I suggest two regulatory modifications: one in relation to expediting review of novel and makeshift solutions and the second in relation to mandatory retrospective research on all relevant medical data and standard (as opposed to experimental) interventions that are influenced by the triage.

The Role of Doctors in Hunger Strikes.

In its Malta Declaration, The World Medical Association prohibits force-feeding of hunger strikers as "degrading and inhuman," even when this is the only way to save their lives. The European Court of Human Rights ruled that lifesaving force-feeding is compatible with the state's duty to protect the lives of prisoners. To understand how such extreme divergence of opinions has become possible, this paper offers a critical examination of the social history of prisoners' hunger strikes, the philosophy of nonviolence, and the debate on its medicalization. The discourse by actors, professionals, regulators, and scholars on hunger strikes is divided into three paradigms: the "communicative," the "extreme violence," and the "psychiatric." I argue that another paradigm is in play, and its incorporation may enrich and balance the discourse. This is the "wounded combatant" paradigm, according to which hunger strikers are like enemy soldiers who are injured in battle.

[From altruism to altruistic punishment: a criticism on granting priority in the waiting list to donor-card holders].

In 2008 Israel enacted a new law on organ transplantation which granted priority on the waiting list to holders of donor-cards who become patients in need of organ transplantation. This paper offers ethical criticism of the priority system arguing that the "reward" is by necessary also a "punishment". Moreover, because donor-cards have no binding power in Israeli law, the reward/punishment is actually directed at declarations, not actions, and, consequently, violates the freedom of conscience and expression. The reward system is also incompatible with fundamental values of medical ethics and with the very logic of talion, because the law punishes non-signers but not patients who are responsible for the loss of their organs. Lastly, I argue, that because priority on a waiting list is a positional good, it communicates a false message as if donation is an excellence of the few, and it legitimizes a rational choice to prefer wholesomeness of the cadaver to the risk of low rank in the priority list.