"I was afraid to go to the hospital": A qualitative analysis and ethical implications of the impacts of COVID-19 on the health and medical care of older adults in Ethiopia.

Objective: The COVID-19 pandemic has brought severe health consequences among older adults and posed ethical challenges. The aim of this study was to explore the impacts of COVID-19 on the health and medical care of older adults in Ethiopia and associated ethical implications, regardless of older adults' COVID-19 infection status. Methods: In this qualitative study, we followed an inductive exploratory approach based on reflexive thematic analysis. We conducted semistructured interviews between March 2021 and November 2021 with 20 older adults and 26 health professionals who were selected from healthcare facilities and communities in Ethiopia using purposive and snowball sampling techniques. We audio-recorded, transcribed, translated, and inductively analyzed the interviews using thematic analysis. Results: Participants reported that the pandemic compromised the accessibility and quality of both COVID and non-COVID healthcare services for older adults, which negatively impacted older adults' health conditions and medical care. Moreover, participants elaborated on the health conditions and care of older patients with COVID-19 and highlighted that older COVID-19 patients often have severe health conditions, do not get adequate COVID-19 care, and may receive lower priority for admission to intensive care units compared to younger patients when resources are limited. Conclusions: Results of this study showed that practices of COVID-19 care and measures may have led to adverse consequences such as limited availability and access to aged care in Ethiopia, which could have further health consequences on older patients. Our results contribute to a better understanding of ethical issues such as distributive justice and prioritization arising in the healthcare of older patients in times of global pandemic. It is imperative for local and international health policymakers and ethicists to further analyze and address the challenges that compromise the accessibility and continuity of quality care for older persons during a public healthcare crisis.

COVID-19 ethics: unique aspects and a review as of early 2024.

COVID-19 presents a variety of ethical challenges in a set of arenas, arenas not always considered in past pandemics. These challenges include issues related to autonomy, distributive ethics, and the establishment of policies of equity and justice. Methods are a literature review based on regular editing of an online textbook during the COVID-19 outbreak and a literature review using key ethical terms. Patients are confronted with new issues related to autonomy. Providers need to expand their concepts of ethical issues to include decisions based on proportionality and public health ethics. The public health sector needs to assess the beneficence of alternative modes of disease control. The research community needs to redefine the concept of informed consent in emergent conditions. All elements of the medical spectrum-physicians, scientists, and the community-at-large including the pharmaceutical industry-need to consider the multifaceted methods for preventing future pandemics. This will require giving particular emphasis to public health funding and ending the documented discrimination that exists in the provision of proven therapies. The developing world is especially at risk for most of the ethical issues, especially those related to equity and justice. The ethical issues associated with the COVID-19 outbreak are not unique but provide a diverse set of issues that apply to patients, providers, social groups, and investigators. The further study of such issues can help with preventing future outbreaks.

The sufficiency theory of justice and the allocation of health resources.

According to the sufficiency theory of justice in health, justice requires that people have equal access to adequate health. In this article, I lay out the structure of this view and I assess its distributive implications for setting priority (i) between health needs across persons and (ii) between health care spending and other societal goods. I argue, first, that according to the sufficiency theory, deficiency in health cannot be completely offset by providing other societal goods. And, second, that it can prevent the medicalization of societies by stressing that improvements beyond the level of adequate health have relatively little weight, if any, from the standpoint of justice.

Distributive justice and value trade-offs in antibiotic use in aged care settings.

Residential aged care facilities (RACF) are sites of high antibiotic use in Australia. Misuse of antimicrobial drugs in RACF contributes to antimicrobial resistance (AMR) burdens that accrue to individuals and the wider public, now and in the future. Antimicrobial stewardship (AMS) practices in RACF, e.g. requiring conformation of infection, are designed to minimise inappropriate use of antibiotics. We conducted dialogue groups with 46 participants with a parent receiving aged care to better understand families' perspectives on antibiotics and care in RACF. Participants grappled with value trade offs in thinking about their own parents' care, juggling imagined population and future harms with known short term comfort of individuals and prioritising the latter. Distributive justice in AMR relies on collective moral responsibility and action for the benefit of future generations and unknown others. In RACF, AMS requires value trade-offs and compromise on antimicrobial use in an environment that is heavily reliant on antimicrobial drugs to perform caring functions. In the context of aged care, AMS is a technical solution to a deeply relational and socio-structural problem and there is a risk that carers (workers, families) are morally burdened by system failures that are not addressed in AMS solutions.

More Satisfaction, Less Equality: Distributive Effects of Transparent Needs in a Laboratory Experiment.

Societies are confronted with the dilemma that need satisfaction requires transparent individual needs. We study the effect of information about others' needs on the distribution of a joint endowment in a three-player network exchange game in a laboratory experiment. Need levels are exogenously given and either transparent (known to all three network members) or opaque (only known to the players themselves). The three players negotiate in dyads until two players agree on a distribution. We expect that the transparency of need thresholds raises need satisfaction but lowers equality. The results suggest that the members of the dyad who agree on the distribution can satisfy their own need thresholds even when information about thresholds is opaque. The effect of transparency on the remaining network member is antithetical: while transparency increases the rate of need satisfaction, it decreases the average share of allocations when needs are low. In the opaque condition, allocated shares are larger, but need satisfaction is lower. This reveals the ambivalent distributive effects of transparent need thresholds: Transparency helps those with the highest need thresholds, but it can hurt those with lower need thresholds, and it barely affects the ones with the most influence on the decision. Supplementary Information: The online version contains supplementary material available at 10.1007/s11211-024-00434-0.

Contract Law When the Poor Pay More.

Taking inequality as a key challenge of our time, this article aims to highlight consumer markets, and their underpinning legal ground rules, as important contributors to inequitable wealth distributions. It illustrates how product design, as manifested in contractual terms, can allow firms to evade competition and divert resources upwards along society's wealth distribution curve. It then highlights the contestable legality of certain pricing practices, such as 'contingent charges', and the challenge they pose to fundamental principles of contract law. An in-depth view of the 2015 case of Beavis v ParkingEye argues that the UK Supreme Court has validated contingent pricing models in a manner unsupported by traditional contractual reasoning and unjustified by contemporary market failure analysis. The article asks contract law to confront the reality that it shapes market distributions in economically and politically significant ways, and appeals for greater scrutiny of the contribution of contract law adjudication to inequality.

Is a larger patient benefit always better in healthcare priority setting?

When considering the introduction of a new intervention in a budget constrained healthcare system, priority setting based on fair principles is fundamental. In many jurisdictions, a multi-criteria approach with several different considerations is employed, including severity and cost-effectiveness. Such multi-criteria approaches raise questions about how to balance different considerations against each other, and how to understand the logical or normative relations between them. For example, some jurisdictions make explicit reference to a large patient benefit as such a consideration. However, since patient benefit is part of a cost-effectiveness assessment it is not clear how to balance considerations of greater patient benefit against considerations of severity and cost-effectiveness. The aim of this paper is to explore the role of a large patient benefit as an independent criterion for priority setting in a healthcare system also considering severity and cost-effectiveness. By taking the opportunity cost of new interventions (i.e., the health forgone in patients already receiving treatment) into account, we argue that patient benefit has a complex relationship to priority setting. More specifically, it cannot be reasonably concluded that large patient benefits should be given priority if severity, cost-effectiveness, and opportunity costs are held constant. Since we cannot find general support for taking patient benefit into account as an independent criterion from any of the most discussed theories about distributive justice: utilitarianism, prioritarianism, telic egalitarianism and sufficientarianism, it is reasonable to avoid doing so. Hence, given the complexity of the role of patient benefit, we conclude that in priority practice, a large patient benefit should not be considered as an independent criterion, on top of considerations of severity and cost-effectiveness.

Comparing the World Psychiatric Association and European Psychiatric Association Codes of Ethics: Discrepancies and shared grounds.

BACKGROUND: Codes of ethics provide guidance to address ethical challenges encountered in clinical practice. The harmonization of global, regional, and national codes of ethics is important to avoid gaps and discrepancies. METHODS: We compare the European Psychiatric Association (EPA) and the World Psychiatric Association (WPA) Codes of Ethics, addressing main key points, similarities, and divergences. RESULTS: The WPA and EPA codes are inspired by similar fundamental values but do show a few differences. The two codes have a different structure. The WPA code includes 4 sections and lists 5 overarching principles as the basis of psychiatrists' clinical practice; the EPA code is articulated in 8 sections, lists 4 ethical principles, and several fundamental values. The EPA code does not include a section on psychiatrists' education and does not contain specific references to domestic violence and death penalty. Differences can be found in how the two codes address the principle of equity: the EPA code explicitly refers to the principle of universal health care, while the WPA code mentions the principle of equity as reflected in the promotion of distributive justice. CONCLUSIONS: We recommend that both WPA and EPA periodically update their ethical codes to minimize differences, eliminate gaps, and help member societies to develop or revise national codes in line with the principles of the associations they belong to.Minimizing differences between national and international codes and fostering a continuous dialogue on ethical issues will provide guidance for psychiatrists and will raise awareness of the importance of ethics in our profession.

Who believes in a just world? A multilevel latent profile analysis of Justice Capital using the European Social Survey.

OBJECTIVE: Justice Capital provides a theoretical framework for explaining individual differences in the belief in a just world (BJW). However, this framework has yet to receive empirical validation. METHOD: Using Round 9 of the European Social Survey, a large (n = 43,209) multi-country (N = 29) sample, I conduct multilevel latent profile analysis and multilevel multinomial logistic regression to determine the latent profiles that emerge at a population level and map the demographic and experiential covariates of these profiles. RESULTS: Incorporating measures of general BJW, distributive and procedural justice, and the belief in equality of opportunity, I find three latent profiles: meritocrats, moderates, and egalitarians. Compared with egalitarians, meritocrats (strong just world believers) are more likely to be male; younger; have a higher income; have attained more years of education; to be politically conservative; and have no recent experience of discrimination or crime. Meritocrats were overrepresented in countries with a higher Human Development Index. CONCLUSION: This study demonstrates the feasibility of Justice Capital for understanding individual variation in general BJW and related justice beliefs; discussion centers on anomalous findings and extension of this theoretical framework.

Can cognitive dissonance explain beliefs regarding meritocracy?

Why do economically disadvantaged people often regard inequality as fair? The literature on deliberative justice suggests that people regard inequality as fair when it is proportional to inequality in effort or other inputs - i.e. when it is meritocratic. But in the real-world there is substantial uncertainty over the distribution of income and merit - so what compels disadvantaged people to legitimate their own disadvantage? This paper suggests it is a reaction to cognitive dissonance. When inequality is high, and when people lack control, their only way to reduce dissonance is to convince themselves the distribution is fair. I implement an online experiment to test this theory. Results do not support a cognitive dissonance mechanism behind meritocracy. But they do indicate that disadvantaged individuals are more likely to regard inequality as fair when they lack control. Analysis of qualitative data indicates that deprivation of control engenders a fatalistic response to inequality.

Trust in leadership and perceptions of justice in fostering employee commitment.

In a period of uncertainty, trust in leadership and perceptions of fairness have emerged as pivotal factors for fostering employee identification and affective commitment. Drawing from authentic leadership theory, this leadership style is identified as a crucial antecedent of affective commitment, examining the mediating role of distributive justice and the moderating role of interactional justice. A quantitative approach was employed, utilizing data from 302 questionnaires completed by Spanish retail workers. For data analysis, SPSS v.25 was used to generate descriptive statistics, while partial least squares structural equation modeling was applied to test the proposed hypotheses. Our findings revealed that authentic leadership is positively associated with the development of affective commitment, with distributive justice acting as a mediating factor between the two. Furthermore, interactional justice negatively moderates the relationship between distributive justice and affective commitment. Contrary to initial expectations, the second moderation, between authentic leadership and affective commitment, was not found to be significant. The research concludes by discussing the practical implications of the results.

The influence of distributive justice on job attitudes and life satisfaction of hotel workers.

This study uses the social exchange and spillover theories to examine the interrelationships between distributive justice, work attitudes, and life satisfaction of hotel employees in Accra, Ghana. Paper-and-pencil questionnaires were used to collect data from 321 respondents after which descriptive statistics and partial least square structural equation modelling were used to analyse the data. Distributive justice and work attitudes were positively related to the life satisfaction levels of hotel employees. This study adds to the scant literature on how workplace goings-on spillover to affect the life satisfaction of hotel workers. Theoretical and practical implications of the results are discussed.

Carbon Pricing is not Unjust.

The aim of this perspective is to argue that carbon pricing is not unjust. Two important dimensions of justice are distributive and procedural (sometimes called "participatory") justice. In terms of distributive justice, it is argued that carbon pricing can be made distributionally just through revenue recycling and that it should be expected that even neutral reductions in emissions will generate progressive benefits, both internationally and regionally. In terms of procedural justice, it is argued that carbon pricing is in principle compatible with any procedure; however, there is also a particular morally justifiable procedure, the Citizens' Assembly, which has been implemented in Ireland on this precise question and has generated broad agreement on carbon pricing. It is suggested that this morally matters because such groups are like "ideal advisors" that offer morally important advice. Finally, an independent objection is offered to some ambitious alternatives to carbon pricing like Green New Deal-type frameworks, frameworks that aim to simultaneously tackle multiple social challenges. The objection is that these will take too long to work in a climate context, both to develop and to iterate.

Minimally good life and the human right to health.

In Global Health Impact: Extending Access to Essential Medicines, Nicole Hassoun argues that the concept of a minimally good life grounds the human right to health, which in turn implies the human right to access essential medicines in developing countries. This article argues that Hassoun's argument must be revised. If the temporal unit of a minimally good life is identified, her argument faces a substantive problem, which undermines an important part of her argument. This article then proposes a solution to this problem. If this proposed solution is accepted, Hassoun's project turns out to be more radical than her argument is supposed to be.

Translating theories of justice into a practice model for triage of scarce intensive care resources during a pandemic.

During the COVID-19 pandemic, national triage guidelines were developed to address the anticipated shortage of life-saving resources, should ICU capacities be overloaded. Rationing and triage imply that in addition to individual patient interests, interests of population health have to be integrated. The transfer of theoretical and empirical knowledge into feasible and useful practice models and their implementation in clinical settings need to be improved. This paper analyzes how triage protocols could translate abstract theories of distributive justice into concrete material and procedural criteria for rationing intensive care resources during a pandemic. We reconstruct the development and implementation of a rationing protocol at a German university hospital: describing the ethical challenge of triage, clarifying the aspirational norms, and summarizing specific norms of fair triage and allocation for developing an institutional policy and practice model and implementing it. We reflect on how critical topics are seen by clinicians and what helped manage the perceived burdens of the triage dilemma. We analyze what can be learned from this debate regarding the difficult issues around triage protocols and their potential implementation into clinical settings. Analyzing the ought-to-is gap of triage, integrating abstract ethical principles into practical concepts, and evaluating those should clarify the benefits and risks of different allocation options. We seek to inform debates on triage concepts and policies to ensure the best possible treatment and fair allocation of resources as well as to help protect patients and professionals in worst-case scenarios.

Global health impact, priority and time.

This paper addresses normative issues that arise in relation to indicators and measures of health impact. With inspiration from Nicole Hassoun's recent proposal, the paper argues and illustrates that those interested in measuring global health impact face questions about how to prioritize among those with ill-health, how to weigh benefits to those who cannot lead minimally good lives against benefits to the better off, and how to think about whether someone is badly off.

Reflection on the Elderly Discrimination in the Allocation of Scarce Medical Resources from the Age Restriction Phenomenon in ICU of a Certain Country / 中国医学伦理学

In March 2020, the outflow of age limited videos from ICU in Spain inspired us to rethink whether there is age discrimination in the allocation of scarce medical resources. This paper frist reflected on the problem of age discrimination caused by this phenomenon from four moral intuitions: the sacred view of life, the quality of life and values, public health ethics and Chinese culture, and then examined whether it is illegal from the legal level, finally pointed out the negative impact on the society, and put forward that taking age as the standard for the allocation of scarce medical resources is not suitable for China’s national conditions.

When abusive supervision affects creative idea sharing: Understanding the role of employee cheating and organizational justice.

Getting employees to share their creative ideas has long been recognized as a vital source of organizational effectiveness. This research uses the conservation of resources theory to investigate how employee's creative idea sharing is affected by abusive supervision. Data for this research was collected from 209 employees and their immediate supervisors of generic nurses and medical dispensers of Southern Punjab public sector hospitals working under the Ministry of national health services regulation and Coordination. Data were then analyzed with the AMOS software package for simple regression and moderated mediation. This study found that with the increase in abusive supervision, employees develop cheating behavior, diminishing probability of sharing their creative ideas with coworkers. Along these lines, organizational justice moderates this relationship and attenuates the negative indirect effect of abusive supervision on creative idea sharing. The researchers recommended that organizations should develop training programs or coaching sessions for leaders to make them equip with essential interpersonal skills that can eradicate abusive supervision. Research implications, limitations, and future research directions are also discussed.