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Griffin C, Lee C, Shin P, Helmers A, Kalocsai C, Karim A, Piquette D. Healthcare Provider Experiences With Unvaccinated COVID-19 Patients: A Qualitative Study. Crit Care Explor 2024; 6:e1157. [PMID: 39250800 PMCID: PMC11387047 DOI: 10.1097/cce.0000000000001157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/11/2024] Open
Abstract
IMPORTANCE In the setting of an active pandemic the impact of public vaccine hesitancy on healthcare workers has not yet been explored. There is currently a paucity of literature that examines how patient resistance to disease prevention in general impacts practitioners. OBJECTIVES The COVID-19 pandemic created unprecedented healthcare challenges with impacts on healthcare workers' wellbeing. Vaccine hesitancy added complexity to providing care for unvaccinated patients. Our study qualitatively explored experiences of healthcare providers caring for unvaccinated patients with severe COVID-19 infection in the intensive care setting. DESIGN We used interview-based constructivist grounded theory methodology to explore experiences of healthcare providers with critically ill unvaccinated COVID-19 patients. SETTING AND PARTICIPANTS Healthcare providers who cared for unvaccinated patients with severe COVID-19 respiratory failure following availability of severe acute respiratory syndrome coronavirus 2 vaccines were recruited from seven ICUs located within two large academic centers and one community-based hospital. We interviewed 24 participants, consisting of eight attending physicians, seven registered nurses, six critical care fellows, one respiratory therapist, one physiotherapist, and one social worker between March 2022 and September 2022 (approximately 1.5 yr after the availability of COVID-19 vaccines in Canada). ANALYSIS Interviews were recorded, transcribed, de-identified, and coded to identify emerging themes. The final data was analyzed to generate the thematic framework. Reflexivity was employed to reflect upon and discuss individual pre-conceptions and opinions that may impact collection and interpretation of the data. RESULTS Healthcare providers maintained dedication toward professionalism during provision of care, at the cost of suffering emotional turmoil from the pandemic and COVID-19 vaccine hesitancy. Evolving sources of stress associated with vaccine hesitancy included ongoing high volumes of critically ill patients, resource shortages, and visitation restrictions, which contributed to perceived emotional distress, empathy loss, and professional dissatisfaction. As a result, there were profound personal and professional consequences for healthcare professionals, with perceived impacts on patient care. CONCLUSIONS Our study highlights struggles of healthcare providers in fulfilling professional duties while navigating emotional stressors unique to vaccine hesitancy. System-based interventions should be explored to help providers navigate biases and moral distress, and to foster resilience for the next major healthcare system strain.
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Affiliation(s)
- Candice Griffin
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Department of Critical Care, Sunnybrook Health Sciences, Toronto, ON, Canada
| | - Christie Lee
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Department of Critical Care, Mount Sinai Health System, Toronto, ON, Canada
| | - Phil Shin
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Department of Critical Care, North York General Hospital, Toronto, ON, Canada
| | - Andrew Helmers
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Department of Critical Care, The Hospital for Sick Children, Toronto, ON, Canada
| | - Csilla Kalocsai
- Department of Critical Care, Sunnybrook Health Sciences, Toronto, ON, Canada
| | | | - Dominique Piquette
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Department of Critical Care, Sunnybrook Health Sciences, Toronto, ON, Canada
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Johnson T, Jamrozik E, Hurst T, Cheah PY, Parker MJ. Ethical issues in Nipah virus control and research: addressing a neglected disease. JOURNAL OF MEDICAL ETHICS 2024; 50:612-617. [PMID: 38071589 PMCID: PMC11347257 DOI: 10.1136/jme-2023-109469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 11/12/2023] [Indexed: 08/23/2024]
Abstract
Nipah virus is a priority pathogen that is receiving increasing attention among scientists and in work on epidemic preparedness. Despite this trend, there has been almost no bioethical work examining ethical considerations surrounding the epidemiology, prevention, and treatment of Nipah virus or research that has already begun into animal and human vaccines. In this paper, we advance the case for further work on Nipah virus disease in public health ethics due to the distinct issues it raises concerning communication about the modes of transmission, the burdens of public health surveillance, the recent use of stringent public health measures during epidemics, and social or religious norms intersecting with preventive measures. We also advance the case for further work on Nipah virus disease in research ethics, given ethical issues surrounding potential vaccine trials for a high-fatality disease with sporadic spillover events, the different local contexts where trials may occur, and the potential use of unproven therapeutics during outbreaks. Further bioethics work may help to ensure that research and public health interventions for Nipah virus disease are ethically acceptable and more likely to be effective.
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Affiliation(s)
- Tess Johnson
- Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Pandemic Sciences Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Euzebiusz Jamrozik
- Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Pandemic Sciences Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Royal Melbourne Hospital Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Tara Hurst
- Pandemic Sciences Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Phaik Yeong Cheah
- Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Mahidol-Oxford Tropical Medicine Research, Mahidol University, Bangkok, Thailand
| | - Michael J Parker
- Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Kassam A, Page S, Lauzon J, Hay R, Coret M, Mitchell I. Ethical issues in residency education related to the COVID-19 pandemic: a narrative inquiry study. JOURNAL OF MEDICAL ETHICS 2024:jme-2023-108917. [PMID: 38925879 DOI: 10.1136/jme-2023-108917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 06/05/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND The COVID-19 pandemic introduced new challenges to provide care and educate junior doctors (resident physicians). We sought to understand the positive and negative experiences of first-year resident physicians and describe potential ethical issues from their stories. METHOD We used narrative inquiry (NI) methodology and applied a semistructured interview guide with questions pertaining to ethical principles and both positive and negative aspects of the pandemic. Sampling was purposive. Interviews were audio recorded and transcribed. Three members of the research team coded transcripts in duplicate to elicit themes. Discrepancies were resolved through discussion to attain consensus. A composite story with threads was constructed. RESULTS 11 residents participated across several programmes. Three main themes emerged from the participants' stories: (1) complexities in navigating intersecting healthcare and medical education systems, (2) balancing public health and the public good versus the individual and (3) fair health systems planning/healthcare delivery. Within these themes, participants' journeys through the first wave were elicited through the threads of (1) engage us, (2) because we see the need for the duty to treat and (3) we are all in this together. DISCUSSION Cases of the ethical issues that took place during the COVID-19 pandemic may serve as a foundation on which ethics teaching and future pandemic planning can take place. Principles of clinical ethics and their limitations, when applied to public health issues, could help in contrasting clinical ethics with public health ethics. CONCLUSION Efforts to understand how resident physicians can navigate public health emergencies along with the ethical issues that arise could benefit both residency education and healthcare systems.
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Affiliation(s)
- Aliya Kassam
- Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- Office of Postgraduate Medical Education, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Stacey Page
- Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Julie Lauzon
- Medical Genetics, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Rebecca Hay
- Pediatric Critical Care Medicine, Children's Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada
| | - Marian Coret
- Adolescent Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ian Mitchell
- Pediatrics, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
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Pokharel S, Adhikari B, Johnson T, Cheah PY. Interventions to address antimicrobial resistance: an ethical analysis of key tensions and how they apply in low- income and middle-income countries. BMJ Glob Health 2024; 9:e012874. [PMID: 38569658 PMCID: PMC11002359 DOI: 10.1136/bmjgh-2023-012874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 01/14/2024] [Indexed: 04/05/2024] Open
Abstract
Antimicrobial resistance (AMR) is a global health and one health problem. Efforts to mitigate the problem of AMR are challenging to implement due to unresolved ethical tensions. We present an in-depth ethical analysis of tensions that might hinder efforts to address AMR. First, there is a tension between access and excess in the current population: addressing lack of access requires facilitating use of antimicrobials for some populations, while addressing excessive use for other populations. Second, there is a tension between personal interests and a wider, shared interest in curbing AMR. These personal interests can be viewed from the perspective of individuals seeking care and healthcare providers whose livelihoods depend on using or selling antimicrobials and who profit from the sales and use of antimicrobials. Third, there is a tension between the interests of current populations and the interests of future generations. Last, there is a tension between addressing immediate health threats such as pandemics, and AMR as a 'silent', chronic threat. For each of these tensions, we apply 'descriptive ethics' methods that draw from existing evidence and our experiences living and working in low-income and middle-income countries to highlight how these ethical tensions apply in such settings.
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Affiliation(s)
- Sunil Pokharel
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Bipin Adhikari
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University Phayathai Campus, Bangkok, Thailand
| | - Tess Johnson
- Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Phaik Yeong Cheah
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University Phayathai Campus, Bangkok, Thailand
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Hoefle-Bénard J, Salloch S. Mass drug administration for neglected tropical disease control and elimination: a systematic review of ethical reasons. BMJ Glob Health 2024; 9:e013439. [PMID: 38485140 PMCID: PMC10941120 DOI: 10.1136/bmjgh-2023-013439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 02/25/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Neglected tropical diseases (NTDs) are a diverse group of debilitating diseases and conditions afflicting more than one billion people in impoverished communities. Control of these diseases is crucial to achieve Sustainable Development Goal 3 and the pledge to 'leave no one behind'. Relying on large-scale delivery of wide-spectrum drugs to individuals in at-risk communities irrespective of their health status, mass drug administration is a core strategy for tackling half of the NTDs targeted by the latest WHO roadmap (2021-2030). However, ethical challenges surround its implementation and long-term impact. This systematic review aims to give a comprehensive picture of the variety of ethical reasons for and against mass drug administration for NTD control and elimination, facilitating further debate in ethics and policy. METHODS PubMed and Web of Science Core Collection were searched for all relevant publications. Of the 486 retrieved records, 60 met the inclusion criteria for qualitative analysis. Ethical reasons discussing the topic at hand were extracted from full texts and synthesised through the Kuckartz method of qualitative content analysis. RESULTS Data extraction revealed 61 ethical reasons, of which 20 (32.7%) had positive, 13 (21.3%) had ambivalent and 28 (45.9%) had negative implications regarding mass drug administration for NTDs. The health benefits and cost-effectiveness of the measure were extensively highlighted. However, equity, autonomy and sustainability emerged as the domains with the most pressing ethical concerns. Many issues related to implementation are yet to be adequately addressed in policy documents. CONCLUSIONS This is the first systematic review of ethical reasons pertaining to mass drug administration for NTD control and elimination. Due to the diversity of included studies, no general recommendations can be made. Instead, context-specific strategies seem necessary. Alternative approaches tackling socioecological determinants of ill health are needed for long-term sustainability. Future research could benefit from contributions of non-Western philosophies and perspectives by local researchers.
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Affiliation(s)
- Juliette Hoefle-Bénard
- Institute for Ethics, History and Philosophy of Medicine, Hannover Medical School, Hannover, Germany
| | - Sabine Salloch
- Institute for Ethics, History and Philosophy of Medicine, Hannover Medical School, Hannover, Germany
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Anderson E, Fenton E, Priest P, Sullivan T. How Do Past Immunization Strategies Compare With the COVID-19 Immunization Rollout: A New Zealand Analysis. Disaster Med Public Health Prep 2024; 18:e18. [PMID: 38329080 DOI: 10.1017/dmp.2024.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
OBJECTIVE The aim of this study was to compare past New Zealand immunization strategies with the New Zealand coronavirus disease 2019 (COVID-19) immunization roll-out. METHODS Using the READ document analysis method, 2 New Zealand immunization strategies (for influenza and measles) were analyzed for how the disease, context, vaccine supply and demand, ethical principles (equity, individual autonomy, and maximizing benefits), and the Treaty of Waitangi impacted the immunization programs. The findings were compared with the ongoing COVID-19 mass immunization program in New Zealand, as of October 15, 2021. RESULTS Several themes common to the case-studies and the COVID-19 pandemic were identified including the importance of equity, obligations under the Treaty of Waitangi, ethical mandates, and preparedness. CONCLUSIONS Future emergency planning should integrate learnings from other infectious disease responses and immunization programs to avoid repeating mistakes and to create better health outcomes. This study has provided a basis for ongoing research into how an appropriate immunization plan can be developed that incorporates ethical values, the Treaty of Waitangi (in the NZ context), and evidence-based research to increase trust, equity, health, and preparedness for future outbreaks.
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Affiliation(s)
- Emma Anderson
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | | | - Patricia Priest
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Trudy Sullivan
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
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Silva DS, Smith MJ. Data Sharing During Pandemics: Reciprocity, Solidarity, and Limits to Obligations. JOURNAL OF BIOETHICAL INQUIRY 2023; 20:667-672. [PMID: 37440154 PMCID: PMC10942926 DOI: 10.1007/s11673-023-10251-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 04/03/2023] [Indexed: 07/14/2023]
Abstract
South Africa shared with the world the warning of a new strain of SARS-CoV2, Omicron, in November 2021. As a result, many high-income countries (HICs) instituted complete travel bans on persons leaving South Africa and other neighbouring countries. These bans were unnecessary from a scientific standpoint, and they ran counter to the International Health Regulations. In short, South Africa was penalized for sharing data. Data sharing during pandemics is commonly justified by appeals to solidarity. In this paper, we argue that solidarity is, at best, an aspirational ideal to work toward but that it cannot ground an obligation to share data. Instead, low-and-middle income countries (LIMCs) should be guided by the principle of reciprocity, which states that we ought to return good for good received. Reciprocity is necessarily a conditional principle. LMICs, we argue, should only share data during future pandemics on the condition that HICs provide enforceable assurances that the benefits of data sharing will be equitably distributed and that LMICs won't be penalized for sharing information.
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Affiliation(s)
- Diego S Silva
- Sydney Health Ethics, School of Public Health, University of Sydney, Edward Ford Building, A27 Fisher Rd, Camperdown, New South Wales, 2006, Australia.
| | - Maxwell J Smith
- School of Health Studies & Rotman Institute of Philosophy, Western University, 1151 Richmond Street, London, Ontario, N6A 3K7, Canada
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Mercuri M, Hackett K, Upshur R, Emerson CI. Expediting approval for medical countermeasures to address high burden disease: an ethical justification to move beyond emergency use authorisation. BMJ Glob Health 2023; 8:e013480. [PMID: 37918871 PMCID: PMC10626867 DOI: 10.1136/bmjgh-2023-013480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 09/30/2023] [Indexed: 11/04/2023] Open
Abstract
Addressing global health crises requires a receptive and expedient policy environment to minimise delays in making available potentially life-saving technologies. Over time, the policy environment has adapted to ensure that communities have expedited access to promising technologies, such as vaccines, that can mitigate morbidity and mortality. Emergency authorisations are one such policy mechanism. While these have been employed successfully for several diseases, such as influenza, Ebola and COVID-19, the policy mechanism is tied to contexts where key bodies have designated the disease an 'emergency', whereas no equivalent mechanism exists for those failing to acquire the designation (eg, malaria and tuberculosis). In this paper, we examine ethical issues associated with emergency authorisations. We argue that there is no moral difference between those diseases considered emergencies and many that fail to be designated as such with respect to impact on affected communities. Thus, tying access to an expedient policy mechanism for approval to an emergency designation is ethically unjustified-it should be based on considerations of risks and benefits, the disease burden and the values of the communities that carry those risks and not contingent on if the disease is designated an emergency. We suggest the need to further enhance the policy environment to ensure access to similar expedited approval programmes irrespective of if a disease is an emergency. Levelling the field for access to expedited approval programmes across diseases can help in moving towards achieving global health equity but is not a panacea.
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Affiliation(s)
- Mathew Mercuri
- Institute on Ethics & Policy for Innovation, McMaster University, Hamilton, Ontario, Canada
- Medicine, McMaster University, Hamilton, Ontario, Canada
- Dala Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Philosophy, McMaster University Faculty of Humanities, Hamilton, Ontario, Canada
| | - Kristy Hackett
- Institute on Ethics & Policy for Innovation, McMaster University, Hamilton, Ontario, Canada
- Dala Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Ross Upshur
- Dala Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Claudia Isabel Emerson
- Institute on Ethics & Policy for Innovation, McMaster University, Hamilton, Ontario, Canada
- Philosophy, McMaster University Faculty of Humanities, Hamilton, Ontario, Canada
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Kraaijeveld SR, Gur-Arie R, Jamrozik E. A Scalar Approach to Vaccination Ethics. THE JOURNAL OF ETHICS 2023; 28:145-169. [PMID: 38375445 PMCID: PMC10874331 DOI: 10.1007/s10892-023-09445-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 07/28/2023] [Indexed: 02/21/2024]
Abstract
Should people get vaccinated for the sake of others? What could ground-and limit-the normative claim that people ought to do so? In this paper, we propose a reasons-based consequentialist account of vaccination for the benefit of others. We outline eight harm-based and probabilistic factors that, we argue, give people moral reasons to get vaccinated. Instead of understanding other-directed vaccination in terms of binary moral duties (i.e., where people either have or do not have a moral duty to get vaccinated), we develop a scalar approach according to which people can have stronger or weaker moral reasons to get vaccinated in view of the moral good of vaccination. One advantage of our approach is that it can capture why a person might have strong moral reasons to get vaccinated with Vaccine A, but only weak moral reasons to get vaccinated with Vaccine B. We discuss theoretical strengths of our approach and provide a case study of vaccination against COVID-19 to demonstrate its practical significance.
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Affiliation(s)
- Steven R. Kraaijeveld
- Wageningen University & Research, Hollandseweg 1, 6700 EW Wageningen, The Netherlands
| | - Rachel Gur-Arie
- Edson College of Nursing and Health Innovation, Arizona State University, 550 N 3rd St., Phoenix, AZ 85004 USA
- Oxford-Johns Hopkins Global Infectious Disease Ethics (GLIDE) Collaborative, Oxford, United Kingdom, Baltimore, MD USA
| | - Euzebiusz Jamrozik
- Wellcome Centre for Ethics and Humanities, Big Data Institute, University of Oxford, Li Ka Shing Centre for Health Information and Discovery, Old Road Campus, Oxford, OX3 7LF UK
- Royal Melbourne Hospital Department of Medicine, University of Melbourne, Parkville, 3052 Australia
- Monash Bioethics Centre, Monash University, Clayton, 3168 Australia
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Bavli I. When Public Health Goes Wrong: Toward a New Concept of Public Health Error. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2023; 51:385-402. [PMID: 37655561 PMCID: PMC10881261 DOI: 10.1017/jme.2023.67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Studies of public health decisions that have had harmful effects tend to disagree about what constitutes a public health error. Debates exist about whether public health errors must be culpable or not, as well as about what the criteria for judging public health errors should be.
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Affiliation(s)
- Itai Bavli
- UNIVERSITY OF BRITISH COLUMBIA, VANCOUVER, CANADA
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11
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Roberts D, Jamrozik E, Heriot GS, Slim AC, Selgelid MJ, Miller JC. Quantifying the impact of individual and collective compliance with infection control measures for ethical public health policy. SCIENCE ADVANCES 2023; 9:eabn7153. [PMID: 37146140 PMCID: PMC10162661 DOI: 10.1126/sciadv.abn7153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 03/31/2023] [Indexed: 05/07/2023]
Abstract
Infectious disease control measures often require collective compliance of large numbers of individuals to benefit public health. This raises ethical questions regarding the value of the public health benefit created by individual and collective compliance. Answering these requires estimating the extent to which individual actions prevent infection of others. We develop mathematical techniques enabling quantification of the impacts of individuals or groups complying with three public health measures: border quarantine, isolation of infected individuals, and prevention via vaccination/prophylaxis. The results suggest that (i) these interventions exhibit synergy: They become more effective on a per-individual basis as compliance increases, and (ii) there is often substantial "overdetermination" of transmission. If a susceptible person contacts multiple infectious individuals, an intervention preventing one transmission may not change the ultimate outcome (thus, risk imposed by some individuals may erode the benefits of others' compliance). These results have implications for public health policy during epidemics.
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Affiliation(s)
- Daniel Roberts
- Royal Melbourne Institute of Technology, Melbourne, VIC, Australia
| | - Euzebiusz Jamrozik
- University of Oxford, Oxford, UK
- Monash University, Melbourne, VIC, Australia
- University of Melbourne, Melbourne, VIC, Australia
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Dees RH, Herington J, Chiafery M, Shand JC, D'Angio CT, Ching CL, Shaw MH. The Ethics of Implementing Emergency Resource Allocation Protocols. THE JOURNAL OF CLINICAL ETHICS 2023; 34:58-68. [PMID: 36940356 DOI: 10.1086/723323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/22/2023]
Abstract
AbstractWe explore the various ethical challenges that arise during the practical implementation of an emergency resource allocation protocol. We argue that to implement an allocation plan in a crisis, a hospital system must complete five tasks: (1) formulate a set of general principles for allocation, (2) apply those principles to the disease at hand to create a concrete protocol, (3) collect the data required to apply the protocol, (4) construct a system to implement triage decisions with those data, and (5) create a system for managing the consequences of implementing the protocol, including the effects on those who must carry out the plan, the medical staff, and the general public. Here we illustrate the complexities of each task and provide tentative solutions, by describing the experiences of the Coronavirus Ethics Response Group, an interdisciplinary team formed to address the ethical issues in pandemic resource planning at the University of Rochester Medical Center. While the plan was never put into operation, the process of preparing for emergency implementation exposed ethical issues that require attention.
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Hopwood P, MacEachen E, Majowicz SE, Meyer SB, Amoako J. "We need to talk to each other": Crossing traditional boundaries between public health and occupational health to address COVID-19. Front Public Health 2022; 10:1046628. [PMID: 36561864 PMCID: PMC9763554 DOI: 10.3389/fpubh.2022.1046628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction This study examined how public health (PH) and occupational health (OH) sectors worked together and separately, in four different Canadian provinces to address COVID-19 as it affected at-risk workers. In-depth interviews were conducted with 18 OH and PH experts between June to December 2021. Responses about how PH and OH worked across disciplines to protect workers were analyzed. Methods We conducted a qualitative analysis to identify Strengths, Weakness, Opportunities and Threats (SWOT) in multisectoral collaboration, and implications for prevention approaches. Results We found strengths in the new ways the PH and OH worked together in several instances; and identified weaknesses in the boundaries that constrain PH and OH sectors and relate to communication with the public. Threats to worker protections were revealed in policy gaps. Opportunities existed to enhance multisectoral PH and OH collaboration and the response to the risk of COVID-19 and potentially other infectious diseases to better protect the health of workers. Discussion Multisectoral collaboration and mutual learning may offer ways to overcome challenges that threaten and constrain cooperation between PH and OH. A more synchronized approach to addressing workers' occupational determinants of health could better protect workers and the public from infectious diseases.
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Lederman Z, Halberthal M. A Close Shave: Balancing Religious Tolerance and Patient Care in the Age of COVID-19. JOURNAL OF BIOETHICAL INQUIRY 2022; 19:625-633. [PMID: 35852780 DOI: 10.1007/s11673-022-10201-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 04/30/2022] [Indexed: 06/15/2023]
Abstract
In this essay we discuss an ethical dilemma that recently arose in our institution, involving healthcare workers who lamented the requirement to shave their facial hair as a condition to care for COVID-19 patients. The essay represents a genuine attempt to grapple with the dilemma sensibly and vigorously. We first provide a brief introduction, focusing on the tension between religious tolerance and the institutional obligation to optimize patient care and public health in the age of COVID-19. We then discuss the complex relationship between facial hair and cultural as well as religious factors throughout history. Next, we make a case, based on several principles in Islam jurisprudence, that Muslim healthcare professionals in our institution should be expected to shave their facial hair so they could care for COVID patients. We end with considering two alternative solutions that were offered in the literature.
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Affiliation(s)
- Zohar Lederman
- Rambam Medical Campus, Ha'alyia Hashnia 8, Haifa, Israel.
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15
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Williams J, Gilbert G, Dawson A, Kaldor J, Hendrickx D, Haire B. Uncertainty and agency in COVID-19 hotel quarantine in Australia. SSM. QUALITATIVE RESEARCH IN HEALTH 2022; 2:100034. [PMID: 34950927 PMCID: PMC8677425 DOI: 10.1016/j.ssmqr.2021.100034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 11/25/2021] [Accepted: 12/13/2021] [Indexed: 01/12/2023]
Abstract
Mandatory 14-day hotel COVID-19 quarantine was introduced for international arrivals into Australia in late March 2020, with no precedent and little time to prepare. This public health initiative was a key factor in Australia's relatively low COVID-19 burden in the first 18 months of the pandemic. We conducted an empirical bioethics study exploring the experience of people who had quarantined in hotels in Australia. We used in depth interviews to develop an understanding of context and normative analysis to consider whether the way the program is conducted is ethically justifiable. 58 people participated; they had been in hotel quarantine in different parts of Australia in the period March 2020-January 2021. Participants faced considerable uncertainty while in quarantine and many experienced this as burdensome. Some uncertainty resulted from not being given information about key aspects of quarantine, some from rules that changed frequently or were otherwise inconsistent, some from being physically isolated. Lack of information and uncertainty contributed to diminished agency. Communication efforts made by individual hotels was well received. Earlier ethics literature about quarantine does not take into account the context our participants described, where the hotel and supervision arrangements were central to the experience. We argue that more suitable arrangements must be made if quarantine is to be an ongoing proposition.
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Affiliation(s)
- Jane Williams
- Sydney Health Ethics, The University of Sydney, Australia
| | - Gwendolyn Gilbert
- Sydney Health Ethics, The University of Sydney, Australia
- Sydney Institute for Infectious Diseases, The University of Sydney, Australia
| | - Angus Dawson
- Sydney Health Ethics, The University of Sydney, Australia
- Sydney Institute for Infectious Diseases, The University of Sydney, Australia
| | - John Kaldor
- Kirby Institute, University of New South Wales, Australia
| | - David Hendrickx
- Wesfarmer's Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Australia
| | - Bridget Haire
- Kirby Institute, University of New South Wales; Australian Human Rights Institute, University of New South Wales, Australia
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16
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Jamrozik E. Public health ethics: critiques of the "new normal". New Bioeth 2022; 40:1-16. [PMID: 36167921 PMCID: PMC9514707 DOI: 10.1007/s40592-022-00163-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 08/02/2022] [Accepted: 08/06/2022] [Indexed: 11/25/2022]
Abstract
The global response to the recent coronavirus pandemic has revealed an ethical crisis in public health. This article analyses key pandemic public health policies in light of widely accepted ethical principles: the need for evidence, the least restrictive/harmful alternative, proportionality, equity, reciprocity, due legal process, and transparency. Many policies would be considered unacceptable according to pre-pandemic norms of public health ethics. There are thus significant opportunities to develop more ethical responses to future pandemics. This paper serves as the introduction to this Special Issue of Monash Bioethics Review and provides background for the other articles in this collection.
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Affiliation(s)
- Euzebiusz Jamrozik
- The Ethox Centre & Wellcome Centre for Ethics and Humanities, University of Oxford, Old Rd, OX3 7LF, Headington, Oxford, UK.
- Monash Bioethics Centre, Monash University, Melbourne, Australia.
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia.
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17
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van der Scheer JW, Ansari A, McLaughlin M, Cox C, Liddell K, Burt J, George J, Kenny R, Cousens R, Leach B, McGowan J, Morley K, Willars J, Dixon-Woods M. Guiding organisational decision-making about COVID-19 asymptomatic testing in workplaces: mixed-method study to inform an ethical framework. BMC Public Health 2022; 22:1747. [PMID: 36109810 PMCID: PMC9476340 DOI: 10.1186/s12889-022-13993-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 08/08/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Workplace programmes to test staff for asymptomatic COVID-19 infection have become common, but raise a number of ethical challenges. In this article, we report the findings of a consultation that informed the development of an ethical framework for organisational decision-making about such programmes. METHODS We conducted a mixed-method consultation - a survey and semi-structured interviews during November-December 2020 in a UK case study organisation that had introduced asymptomatic testing for all staff working on-site in its buildings. Analysis of closed-ended survey data was conducted descriptively. An analysis approach based on the Framework Method was used for the open-ended survey responses and interview data. The analyses were then integrated to facilitate systematic analysis across themes. Inferences were based on the integrated findings and combined with other inputs (literature review, ethical analysis, legal and public health guidance, expert discussions) to develop an ethical framework. RESULTS The consultation involved 61 staff members from the case study organisation (50 survey respondents and 11 interview participants). There was strong support for the asymptomatic testing programme: 90% of the survey respondents viewed it as helpful or very helpful. Open-ended survey responses and interviews gave insight into participants' concerns, including those relating to goal drift, risk of false negatives, and potential negative impacts for household members and people whose roles lacked contractual and financial stability. Integration of the consultation findings and the other inputs identified the importance of a whole-system approach with appropriate support for the key control measure of isolation following positive tests. The need to build trust in the testing programme, for example through effective communication from leaders, was also emphasised. CONCLUSIONS The consultation, together with other inputs, informed an ethical framework intended to support employers. The framework may support organisational decision-making in areas ranging from design and operation of the programme through to choices about participation. The framework is likely to benefit from further consultation and refinement in new settings.
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Affiliation(s)
- Jan W. van der Scheer
- THIS Institute, University of Cambridge, Cambridge Biomedical Campus, Clifford Allbutt Building, Cambridge, CB2 0AH UK
| | - Akbar Ansari
- THIS Institute, University of Cambridge, Cambridge Biomedical Campus, Clifford Allbutt Building, Cambridge, CB2 0AH UK
| | - Meredith McLaughlin
- THIS Institute, University of Cambridge, Cambridge Biomedical Campus, Clifford Allbutt Building, Cambridge, CB2 0AH UK
- Homerton College, Hills Rd, Cambridge, CB2 8PH UK
| | - Caitríona Cox
- THIS Institute, University of Cambridge, Cambridge Biomedical Campus, Clifford Allbutt Building, Cambridge, CB2 0AH UK
| | - Kathleen Liddell
- Faculty of Law, The David Williams Building, 10 West Rd, Cambridge, CB3 9DZ UK
| | - Jenni Burt
- THIS Institute, University of Cambridge, Cambridge Biomedical Campus, Clifford Allbutt Building, Cambridge, CB2 0AH UK
| | - Jenny George
- RAND Europe, Westbrook Centre/Milton Rd, Cambridge, CB4 1YG UK
| | - Rebecca Kenny
- THIS Institute, University of Cambridge, Cambridge Biomedical Campus, Clifford Allbutt Building, Cambridge, CB2 0AH UK
| | - Ruth Cousens
- THIS Institute, University of Cambridge, Cambridge Biomedical Campus, Clifford Allbutt Building, Cambridge, CB2 0AH UK
| | - Brandi Leach
- RAND Europe, Westbrook Centre/Milton Rd, Cambridge, CB4 1YG UK
| | - James McGowan
- THIS Institute, University of Cambridge, Cambridge Biomedical Campus, Clifford Allbutt Building, Cambridge, CB2 0AH UK
| | | | - Janet Willars
- Department of Health Sciences, University of Leicester, George Davies Centre, University Road, Leicester, LE1 7RH UK
| | - Mary Dixon-Woods
- THIS Institute, University of Cambridge, Cambridge Biomedical Campus, Clifford Allbutt Building, Cambridge, CB2 0AH UK
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18
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Ethical considerations in deploying triple artemisinin-based combination therapies for malaria: An analysis of stakeholders’ perspectives in Burkina Faso and Nigeria. PLoS One 2022; 17:e0273249. [PMID: 36083995 PMCID: PMC9462557 DOI: 10.1371/journal.pone.0273249] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 08/04/2022] [Indexed: 11/24/2022] Open
Abstract
Background Artemisinin-based combination therapies (ACTs) are the recommended treatment for uncomplicated Plasmodium falciparum malaria in all malaria endemic countries. Artemisinin resistance, partner drug resistance, and subsequent ACT failure are widespread in Southeast Asia. The more recent independent emergence of artemisinin resistance in Africa is alarming. In response, triple artemisinin-based combination therapies (TACTs) are being developed to mitigate the risks associated with increasing drug resistance. Since ACTs are still effective in Africa, where malaria is mainly a paediatric disease, the potential deployment of TACTs raises important ethical questions. This paper presents an analysis of stakeholders’ perspectives regarding key ethical considerations to be considered in the deployment of TACTs in Africa provided they are found to be safe, well-tolerated and effective for the treatment of uncomplicated malaria. Methods We conducted a qualitative study in Burkina Faso and Nigeria assessing stakeholders’ (policy makers, suppliers and end-users) perspectives on ethical issues regarding the potential future deployment of TACTs through 68 in-depth interviews and 11 focus group discussions. Findings Some respondents suggested that there should be evidence of local artemisinin resistance before they consider deploying TACTs, while others suggested that TACTs should be deployed to protect the efficacy of current ACTs. Respondents suggested that additional side effects of TACTs compared to ACTs should be minimal and the cost of TACTs to end-users should not be higher than the cost of current ACTs. There was some disagreement among respondents regarding whether patients should have a choice of treatment options between ACTs and TACTs or only have TACTs available, while ACTs are still effective. The study also suggests that community, public and stakeholder engagement activities are essential to support the introduction and effective uptake of TACTs. Conclusion Addressing ethical issues regarding TACTs and engaging early with stakeholders will be important for their potential deployment in Africa.
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19
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Goel RK, Jones JR. Managing the risk of COVID-19 via vaccine passports: Modeling economic and policy implications. MANAGERIAL AND DECISION ECONOMICS : MDE 2022; 43:2578-2586. [PMID: 35465149 PMCID: PMC9015226 DOI: 10.1002/mde.3546] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 12/14/2021] [Accepted: 12/22/2021] [Indexed: 06/14/2023]
Abstract
The increasing use of vaccine passports (VPs) to certify immunity from the prevailing coronavirus has created positive and negative aspects that have shaken the workings of markets. The VPs are, however, not universally used and not required by all businesses and governments at this point. Given the newness associated with VPs and the ongoing uncertainty of the pandemic, full implications of VPs have not been considered. This paper provides some formal insights into the implications of the use of VPs, borrowing from the established economic theory. Recommendations for public policy are provided.
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Affiliation(s)
- Rajeev K. Goel
- Department of EconomicsIllinois State UniversityNormalIllinoisUSA
- Innovation and International CompetitionKiel Institute for the World EconomyKielGermany
| | - James R. Jones
- Katie School of InsuranceIllinois State UniversityNormalIllinoisUSA
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20
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Martinho SM, Santa-Rosa B, Silvestre M. Where the public health principles meet the individual: a framework for the ethics of compulsory outpatient treatment in psychiatry. BMC Med Ethics 2022; 23:77. [PMID: 35879800 PMCID: PMC9309603 DOI: 10.1186/s12910-022-00814-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 07/20/2022] [Indexed: 11/10/2022] Open
Abstract
Background Compulsory treatments represent a legal means of imposing treatment on an individual, usually with a mental illness, who refuses therapeutic intervention and poses a risk of self-harm or harm to others. Compulsory outpatient treatment (COT) in psychiatry, also known as community treatment order, is a modality of involuntary treatment that broadens the therapeutic imposition beyond hospitalization and into the community. Despite its existence in over 75 jurisdictions worldwide, COT is currently one of the most controversial topics in psychiatry, and it presents significant ethical challenges. Nonetheless, the ethical debate regarding compulsory treatment almost always stops at a preclinical level, with the different ethical positions arguing for or against its use, and there is little guidance to support for the individual clinicians to act ethically when making the decision to implement COT. Main body The current body of evidence is not clear about the efficacy of COT. Therefore, despite its application in several countries, evidence favouring the use of COT is controversial and mixed at best. In these unclear circumstances, ethical guidance becomes paramount. This paper provides an ethical analysis of use of COT, considering the principlist framework established by Ross Upshur in 2002 to justify public health interventions during the 2002–2004 severe acute respiratory syndrome outbreak. This paper thoroughly examines the pertinence of using the principles of harm, proportionality, reciprocity, and transparency when considering the initiation of COT. Conclusion Ross Upshur’s principlist model provides a useful reflection tool for justifying the application of COT. This framework may help to inform sounder ethical decisions in clinical psychiatric practice.
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Affiliation(s)
- Sérgio M Martinho
- Bioethics Institute, Faculty of Medicine, University of Coimbra, Azinhaga de Santa Comba, Celas, 3000-548, Coimbra, Portugal.
| | - Bárbara Santa-Rosa
- Bioethics Institute, Faculty of Medicine, University of Coimbra, Azinhaga de Santa Comba, Celas, 3000-548, Coimbra, Portugal.,National Institute of Legal Medicine and Forensic Sciences, North Branch, Porto, Portugal
| | - Margarida Silvestre
- Bioethics Institute, Faculty of Medicine, University of Coimbra, Azinhaga de Santa Comba, Celas, 3000-548, Coimbra, Portugal.,Reproductive Medicine Department, Coimbra Hospital and University Centre, Coimbra, Portugal
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21
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Anom BY. The ethical dilemma of mobile phone data monitoring during COVID-19: The case for South Korea and the United States. J Public Health Res 2022; 11:22799036221102491. [PMID: 35911427 PMCID: PMC9335476 DOI: 10.1177/22799036221102491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 03/25/2022] [Indexed: 11/17/2022] Open
Abstract
Governments across the world have integrated a variety of advanced technologies to respond to the COVID-19 crisis. In particular, the use of surveillance programs that leverage data and tools from mobile phones have become important components of public health strategies to contain the spread of SARS-CoV-2 across the globe. Currently, big technology companies around the world are helping governments evaluate the effectiveness of their social distancing protocols by examining and analyzing movements of millions of mobile phone users in order to determine how the virus is spreading across the various geographic locations, and the effectiveness of the various social distancing methods that have been implemented. The collection and use of individual mobile phone data as a public health surveillance tool presents tensions between several ethical priorities. Such a dilemma resides in the tensions between public health ethics goals and clinical ethics goals. While public health ethics pursues goals that seek to ensure the good of the community, such goals are often achieved at the expense of clinical ethics goals which emphasize individual autonomy and civil liberty. In using persons' mobile phone data as a tool to fight the COVID-19 pandemic, we must address the tensions associated with weighing the needs of "the many" with ensuring the rights of the individual.
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22
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Helmers AJ, Anderson JA, Kirsch RE. Caregiver COVID-19 Vaccination Status in Pediatric Hospitals-Ethics of Exclusion. JAMA Pediatr 2022; 176:441-442. [PMID: 35226057 DOI: 10.1001/jamapediatrics.2021.6582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Andrew J Helmers
- Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Bioethics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - James A Anderson
- Department of Bioethics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Roxanne E Kirsch
- Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Bioethics, The Hospital for Sick Children, Toronto, Ontario, Canada
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23
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Purohit N, Mehta S, Hossain MM. Compliance to Public Health Advisory amid COVID-19 Scare: The Communication Conundrum and Public Health Ethics. JOURNAL OF HEALTH MANAGEMENT 2022. [DOI: 10.1177/09720634221088065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Discussion of ethics in the public health arena has primarily focused on the practices of public health doctors and professionals. The community could not get the required attention in terms of their role in compliance with the communication in the form of public health advisory in times of public health crisis. Even though public health is the societal approach to protecting and promoting health, ethics in public health have prioritised behaviours of and moral dilemmas faced by public health professionals only. Leaving out the community’s responsibility makes the entire gamut of public health efforts incomplete and deficient. Amid the COVID-19 pandemic, non-compliance to the public health advisory raised an important aspect of expectation of ethical behaviour by the community and what could facilitate and hinder compliance of ethical behaviour ensuring the safety of self and others. Public health ought to consider the community as not only an important but also responsible stakeholder in its pursuit of promotion of health and prevention of disease.
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Affiliation(s)
| | | | - Md M. Hossain
- Department of Health Promotion and Community Health Sciences, Texas A&M School of Public Health, TX 77843, USA
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24
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Essack Z, Groenewald C, Isaacs N, Ntini T, Maluleka M, Bhembe L, Nkwanyana S, Strode A. Lives versus livelihoods: South African adults’ perspectives on the alcohol ban during the COVID-19 lockdown. JOURNAL OF SUBSTANCE USE 2022. [DOI: 10.1080/14659891.2022.2060141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Zaynab Essack
- Human and Social Capabilities, Centre for Community-Based Research, Human Sciences Research Council, Pietermaritzburg, South Africa
- Honorary Research Fellow, School of Law, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Candice Groenewald
- Human and Social Capabilities, Centre for Community-Based Research, Human Sciences Research Council, Pietermaritzburg, South Africa
- Honorary Research Fellow, School of Law, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Nazeema Isaacs
- Impact Centre, Human Sciences Research Council, Cape Town, South Africa
| | - Thobeka Ntini
- Department of Social Work, University of Zululand, Empangeni South Africa
| | | | | | | | - Ann Strode
- School of Law, University of KwaZulu-Natal, Pietermaritzburg, South Africa
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25
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Tallaa F, Gunaratnam L, Suri R. SARS-CoV-2 Vaccine Mandates for Patients on the Kidney Transplant Waitlist. Clin J Am Soc Nephrol 2022; 17:746-748. [PMID: 35236716 PMCID: PMC9269578 DOI: 10.2215/cjn.15611121] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Faissal Tallaa
- F Tallaa, Internal Medicine Training Program, McGill University, Montreal, Canada
| | - Lakshman Gunaratnam
- L Gunaratnam, Division of Nephrology, Schulich School of Medicine and Dentistry, London, Canada
| | - Rita Suri
- R Suri, Research Institute of the McGill University Health Centre, Montreal, Canada
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26
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Tacumá Prada CP, Tovar Riveros BE. La relación entre Bioética y Salud Pública. REVISTA LATINOAMERICANA DE BIOÉTICA 2021. [DOI: 10.18359/rlbi.5020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
El proceso de toma de decisiones desde la Salud Pública (SP) se basa en el ser y el deber ser. En Colombia los comités de bioética, ética de la investigación y ética clínica han funcionado con sus propios estatutos para garantizar el derecho a la salud, a pesar de las reformas a la seguridad social. Los antecedentes los llevaron a una fragmentación del sistema de salud caracterizada por la axiología neoliberal (economía de mercado según capacidad de pago) y normativa del Estado Social de Derecho. El sistema pretende resolver esta fragmentación, pero existen problemas estructurales del mercado que solo se solucionarían si funcionaran los mecanismos de regulación y el papel del Estado. Es decir, el sistema es insuficiente para lograr satisfacer las necesidades de la salud debido a las interacciones entre actores sociopolíticos. Este proceso conduce a opciones utilitaristas que sustentan la tendencia en temas de investigación. Los valores en SP junto con la ética de la SP son variables. Para la ética de la SP los valores de la práctica son de importancia pública, relacionados con los objetivos de la SP y los profesionales.
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27
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Ho A, Huang V. Unmasking the Ethics of Public Health Messaging in a Pandemic. JOURNAL OF BIOETHICAL INQUIRY 2021; 18:549-559. [PMID: 34559377 PMCID: PMC8461593 DOI: 10.1007/s11673-021-10126-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 06/11/2021] [Indexed: 05/09/2023]
Abstract
Uncertainty is inherent in new and unexpected viral outbreaks such as the current COVID-19 pandemic. It imposes challenges for health officials in soliciting cooperative behavioural changes based on incomplete information. In this paper, we use evolving mask recommendations in the United States as an example to analyse the ethical importance and practical demonstration of trustworthiness in pandemic messaging and decision-making. We argue that responsible public health interventions in the time of uncertainties requires explicit intersecting ethical considerations both in action and in communication to promote trustworthiness. First, as public health decisions have to be made in the face of incomplete and evolving data, health officials need to exhibit competence while committing to epistemic humility. They can explain the methods used in making and updating mask recommendations as well as explicitly acknowledge the need to incorporate sociocultural and other contextual considerations in translating scientific data into mask recommendations. Second, officials and agencies must uphold and communicate decisional transparency as part of their effort to demonstrate accountability and promote the public's understanding of the evolving pandemic. Third, especially since both the pandemic and mask recommendations may have disparate impact on different populations, officials should start with the fair implementation of the least restrictive measures that can help reduce harm.
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Affiliation(s)
- Anita Ho
- University of British Columbia, Vancouver, BC V6T 1Z2 Canada
- University of California, San Francisco, San Francisco, CA USA
| | - Vivian Huang
- University of British Columbia, Vancouver, BC V6T 1Z4 Canada
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28
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Parker L, Byrne JA, Goldwater M, Enfield N. Misinformation: an empirical study with scientists and communicators during the COVID-19 pandemic. BMJ OPEN SCIENCE 2021; 5:e100188. [PMID: 35047703 PMCID: PMC8749236 DOI: 10.1136/bmjos-2021-100188] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 10/29/2021] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES To study the experiences and views within the health science community regarding the spread and prevention of science misinformation within and beyond the setting of the COVID-19 pandemic. METHODS An exploratory study with an empirical ethics approach using qualitative interviews with Australians who produce, communicate and study health science research. RESULTS Key elements that participants considered might facilitate misinformation included: the production of low-quality, fraudulent or biased science research; inadequate public access to high-quality research; insufficient public reading of high-quality research. Strategies to reduce or prevent misinformation could come from within the academic community, academic and lay media publishing systems, government funders and educators of the general public. Recommended solutions from within the scientific community included: rewarding research translation, encouraging standardised study design, increasing use of automated quality assessment tools, mandating study protocol registration, transparent peer review, facilitating wider use of open access and use of newer technologies to target public audiences. There was disagreement over whether preprints were part of the problem or part of the solution. CONCLUSIONS There is concern from within the health science community about systemic failings that might facilitate the production and spread of false or misleading science information. We advocate for further research into ways to minimise the production and spread of misinformation about COVID-19 and other science crises in the future.
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Affiliation(s)
- Lisa Parker
- School of Pharmacy, Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Jennifer A Byrne
- School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Biobanking, NSW Health Pathology, Camperdown, New South Wales, Australia
| | - Micah Goldwater
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
| | - Nick Enfield
- Sydney Social Sciences and Humanities Advanced Research Centre, Faculty of Arts and Social Sciences, The University of Sydney, Sydney, New South Wales, Australia
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29
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Gaspar da Rocha A, Santa-Rosa B, Vieira D, Silvestre M. Vaccination Hesitancy in Health Care Providers: The Example for the General Population in the Time of a Pandemic. PORTUGUESE JOURNAL OF PUBLIC HEALTH 2021. [DOI: 10.1159/000519488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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30
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Gandhi R, Piscitello GM, Parker WF, Michelson K. Variation in COVID-19 Resource Allocation Protocols and Potential Implementation in the Chicago Metropolitan Area. AJOB Empir Bioeth 2021; 12:266-275. [PMID: 34596474 DOI: 10.1080/23294515.2021.1983667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Scarce resource allocation policies vary across the United States. Little is known about regional variation in resource allocation protocols and variation in their application. We sought to evaluate how Covid-19 scarce resource allocation policies vary throughout the Chicago metropolitan area and whether there are differences in policy application within hospitals when prioritizing hypothetical patients who need critical care resources. METHODS Two cross-sectional surveys were distributed to Chicago metropolitan area hospital representatives and triage officers. Survey responses and categorical variables are described by frequency of occurrence. Intra- and interhospital variation in ranking of hypothetical patients was assessed using Fleiss's Kappa coefficients. RESULTS Eight Chicago-area hospitals responded to the survey assessing scarce resource allocation protocols (N = 8/18, response rate 44%). For hospitals willing to describe their ventilator allocation protocol (N = 7), most used the sequential organ failure assessment (SOFA) score (N = 6/7, 86%) and medical comorbidities (N = 4/7, 57%) for initial scoring of patients. A majority gave priority in initial scoring to pre-defined groups (N = 5/7, 71%), all discussed withdrawal of mechanical ventilation for adult patients (N = 7/7, 100%), and a minority had exclusion criteria (N = 3/7, 43%). Forty-nine triage officers from nine hospitals responded to the second survey (N = 9/10 hospitals, response rate 90%). Their rankings of hypothetical patients showed only slight agreement amongst all hospitals (Kappa 0.158) and fair agreement within two hospitals with the most respondents (Kappa 0.21 and 0.25). Almost half used tiebreakers to rank patients (N = 23/49, 47%). CONCLUSIONS Although most respondents from Chicago-area hospitals described policies for resource allocation during the COVID-19 pandemic, the substance and application of these protocols varied. There was little agreement when prioritizing hypothetical patients to receive scarce resources, even among people from the same hospital. Variations in resource allocation protocols and their application could lead to inequitable distribution of resources, further exacerbating community distrust and disparities in health. Supplemental data for this article is available online at https://doi.org/10.1080/23294515.2021.1983667.
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Affiliation(s)
- Rupali Gandhi
- Department of Pediatrics, Advocate Children's Hospital, Oak Lawn, Illinois, USA
| | | | - William F Parker
- Department of Medicine, University of Chicago, Chicago, Illinois, USA.,MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, Illinois, USA
| | - Kelly Michelson
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Center for Bioethics & Medical Humanities, Northwestern University Feinberg School of Medicine Institute for Public Health and Medicine, Chicago, Illinois, USA.,Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
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Levin S, Farina M, Lavazza A. Dealing with Criminal Behavior: the Inaccuracy of the Quarantine Analogy. CRIMINAL LAW AND PHILOSOPHY 2021; 17:135-154. [PMID: 34567281 PMCID: PMC8450717 DOI: 10.1007/s11572-021-09608-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/19/2021] [Indexed: 06/13/2023]
Abstract
Pereboom and Caruso propose the quarantine model as an alternative to existing models of criminal justice. They appeal to the established public health practice of quarantining people, which is believed to be effective and morally justified, to explain why -in criminal justice- it is also morally acceptable to detain wrongdoers, without assuming the existence of a retrospective moral responsibility. Wrongdoers in their model are treated as carriers of dangerous diseases and as such should be preventively detained (or rehabilitated) until they no longer pose a threat to society. Our main concern in this paper is that Pereboom and Caruso adopt an idiosyncratic meaning of quarantine regulations. We highlight a set of important disanalogies between their quarantine model and the quarantine regulations currently adopted in public health policies. More specifically, we argue that the similarities that Pereboom and Caruso propose to substantiate their analogy are not consistent-despite what they claim-with the regulations underlying quarantine as an epidemiological process. We also notice that certain quarantine procedures adopted in public health systems are inadequate to deal with criminal behaviors. On these grounds, we conclude that Pereboom and Caruso should not appeal to the quarantine analogy to substantiate their view, unless they address the issues and criticism we raise in this paper.
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Affiliation(s)
- Sergei Levin
- National Research University Higher School of Economics, 16 Soyuza Pechatnikov Street, St Petersburg, Russian Federation 190121
| | - Mirko Farina
- Faculty of Humanities and Social Sciences, Universitetskaya St,1, Innopolis, Russian Federation 420500
- Department of Philosophy, Philosophy Building, Strand Campus, King′s College, London, WC2R 2LS UK
| | - Andrea Lavazza
- Senior Research Fellow in Neuroethics, Centro Universitario Internazionale, Via Antonio Garbasso 42, 52100 Arezzo, Italy
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Pauly B, Revai T, Marcellus L, Martin W, Easton K, MacDonald M. "The health equity curse": ethical tensions in promoting health equity. BMC Public Health 2021; 21:1567. [PMID: 34407781 PMCID: PMC8375114 DOI: 10.1186/s12889-021-11594-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 08/04/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Public health (PH) practitioners have a strong moral commitment to health equity and social justice. However, PH values often do not align with health systems values, making it challenging for PH practitioners to promote health equity. In spite of a growing range of PH ethics frameworks and theories, little is known about ethical concerns related to promotion of health equity in PH practice. The purpose of this paper is to examine the ethical concerns of PH practitioners in promoting health equity in the context of mental health promotion and prevention of harms of substance use. METHODS As part of a broader program of public health systems and services research, we interviewed 32 PH practitioners. RESULTS Using constant comparative analysis, we identified four systemic ethical tensions: [1] biomedical versus social determinants of health agenda; [2] systems driven agendas versus situational care; [3] stigma and discrimination versus respect for persons; and [4] trust and autonomy versus surveillance and social control. CONCLUSIONS Naming these tensions provides insights into the daily ethical challenges of PH practitioners and an opportunity to reflect on the relevance of PH frameworks. These findings highlight the value of relational ethics as a promising approach for developing ethical frameworks for PH practice.
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Affiliation(s)
- Bernie Pauly
- School of Nursing and Canadian Institute for Substance Use Research, University of Victoria, Box 1700 STN CSC, Victoria, BC, V8W 2Y2, Canada
| | - Tina Revai
- Equity Lens in Public Health Project, University of Victoria, Box 1700 STN CSC, Victoria, BC, V8W 2Y2, Canada
| | - Lenora Marcellus
- School of Nursing, University of Victoria, PO Box 1700 STN CSC, Victoria, BC, V8W 2Y2, Canada
| | - Wanda Martin
- College of Nursing, University of Saskatchewan, Health Science Building-1A10, Box 6, 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada.
| | - Kathy Easton
- Island Health, 345 Wale Rd, Victoria, BC, V9B 6X2, Canada
| | - Marjorie MacDonald
- School of Nursing and Canadian Institute for Substance Use Research, University of Victoria, Box 1700 STN CSC, Victoria, BC, V8W 2Y2, Canada
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Slemon A, McAuliffe C, Goodyear T, McGuinness L, Shaffer E, Jenkins EK. Reddit Users' Experiences of Suicidal Thoughts During the COVID-19 Pandemic: A Qualitative Analysis of r/Covid19_support Posts. Front Public Health 2021; 9:693153. [PMID: 34458223 PMCID: PMC8397453 DOI: 10.3389/fpubh.2021.693153] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 07/20/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The COVID-19 pandemic is having considerable impacts on population-level mental health, with research illustrating an increased prevalence in suicidal thoughts due to pandemic stressors. While the drivers of suicidal thoughts amid the pandemic are poorly understood, qualitative research holds great potential for expanding upon projections from pre-pandemic work and nuancing emerging epidemiological data. Despite calls for qualitative inquiry, there is a paucity of qualitative research examining experiences of suicidality related to COVID-19. The use of publicly available data from social media offers timely and pertinent information into ongoing pandemic-related mental health, including individual experiences of suicidal thoughts. Objective: To examine how Reddit users within the r/COVID19_support community describe their experiences of suicidal thoughts amid the COVID-19 pandemic. Methods: This study draws on online posts from within r/COVID19_support that describe users' suicidal thoughts during and related to the COVID-19 pandemic. Data were collected from creation of this subreddit on February 12, 2020 until December 31, 2020. A qualitative thematic analysis was conducted to generate themes reflecting users' experiences of suicidal thoughts. Results: A total of 83 posts from 57 users were included in the analysis. Posts described a range of users' lived and living experiences of suicidal thoughts related to the pandemic, including deterioration in mental health and complex emotions associated with suicidal thinking. Reddit users situated their experiences of suicidal thoughts within various pandemic stressors: social isolation, employment and finances, virus exposure and COVID-19 illness, uncertain timeline of the pandemic, news and social media, pre-existing mental health conditions, and lack of access to mental health resources. Some users described individual coping strategies and supports used in attempt to manage suicidal thoughts, however these were recognized as insufficient for addressing the multilevel stressors of the pandemic. Conclusions: Multiple and intersecting stressors have contributed to individuals' experiences of suicidal thoughts amid the COVID-19 pandemic, requiring thoughtful and complex public health responses. While ongoing challenges exist with self-disclosure of mental health challenges on social media, Reddit and other online platforms may offer a space for users to share suicidal thoughts and discuss potential coping strategies.
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Affiliation(s)
- Allie Slemon
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Corey McAuliffe
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Trevor Goodyear
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
| | - Liza McGuinness
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Elizabeth Shaffer
- Indian Residential School History and Dialogue Centre, University of British Columbia, Vancouver, BC, Canada
| | - Emily K. Jenkins
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
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Cameron J, Williams B, Ragonnet R, Marais B, Trauer J, Savulescu J. Ethics of selective restriction of liberty in a pandemic. JOURNAL OF MEDICAL ETHICS 2021; 47:553-562. [PMID: 34059520 PMCID: PMC8327318 DOI: 10.1136/medethics-2020-107104] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 04/13/2021] [Accepted: 04/28/2021] [Indexed: 05/12/2023]
Abstract
Liberty-restricting measures have been implemented for centuries to limit the spread of infectious diseases. This article considers if and when it may be ethically acceptable to impose selective liberty-restricting measures in order to reduce the negative impacts of a pandemic by preventing particularly vulnerable groups of the community from contracting the disease. We argue that the commonly accepted explanation-that liberty restrictions may be justified to prevent harm to others when this is the least restrictive option-fails to adequately accommodate the complexity of the issue or the difficult choices that must be made, as illustrated by the COVID-19 pandemic. We introduce a dualist consequentialist approach, weighing utility at both a population and individual level, which may provide a better framework for considering the justification for liberty restrictions. While liberty-restricting measures may be justified on the basis of significant benefits to the population and small costs for overall utility to individuals, the question of whether it is acceptable to discriminate should be considered separately. This is because the consequentialist approach does not adequately account for the value of equality. This value may be protected through the application of an additional proportionality test. An algorithm for making decisions is proposed. Ultimately whether selective liberty-restricting measures are imposed will depend on a range of factors, including how widespread infection is in the community, the level of risk and harm a society is willing to accept, and the efficacy and cost of other mitigation options.
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Affiliation(s)
- James Cameron
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Bridget Williams
- School of Public Health and Preventative Medicine, Monash University, Clayton, Victoria, Australia
| | - Romain Ragonnet
- School of Public Health and Preventative Medicine, Monash University, Clayton, Victoria, Australia
| | - Ben Marais
- Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Sydney, New South Wales, Australia
| | - James Trauer
- School of Public Health and Preventative Medicine, Monash University, Clayton, Victoria, Australia
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Nyrup R. From General Principles to Procedural Values: Responsible Digital Health Meets Public Health Ethics. Front Digit Health 2021; 3:690417. [PMID: 34713166 PMCID: PMC8521828 DOI: 10.3389/fdgth.2021.690417] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 06/14/2021] [Indexed: 11/13/2022] Open
Abstract
Most existing work in digital ethics is modeled on the "principlist" approach to medical ethics, seeking to articulate a small set of general principles to guide ethical decision-making. Critics have highlighted several limitations of such principles, including (1) that they mask ethical disagreements between and within stakeholder communities, and (2) that they provide little guidance for how to resolve trade-offs between different values. This paper argues that efforts to develop responsible digital health practices could benefit from paying closer attention to a different branch of medical ethics, namely public health ethics. In particular, I argue that the influential "accountability for reasonableness" (A4R) approach to public health ethics can help overcome some of the limitations of existing digital ethics principles. A4R seeks to resolve trade-offs through decision-procedures designed according to certain shared procedural values. This allows stakeholders to recognize decisions reached through these procedures as legitimate, despite their underlying disagreements. I discuss the prospects for adapting A4R to the context of responsible digital health and suggest questions for further research.
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Affiliation(s)
- Rune Nyrup
- Leverhulme Centre for the Future of Intelligence, University of Cambridge, Cambridge, United Kingdom
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36
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Dive L, Newson AJ. Ethics of Reproductive Genetic Carrier Screening: From the Clinic to the Population. Public Health Ethics 2021; 14:202-217. [PMID: 34650621 PMCID: PMC8510688 DOI: 10.1093/phe/phab017] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Reproductive genetic carrier screening (RCS) is increasingly being offered more widely, including to people with no family history or otherwise elevated chance of having a baby with a genetic condition. There are valid reasons to reject a prevention-focused public health ethics approach to such screening programs. Rejecting the prevention paradigm in this context has led to an emphasis on more individually-focused values of freedom of choice and fostering reproductive autonomy in RCS. We argue, however, that population-wide RCS has sufficient features in common with other public health screening programs that it becomes important also to attend to its public health implications. Not doing so constitutes a failure to address the social conditions that significantly affect people's capacity to exercise their reproductive autonomy. We discuss how a public health ethics approach to RCS is broader in focus than prevention. We also show that additional values inherent to ethical public health-such as equity and solidarity-are essential to underpin and inform the aims and implementation of reproductive carrier screening programs.
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Affiliation(s)
- Lisa Dive
- Sydney Health Ethics, The University of Sydney
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Addiss DG, Kienast Y, Lavery JV. Ethical dimensions of neglected tropical disease programming. Trans R Soc Trop Med Hyg 2021; 115:190-195. [PMID: 33339025 PMCID: PMC7842092 DOI: 10.1093/trstmh/traa155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 10/14/2020] [Accepted: 11/20/2020] [Indexed: 11/13/2022] Open
Abstract
The global movement to control and eliminate neglected tropical diseases (NTDs) is grounded in an ethic of social justice, solidarity and health equity. NTD programmes deliver significant health benefits in socially complex environments characterized by poverty and economic disparity. We used two ethics frameworks—principlism and Upshur's public health framework—to examine ethical challenges faced by NTD programmes. They include management of serious adverse reactions associated with preventive chemotherapy, centralization of decision-making, ‘opt-out’ policies for school-based deworming, incomplete evidence for ‘pro-poor’ impact and persistent inequities in global partnerships. NTD programmes must actively address ethical challenges while pursuing global health goals.
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Affiliation(s)
- David G Addiss
- Focus Area for Compassion and Ethics, Task Force for Global Health, Decatur, GA, USA
| | - Yvonne Kienast
- Focus Area for Compassion and Ethics, Task Force for Global Health, Decatur, GA, USA.,Center for Ethics, Emory University, Atlanta, GA, USA
| | - James V Lavery
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Nussbaumer A, Pope A, Neville K. A framework for applying
ethics‐by‐design
to decision support systems for emergency management. INFORMATION SYSTEMS JOURNAL 2021. [DOI: 10.1111/isj.12350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Alexander Nussbaumer
- Institute of Interactive Systems and Data Science (ISDS) Graz University of Technology Graz Austria
| | - Andrew Pope
- Business Information Systems University College Cork Cork Ireland
| | - Karen Neville
- Business Information Systems University College Cork Cork Ireland
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O'Connell J, Abbas M, Beecham S, Buckley J, Chochlov M, Fitzgerald B, Glynn L, Johnson K, Laffey J, McNicholas B, Nuseibeh B, O'Callaghan M, O'Keeffe I, Razzaq A, Rekanar K, Richardson I, Simpkin A, Storni C, Tsvyatkova D, Walsh J, Welsh T, O'Keeffe D. Best Practice Guidance for Digital Contact Tracing Apps: A Cross-disciplinary Review of the Literature. JMIR Mhealth Uhealth 2021; 9:e27753. [PMID: 34003764 PMCID: PMC8189288 DOI: 10.2196/27753] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/17/2021] [Accepted: 04/05/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Digital contact tracing apps have the potential to augment contact tracing systems and disrupt COVID-19 transmission by rapidly identifying secondary cases prior to the onset of infectiousness and linking them into a system of quarantine, testing, and health care worker case management. The international experience of digital contact tracing apps during the COVID-19 pandemic demonstrates how challenging their design and deployment are. OBJECTIVE This study aims to derive and summarize best practice guidance for the design of the ideal digital contact tracing app. METHODS A collaborative cross-disciplinary approach was used to derive best practice guidance for designing the ideal digital contact tracing app. A search of the indexed and gray literature was conducted to identify articles describing or evaluating digital contact tracing apps. MEDLINE was searched using a combination of free-text terms and Medical Subject Headings search terms. Gray literature sources searched were the World Health Organization Institutional Repository for Information Sharing, the European Centre for Disease Prevention and Control publications library, and Google, including the websites of many health protection authorities. Articles that were acceptable for inclusion in this evidence synthesis were peer-reviewed publications, cohort studies, randomized trials, modeling studies, technical reports, white papers, and media reports related to digital contact tracing. RESULTS Ethical, user experience, privacy and data protection, technical, clinical and societal, and evaluation considerations were identified from the literature. The ideal digital contact tracing app should be voluntary and should be equitably available and accessible. User engagement could be enhanced by small financial incentives, enabling users to tailor aspects of the app to their particular needs and integrating digital contact tracing apps into the wider public health information campaign. Adherence to the principles of good data protection and privacy by design is important to convince target populations to download and use digital contact tracing apps. Bluetooth Low Energy is recommended for a digital contact tracing app's contact event detection, but combining it with ultrasound technology may improve a digital contact tracing app's accuracy. A decentralized privacy-preserving protocol should be followed to enable digital contact tracing app users to exchange and record temporary contact numbers during contact events. The ideal digital contact tracing app should define and risk-stratify contact events according to proximity, duration of contact, and the infectiousness of the case at the time of contact. Evaluating digital contact tracing apps requires data to quantify app downloads, use among COVID-19 cases, successful contact alert generation, contact alert receivers, contact alert receivers that adhere to quarantine and testing recommendations, and the number of contact alert receivers who subsequently are tested positive for COVID-19. The outcomes of digital contact tracing apps' evaluations should be openly reported to allow for the wider public to review the evaluation of the app. CONCLUSIONS In conclusion, key considerations and best practice guidance for the design of the ideal digital contact tracing app were derived from the literature.
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Affiliation(s)
- James O'Connell
- Lero, Science Foundation Ireland Research Centre for Software, University of Limerick, Limerick, Ireland
| | - Manzar Abbas
- Lero, Science Foundation Ireland Research Centre for Software, University of Limerick, Limerick, Ireland
| | - Sarah Beecham
- Lero, Science Foundation Ireland Research Centre for Software, University of Limerick, Limerick, Ireland
| | - Jim Buckley
- Lero, Science Foundation Ireland Research Centre for Software, University of Limerick, Limerick, Ireland
| | - Muslim Chochlov
- Lero, Science Foundation Ireland Research Centre for Software, University of Limerick, Limerick, Ireland
| | - Brian Fitzgerald
- Lero, Science Foundation Ireland Research Centre for Software, University of Limerick, Limerick, Ireland
| | - Liam Glynn
- School of Medicine, University of Limerick, Limerick, Ireland
| | - Kevin Johnson
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - John Laffey
- School of Medicine, National University of Ireland Galway, Galway, Ireland
- University Hospital Galway, Saolta, Health Services Executive, Galway, Ireland
| | - Bairbre McNicholas
- School of Medicine, National University of Ireland Galway, Galway, Ireland
- University Hospital Galway, Saolta, Health Services Executive, Galway, Ireland
| | - Bashar Nuseibeh
- Lero, Science Foundation Ireland Research Centre for Software, University of Limerick, Limerick, Ireland
- School of Computing and Communications, The Open University, Milton Keynes, United Kingdom
| | | | - Ian O'Keeffe
- Lero, Science Foundation Ireland Research Centre for Software, University of Limerick, Limerick, Ireland
| | - Abdul Razzaq
- Lero, Science Foundation Ireland Research Centre for Software, University of Limerick, Limerick, Ireland
| | - Kaavya Rekanar
- Lero, Science Foundation Ireland Research Centre for Software, University of Limerick, Limerick, Ireland
| | - Ita Richardson
- Lero, Science Foundation Ireland Research Centre for Software, University of Limerick, Limerick, Ireland
| | - Andrew Simpkin
- School of Mathematics, Statistics and Applied Mathematics, National University of Ireland Galway, Galway, Ireland
| | - Cristiano Storni
- Lero, Science Foundation Ireland Research Centre for Software, University of Limerick, Limerick, Ireland
| | - Damyanka Tsvyatkova
- Lero, Science Foundation Ireland Research Centre for Software, University of Limerick, Limerick, Ireland
| | - Jane Walsh
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Thomas Welsh
- Lero, Science Foundation Ireland Research Centre for Software, University of Limerick, Limerick, Ireland
| | - Derek O'Keeffe
- Lero, Science Foundation Ireland Research Centre for Software, University of Limerick, Limerick, Ireland
- School of Medicine, National University of Ireland Galway, Galway, Ireland
- University Hospital Galway, Saolta, Health Services Executive, Galway, Ireland
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Zadey S, Dharmadhikari S, Mukuntharaj P. Ethics-driven policy framework for implementation of movement restrictions in pandemics. BMJ Glob Health 2021; 6:e005202. [PMID: 34083240 PMCID: PMC8183287 DOI: 10.1136/bmjgh-2021-005202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 05/13/2021] [Indexed: 11/04/2022] Open
Abstract
In the ongoing COVID-19 pandemic, countries across the globe undertook several stringent movement restrictions to prevent the virus spread. In April 2020, around 3.9 billion people in 90 countries were contained in their homes. Discourse on the ethical questions raised by such restrictions while historically rich is absent when it comes to pragmatic policy considerations by the decision-makers. Drawing from the existing literature, we present a unified ethical principles-pragmatic considerations-policy indicators framework flexibly applicable across different countries and contexts to assess the ethical soundness of movement-restricting policies. Our framework consolidates 11 unique but related ethical principles (harm, justifiability, proportionality, least restrictive means, utility efficiency, reciprocity, transparency, relevance, equity, accountability, and cost and feasibility). We mapped each ethical principle to answerable questions or pragmatic considerations to subsequently generate 34 policy indicators. These policy indicators can help policymakers and health practitioners to decide the ethically substantiated initiation of movement restrictions, monitor progress and systematically evaluate the imposed restrictions. As an example, we applied the framework to evaluate the first two phases of the largest lockdown (March-May 2020) implemented nationwide in India for its adherence to ethical principles. The policy indicators revealed ethical lapses in proportionality, utility efficiency and accountability for India's lockdown that should be focused on in subsequent restrictions. The framework possesses value towards ensuring that movement-restrictive public health interventions across different parts of the world in the ongoing pandemic and possible future outbreaks are ethically sound.
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Affiliation(s)
- Siddhesh Zadey
- Association for Socially Applicable Research, Pune, India
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Surabhi Dharmadhikari
- Association for Socially Applicable Research, Pune, India
- Rajashree Chatrapati Shahu Maharaj Government Medical College, Kolhapur, Maharashtra, India
| | - Pradeeksha Mukuntharaj
- Association for Socially Applicable Research, Pune, India
- Urban Health and Training Centre India, Mumbai, India
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A Public Health Ethics Case for Mitigating Zoonotic Disease Risk in Food Production. ACTA ACUST UNITED AC 2021; 6:9. [PMID: 33997264 PMCID: PMC8106510 DOI: 10.1007/s41055-021-00089-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2021] [Indexed: 12/29/2022]
Abstract
This article argues that governments in countries that currently permit intensive animal agriculture - especially but not exclusively high-income countries - are, in principle, morally justified in taking steps to restrict or even eliminate intensive animal agriculture to protect public health from the risk of zoonotic pandemics. Unlike many extant arguments for restricting, curtailing, or even eliminating intensive animal agriculture which focus on environmental harms, animal welfare, or the link between animal source food (ASF) consumption and noncommunicable disease, the argument in this article appeals to the value of protecting populations from future global health emergencies and their broad social, economic, and health impacts, taking the SARS-CoV-2 virus as a particularly salient example. The article begins by identifying how intensive animal agriculture contributes to the outbreak (and risk of future outbreaks) of zoonotic diseases. Next, we explore three specific policy options: 1. Incentivizing plant-based and cell-based ASF alternatives through government subsidies; 2. Disincentivizing intensive ASF production through the adoption of a “zoonotic tax”; and 3. Eliminating intensive ASF production through a total ban. We argue that all three of these measures are permissible, although we remain agnostic as to whether these measures are obligatory. We argue for this conclusion on the grounds that each measure is justified by the same sorts of considerations that justify other widely accepted public health interventions, and each is compatible with a variety of theories of justice. We then address potential objections. Finally, we discuss how our novel argument relates to extant ethical arguments in favor or curtailing ASF production and consumption.
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Cox C, Ansari A, McLaughlin M, Van der Scheer J, Liddell K, Burt J, McGowan J, Bousfield J, George J, Leach B, Parkinson S, Dixon-Woods M. Developing an ethical framework for asymptomatic COVID-19 testing programmes in higher education institutions. Wellcome Open Res 2021. [DOI: 10.12688/wellcomeopenres.16807.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: Mass asymptomatic COVID-19 testing programmes are being introduced in a range of settings, including in higher education institutions (HEIs). We aimed to produce an ethical framework to identify the range of ethical considerations relevant to HEI testing programmes and to support organisational decision-making. Methods: We conducted a mixed-method consultation (survey and semi-structured interviews) with students and staff at a case study university that was running a student testing programme. Survey data were analysed descriptively; data analysis for interviews was based on the Framework method. The findings of the consultation were combined with literature review, legal/ethical analysis and expert views to produce an ethical framework. Results: A total of 239 people took part in the consultation: 213 completed surveys (189 students, 24 staff) and 26 (16 students, 7 staff) participated in interviews. The survey identified clear support (99% of survey respondents) for the testing programme. Around two-thirds (62%) supported non-mandatory participation. Over half (54%) felt that the programme would need to be at least moderately effective to be acceptable. Over three-quarters (76%) felt the university had some responsibility to run a testing programme. Synthesis of consultation findings and further analysis identified nine areas of ethical consideration for HEIs looking to implement mass asymptomatic testing programmes: design and operation; goals; properties of the test; enabling isolation; choices about participation; benefits, harms and opportunity costs; responsibilities between students and institutions; privacy, confidentiality and data-sharing; and communication. The ethical framework includes recommendations in each of these areas, with illustrative examples of how they might be put into practice. Conclusions: By identifying ethical considerations relevant to university student testing programmes using analysis and consultation, the framework we developed has potential to facilitate deliberation about ethical aspects of such programmes, as well as informing decision-making about their introduction, design and delivery.
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Ho CWL, Caals K. A Call for an Ethics and Governance Action Plan to Harness the Power of Artificial Intelligence and Digitalization in Nephrology. Semin Nephrol 2021; 41:282-293. [PMID: 34330368 DOI: 10.1016/j.semnephrol.2021.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Digitalization in nephrology has progressed in a manner that is disparate and siloed, even though learning (under a broader Learning Health System initiative) has been manifested in all the main areas of clinical application. Most applications based on artificial intelligence/machine learning (AI/ML) are still in the initial developmental stages and are yet to be adequately validated and shown to contribute to positive patient outcomes. There is also no consistent or comprehensive digitalization plan, and insufficient data are a limiting factor across all of these areas. In this article, we first consider how digitalization along nephrology care pathways relates to the Learning Health System initiative. We then consider the current state of AI/ML-based software and devices in nephrology and the ethical and regulatory challenges in scaling them up toward broader clinical application. We conclude with our proposal to establish a dedicated ethics and governance framework that is centered around health care providers in nephrology and the AI/ML-based software to which their work relates. This framework should help to integrate ethical and regulatory values and considerations, involve a wide range of stakeholders, and apply across normative domains that are conventionally demarcated as clinical, research, and public health.
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Affiliation(s)
- Calvin Wai-Loon Ho
- Centre for Medical Ethics and Law, Department of Law, The University of Hong Kong, Hong Kong SAR.
| | - Karel Caals
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Beauvais MJS, Knoppers BM. Coming Out to Play: Privacy, Data Protection, Children's Health, and COVID-19 Research. Front Genet 2021; 12:659027. [PMID: 33936177 PMCID: PMC8080022 DOI: 10.3389/fgene.2021.659027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 03/19/2021] [Indexed: 12/29/2022] Open
Abstract
The COVID-19 pandemic has underscored the need for new ways of thinking about data protection. This is especially so in the case of health research with children. The responsible use of children's data plays a key role in promoting children's well-being and securing their right to health and to privacy. In this article, we contend that a contextual approach that appropriately balances children's legal and moral rights and interests is needed when thinking about data protection issues with children. We examine three issues in health research through a child-focused lens: consent to data processing, data retention, and data protection impact assessments. We show that these issues present distinctive concerns for children and that the General Data Protection Regulation provides few bright-line rules. We contend that there is an opportunity for creative approaches to children's data protection when child-specific principles, such as the best interests of the child and the child's right to be heard, are put into dialogue with the structure and logic of data protection law.
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Affiliation(s)
- Michael J. S. Beauvais
- Centre of Genomics and Policy, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Bartha Maria Knoppers
- Centre of Genomics and Policy, Faculty of Medicine, McGill University, Montreal, QC, Canada
- Canada Research Chair in Law and Medicine, Montreal, QC, Canada
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Basu S. Effective Contact Tracing for COVID-19 Using Mobile Phones: An Ethical Analysis of the Mandatory Use of the Aarogya Setu Application in India. Camb Q Healthc Ethics 2021; 30:262-271. [PMID: 32993842 PMCID: PMC7642501 DOI: 10.1017/s0963180120000821] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Several digital contact tracing smartphone applications have been developed worldwide in the effort to combat COVID-19 that warn users of potential exposure to infectious patients and generate big data that helps in early identification of hotspots, complementing the manual tracing operations. In most democracies, concerns over a breach in data privacy have resulted in severe opposition toward their mandatory adoption. This paper examines India as a noticeable exception, where the compulsory installation of such a government-backed application, the "Aarogya Setu" has been deemed mandatory in certain situations. We argue that the mandatory app requirement constitutes a legitimate public health intervention during a public health emergency.
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Community Water Fluoridation: Caveats to Implement Justice in Public Oral Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052372. [PMID: 33804357 PMCID: PMC7967766 DOI: 10.3390/ijerph18052372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 02/19/2021] [Accepted: 02/19/2021] [Indexed: 11/26/2022]
Abstract
Community water fluoridation (CWF), a long-established public health intervention, has been studied for scientific evidence from both of yea and nay standpoints. To justify CWF with scientific evidence inevitably leads to ethical justification, which raises the question of whether oral health is of individual concern or social responsibility. As dental caries is a public health problem, public health ethics should be applied to the topic instead of generic clinical ethics. From both pro- and anti-fluoridationists’ perspectives, CWF is a public health policy requiring a significant level of intervention. Thus, there needs to take further considerations for justifying CWF beyond the simple aspect of utility. For further ethical considerations on CWF, three caveats were suggested: procedural justice, social contexts, and maintenance of trust. The process to justify CWF should also be justified, not simply by majority rule but participatory decision-making with transparency and pluralistic democracy. Social contexts are to be part of the process of resolving conflicting values in public health interventions. Public trust in the dental profession and the oral healthcare system should be maintained over the considerations. This article suggests accountability for reasonableness as a framework to consider infringement by CWF for public justification of its implementation.
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Voo TC, Lederman Z, Kaur S. Patient Isolation during Infectious Disease Outbreaks: Arguments for Physical Family Presence. Public Health Ethics 2020; 13:133-142. [PMID: 33294029 PMCID: PMC7700794 DOI: 10.1093/phe/phaa024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
This article argues that outbreak preparedness and response should implement a ‘family presence’ policy for infected patients in isolation that includes the option of physical visits and care within the isolation facility under some conditions. While such a ‘physical family presence’ (PFP) policy could increase infections during an outbreak and may raise moral dilemmas, we argue that it is ethically justified based on the least infringement principle and the need to minimize the harms and burdens of isolation as a restrictive measure. Categorical prohibition of PFP during the course of an outbreak or epidemic is likely to result in unnecessary harms to patients and families, and violate values such as the moral commitments of families to care for each other. Supporting the option of PFP under particular circumstances, on the other hand, will least infringe these moral considerations. An additional reason for a family presence policy is that it may facilitate voluntary cooperation with isolation and other restrictive measures. We provide an analysis of these considerations for supporting modes of family presence during an outbreak emergency, before defending the riskier option of PFP in the isolation facility from plausible objections and concerns.
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Affiliation(s)
- Teck Chuan Voo
- Centre for Biomedical Ethics, National University of Singapore, Yong Loo Lin School of Medicine
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Dave R, Gupta R. Mandating the Use of Proximity Tracking Apps During Coronavirus Disease 2019: Ethical Justifications. Front Med (Lausanne) 2020; 7:590265. [PMID: 33344477 PMCID: PMC7738463 DOI: 10.3389/fmed.2020.590265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 11/02/2020] [Indexed: 01/07/2023] Open
Abstract
The rise of the coronavirus disease 2019 (COVID-19) in a digital world has expectedly called upon technologies, such as wearables and mobile devices, to work in conjunction with public health interventions to tackle the pandemic. One significant example of this integration is the deployment of proximity tracking apps on smartphones to enhance traditional contact tracing methods. Many countries have adopted proximity tracking apps; however, there is a large degree of global differentiation in the voluntariness of the apps. Further, the concept of a mandatory policy—forcing individuals to use the apps—has been met with ethical concerns (e.g., privacy and liberty). While ethical considerations surrounding deployment have been put forth, such as by the World Health Organization, ethical justifications for a mandatory policy are lacking. Here, we use the Faden–Shebaya framework, which was formed to justify public health interventions, to determine if the compulsory use of proximity tracking apps is ethically appropriate. We show that while theoretically justified, due to the current state of proximity tracking applications and societal factors, it is difficult to defend a mandatory policy in practice.
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Affiliation(s)
- Riya Dave
- Cognitive and Behavioural Neuroscience Laboratory, Department of Humanities and Social Sciences, Indian Institute of Technology Bombay, Mumbai, India
| | - Rashmi Gupta
- Cognitive and Behavioural Neuroscience Laboratory, Department of Humanities and Social Sciences, Indian Institute of Technology Bombay, Mumbai, India
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Spitale G. COVID-19 and the ethics of quarantine: a lesson from the Eyam plague. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2020; 23:603-609. [PMID: 32761351 PMCID: PMC7405927 DOI: 10.1007/s11019-020-09971-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
The recent outbreak of the SARS-CoV-2 coronavirus is posing many different challenges to local communities, directly affected by the pandemic, and to the global community, trying to find how to respond to this threat in a larger scale. The history of the Eyam Plague, read in light of Ross Upshur's Four Principles for the Justification of Public Health Intervention, and of the Siracusa Principles on the Limitation and Derogation Provisions in the International Covenant on Civil and Political Rights, could provide useful guidance in navigating the complex ethical issues that arise when quarantine measures need to be put in place.
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Affiliation(s)
- Giovanni Spitale
- Institute of Biomedical Ethics and History of Medicine, University of Zurich, Winterthurerstrasse 30, 8006, Zurich, Switzerland.
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Philipsborn RP, Sorscher EA, Sexson W, Evans HH. Born on U.S. Soil: Access to Healthcare for Neonates of Non-Citizens. Matern Child Health J 2020; 25:9-14. [PMID: 33201449 DOI: 10.1007/s10995-020-03020-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The 14th amendment of the United States (US) Constitution guarantees citizenship to infants born in the US. With documentation of citizenship, typically through a birth certificate, neonates gain official identity and the opportunity to qualify for services like healthcare. Most guidance on caring for immigrant children assumes that access to health care is guaranteed for babies born in the US. In practice, some infants born to non-citizen mothers face barriers in obtaining services fundamental to neonatal health. METHODS We conducted a review of the literature to identify articles on access to care for infants born to non-citizen mothers in the US. Because of the scarcity of relevant peer-reviewed published literature on this topic, the search was broadened to grey literature including news articles, online articles, and legal reviews. Using these aggregated sources, we created a framework for understanding maternal immigration status and barriers to healthcare for neonates born in the US. We discuss risk factors from the public health, historical and ethical perspectives. RESULTS Barriers exist for some mother-infant dyads in obtaining services such as healthcare, health insurance and supplemental nutrition programs. At-risk dyads include neonates of undocumented immigrants and birth tourists as well as neonates born to women on visas. The impact of these barriers on health-seeking behaviors, access to care, and health outcomes for these neonates is largely unknown. DISCUSSION The framework for understanding challenges of non-citizen mothers and their infants that we present in this article provides a resource for physicians and public health professionals serving this population. That much of the literature exists outside of healthcare highlights the need for more scholarly work on this problem. Future research will better inform advocacy and public health efforts to protect this vulnerable population of newborn citizens and their mothers.
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Affiliation(s)
- Rebecca Pass Philipsborn
- Department of Pediatrics, Emory University, Health Sciences Research Building W417, 1760 Haygood Drive NE, Atlanta, GA, 30322, USA.,Emory Global Health Institute, Emory University, Atlanta, GA, USA
| | - Ella A Sorscher
- University of Colorado Pediatric Residency Program Aurora, Aurora, CO, USA
| | - William Sexson
- Department of Pediatrics, Emory University, Health Sciences Research Building W417, 1760 Haygood Drive NE, Atlanta, GA, 30322, USA
| | - H Hughes Evans
- Department of Pediatrics, Emory University, Health Sciences Research Building W417, 1760 Haygood Drive NE, Atlanta, GA, 30322, USA.
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