Public perceptions of psychiatric, justice-involved, and elderly populations during the COVID-19 pandemic

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

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

Public voices on tie-breaking criteria and underlying values in COVID-19 triage protocols to access critical care: a scoping review

Background

To reduce the arbitrariness in the allocation of rare resources in intensive care units (ICU) in the context of the pandemic, tiebreakers were considered in some COVID-19 triage algorithms. They were also contemplated to facilitate the tragic decisions of healthcare workers when faced with two patients with similar prognosis and only one ICU bed available. Little is known about the public's perspective on tiebreakers.

Objectives

To consolidate the available scientific literature on public consultations, particularly on tiebreakers and their underlying values. Also, to obtain an overview of the key arguments presented by the participating public and to identify potential gaps related to this topic.

Methods

The steps described by Arksey and O'Malley was the preferred method to our approach. Seven electronic databases were searched from January 2020 to April 2022, using keywords for each database: PubMed, Medline, EMBASE, Web of Science, PsycINFO, EBM reviews, CINAHL complete. We also searched in Google and Google Scholar, and in the references of the articles found. Our analysis was mainly qualitative. A thematic analysis was performed to consider the public's perspectives on tiebreakers and their underlying values, according to these studies.

Results

Of 477 publications found, 20 were selected. They carried out public consultations through various methods: surveys (80%), interviews (20%), deliberative processes (15%) and others (5%) in various countries: Australia, Brazil, Canada, China, France, Germany, India, Iran, Italy, Japan, Korea, Netherlands, Portugal, Spain, Switzerland, Thailand, United Kingdom, and United States. Five themes emerged from our analysis. The public favored the life cycle (50%) and absolute age (45%) as a tiebreaker. Other values considered important were reciprocity, solidarity, equality, instrumental value, patient merit, efficiency, and stewardship. Among the new findings were a preference for patient nationality and those affected by COVID-19.

Conclusions

There is a preference for favoring younger patients over older patients when there is a tie between similar patients, with a slight tendency to favor intergenerational equity. Variability was found in the public's perspectives on tiebreakers and their values. This variability was related to socio-cultural and religious factors. More studies are needed to understand the public's perspective on tiebreakers.

Supplementary Information

The online version contains supplementary material available at 10.1007/s44250-023-00027-9.

Analysis of personal psychological motivation and social psychological motivation of Retaliatory Justice under moral public opinion: Chinese cases

From a social psychology perspective, this study explored the personal and social psychological motivation of Retaliatory Justice. This study constructed a four-dimensional model of the psychological motivation of Retaliatory Justice from the two dimensions of "Self vs. Society" and "Identity vs. Resource." They were Identity-Based Self-Oriented Motivation (Pacifying Outrage), Resource-Based Self-Oriented Motivation (Occupying Resource), Identity-Based Society-Oriented Motivation (Value Confirmation), and Resource-Based Society-Oriented Motivation (Deterrence and Control). In this study, 497 sets of valid data were extracted from 6 universities in Xi'an, Shaanxi Province, China, using 3 sets of situational experiments and the "Questionnaire Star" online survey platform as a vehicle to explore the personal motivations and psychosocial motivations of Retaliatory Justice. The empirical results showed that the situational experiment significantly verified the existence of Pacifying Outrage and Value Confirmation, and partially verified the existence of Deterrence and Control and Occupying Resource. Multiple linear regression analysis showed that only the effect of Pacifying Outrage on Retaliatory Justice showed a main effect, and the interaction between Pacifying Outrage and Deterrence and Control was not significant. Pacifying Outrage significantly affects Retaliatory Justice, while Occupying Resource significantly affects Retaliatory Justice, but the interaction between the two was not significant. Value Confirmation significantly affects Retaliatory Justice. Value Confirmation and Deterrence and Control synergistically affect Retaliatory Justice, but Deterrence and Control had no significant effect on Retaliatory Justice. Taking emotions as clues, this paper discussed the realistic value of the rheological paths of the psychological motivation of Retaliatory Justice, which brought enlightenment to the improvement of social morality, the cultivation of judicial trust, and the construction of psychological service system.

Decision Conflicts in Clinical Care during COVID-19: A Multi-Perspective Inquiry

Background: The early COVID-19-pandemic was characterized by changes in decision making, decision-relevant value systems and the related perception of decisional uncertainties and conflicts resulting in decisional burden and stress. The vulnerability of clinical care professionals to these decisional dilemmas has not been characterized yet. Methods: A cross-sectional questionnaire study (540 patients, 322 physicians and 369 nurses in 11 institutions throughout Germany) was carried out. The inclusion criterion was active involvement in clinical treatment or decision making in oncology or psychiatry during the first year of COVID-19. The questionnaires covered five decision dimensions (conflicts and uncertainty, resources, risk perception, perception of consequences for clinical processes, and the perception of consequences for patients). Data analysis was performed using ANOVA, Pearson rank correlations, and the Chi²-test, and for inferential analysis, nominal logistic regression and tree classification were conducted. Results: Professionals reported changes in clinical management (27.5%) and a higher workload (29.2%), resulting in decisional uncertainty (19.2%) and decisional conflicts (22.7%), with significant differences between professional groups (p < 0.005), including anxiety, depression, loneliness and stress in professional subgroups (p < 0.001). Nominal regression analysis targeting “Decisional Uncertainty” provided a highly significant prediction model (LQ p < 0.001) containing eight variables, and the analysis for “Decisional Conflicts” included six items. The classification rates were 64.4% and 92.7%, respectively. Tree analysis confirmed three levels of determinants. Conclusions: Decisional uncertainty and conflicts during the COVID-19 pandemic were independent of the actual pandemic load. Vulnerable professional groups for the perception of a high number of decisional dilemmas were characterized by individual perception and the psychological framework. Coping and management strategies should target vulnerability, enable the handling of the individual perception of decisional dilemmas and ensure information availability and specific support for younger professionals.

Is compassion the flip side of punitiveness? Incorporating COVID-19 crisis in experimental vignettes to examine support for visitation and vaccination in prison

Objectives

The public hold both punitive and pragmatic attitudes toward prison policy. Yet it is unclear whether the public supports compassionate efforts that do not directly relate to recidivism. This study explores the role of exclusionary symbolic aims (prioritizing non-prisoner groups), inclusionary symbolic aims (minimizing health risk for the vulnerable), and cost (taxes).

Methods

Using a quota-based national sample fielded in spring 2021 (N=1260), we embedded two experimental vignettes to assess support for vaccination priorities and personal protective equipment (PPE) for in-person visitation. We also examine respondent experiences (e.g., exposure to COVID-19, vaccine status, personal or vicarious arrest) and beliefs (e.g., political ideology, racial resentment, stigma).

Results

Consistent with dominant exclusionary symbolic aims, respondents showed strong preferences for non-prisoner groups in facilitating safe in-person visits (in long-term care facilities) and vaccine priorities (to prison guards). Inclusionary symbolic aims were less clear when examining risk from vaccine side effects or helping vulnerable populations (the elderly). High cost reduced support for compassionate policy.

Conclusions

Public support for policies aimed at maintaining the health of individuals who are incarcerated may be motivated by similar factors as punishment preferences.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11292-022-09523-z.