Ethical rationing of healthcare resources during COVID-19 outbreak: Review

Ethical Considerations and Equipoise in Cancer Surgery

The changing landscape of cancer surgery requires ongoing consideration of ethical issues to ensure patient-centered care and fair access to treatments. With technological advancements and the global expansion of surgical interventions, healthcare professionals must navigate complex ethical dilemmas related to patient autonomy, informed consent, and the impact of new technologies on the physician-patient relationship. Additionally, ethical principles and decision-making in oncology, especially in the context of genetic predisposition to breast cancer, highlight the importance of integrating patient knowledge, preferences, and alignment between goals and treatments. As global surgery continues to grow, addressing ethical considerations becomes crucial to reduce disparities in access to surgical interventions and uphold ethical duties in patient care. Furthermore, the rise of digital applications in healthcare, such as digital surgery, requires heightened awareness of the unique ethical issues in this domain. The ethical implications of using artificial intelligence (AI) in robotic surgical training have drawn attention to the challenges of protecting patient and surgeon data, as well as the ethical boundaries that innovation may encounter. These discussions collectively emphasize the complex ethical issues associated with surgical innovation and underscore the importance of upholding ethical standards in the pursuit of progress in the field. In this study, we thoroughly analyzed previous scholarly works on ethical considerations and equipoise in the field of oncological surgery. Our main focus was on the use of AI in this specific context.

A Novel Approach for the Early Detection of Medical Resource Demand Surges During Health Care Emergencies: Infodemiology Study of Tweets

BACKGROUND

The COVID-19 pandemic has highlighted gaps in the current handling of medical resource demand surges and the need for prioritizing scarce medical resources to mitigate the risk of health care facilities becoming overwhelmed.

OBJECTIVE

During a health care emergency, such as the COVID-19 pandemic, the public often uses social media to express negative sentiment (eg, urgency, fear, and frustration) as a real-time response to the evolving crisis. The sentiment expressed in COVID-19 posts may provide valuable real-time information about the relative severity of medical resource demand in different regions of a country. In this study, Twitter (subsequently rebranded as X) sentiment analysis was used to investigate whether an increase in negative sentiment COVID-19 tweets corresponded to a greater demand for hospital intensive care unit (ICU) beds in specific regions of the United States, Brazil, and India.

METHODS

Tweets were collected from a publicly available data set containing COVID-19 tweets with sentiment labels and geolocation information posted between February 1, 2020, and March 31, 2021. Regional medical resource shortage data were gathered from publicly available data sets reporting a time series of ICU bed demand across each country. Negative sentiment tweets were analyzed using the Granger causality test and convergent cross-mapping (CCM) analysis to assess the utility of the time series of negative sentiment tweets in forecasting ICU bed shortages.

RESULTS

For the United States (30,742,934 negative sentiment tweets), the results of the Granger causality test (for whether negative sentiment COVID-19 tweets forecast ICU bed shortage, assuming a stochastic system) were significant (P<.05) for 14 (28%) of the 50 states that passed the augmented Dickey-Fuller test at lag 2, and the results of the CCM analysis (for whether negative sentiment COVID-19 tweets forecast ICU bed shortage, assuming a dynamic system) were significant (P<.05) for 46 (92%) of the 50 states. For Brazil (3,004,039 negative sentiment tweets), the results of the Granger causality test were significant (P<.05) for 6 (22%) of the 27 federative units, and the results of the CCM analysis were significant (P<.05) for 26 (96%) of the 27 federative units. For India (4,199,151 negative sentiment tweets), the results of the Granger causality test were significant (P<.05) for 6 (23%) of the 26 included regions (25 states and the national capital region of Delhi), and the results of the CCM analysis were significant (P<.05) for 26 (100%) of the 26 included regions.

CONCLUSIONS

This study provides a novel approach for identifying the regions of high hospital bed demand during a health care emergency scenario by analyzing Twitter sentiment data. Leveraging analyses that take advantage of natural language processing-driven tweet extraction systems has the potential to be an effective method for the early detection of medical resource demand surges.

Ethical challenges faced by healthcare workers in pediatric oncology care during the COVID-19 pandemic in Australia

OBJECTIVE

This qualitative study examined ethical challenges reported by healthcare professionals (HCPs) working in a large Australian pediatric oncology center during a period of strict COVID-19 restrictions.

METHODS

We conducted semi-structured interviews with 21 HCPs who provided pediatric cancer care during the pandemic in 2020, during strict lockdown periods. Interviews examined the difficulties they faced, as well as their own ethical evaluation of the impact of COVID-19 policies on oncology care. Data were analyzed using inductive content analysis and thematic analysis.

RESULTS

HCPs faced several challenges, primarily originating from hospital restrictions, which led to changes in usual clinical practices. These challenges included delivering care with personal protective equipment (PPE), the impact of a one-parent visitation policy, changes in psychosocial and allied health services, and COVID-19 swabbing policies. Overall, there was consensus from participants that hospital restrictions were justified and, while difficult, HCPs simply had to provide the best care possible given the circumstances. However, participants described decreased capacity to deliver holistic patient care and, in some instances, a tendency to avoid ethical reflection. Lastly, there was a consistent theme of shame and sense of responsibility underlying some participants' anxiety around inadvertently transmitting COVID-19 to immunocompromised patients.

CONCLUSION

Our findings show that many staff felt unease at the disruptions in patient care due to COVID-19 restrictions. Some HCPs indicated a degree of moral distress, with a possibility of moral injury among some HCPs. A focus on ethical recovery could assist in preventing any ongoing difficulties among HCPs because of their experiences.

A Community-Based Model of Care During the Fourth Wave of the COVID-19 Outbreak in Ho Chi Minh City, Vietnam

In response to a call for help during a surge in coronavirus disease-19 (COVID-19) cases in Ho Chi Minh City in July 2021, the University of Medicine and Pharmacy at Ho Chi Minh City developed and implemented a community care model for the management of patients with COVID-19. This was based on three main principles: home care; providing monitoring and care at a distance; and providing timely emergency care if needed. One team supported patients at home with frequent contacts and remote monitoring, while a second team transferred and cared for patients requiring treatment at field emergency care facilities. COVID-19-related mortality rates at the two districts where this approach was implemented (0.43% and 0.57%) were substantially lower than the overall rate in Ho Chi Minh City over the same period (4.95%). Thus, utilization of a community care model can increase the number of patients with COVID-19 who can be effectively managed from home, and use of field emergency care facilities limited the number of patients that had to be referred for tertiary care. Importantly, the community care model also markedly reduced the mortality rate compared with traditional methods of COVID-19 patient management.

Ethical Considerations in Ever-Expanding Utilization of ECLS: A Research Agenda

Technological advancements and rapid expansion in the clinical use of extracorporeal life support (ECLS) across all age ranges in the last decade, including during the COVID-19 pandemic, has led to important ethical considerations. As a costly and resource intensive therapy, ECLS is used emergently under high stakes circumstances where there is often prognostic uncertainty and risk for serious complications. To develop a research agenda to further characterize and address these ethical dilemmas, a working group of specialists in ECLS, critical care, cardiothoracic surgery, palliative care, and bioethics convened at a single pediatric academic institution over the course of 18 months. Using an iterative consensus process, research questions were selected based on: (1) frequency, (2) uniqueness to ECLS, (3) urgency, (4) feasibility to study, and (5) potential to improve patient care. Questions were categorized into broad domains of societal decision-making, bedside decision-making, patient and family communication, medical team dynamics, and research design and implementation. A deeper exploration of these ethical dilemmas through formalized research and deliberation may improve equitable access and quality of ECLS-related medical care.