1
|
Göttert EAF. What is fair? Ethical analysis of triage criteria and disability rights during the COVID-19 pandemic and the German legislation. JOURNAL OF MEDICAL ETHICS 2024:jme-2023-109326. [PMID: 37973368 DOI: 10.1136/jme-2023-109326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 10/28/2023] [Indexed: 11/19/2023]
Abstract
This essay discusses the ethical challenges and dilemmas in allocating scarce medical resources during the COVID-19 pandemic, using the German legislative process as a starting point. It is guided by the right to non-discrimination of people with disability and generally contrasts utilitarian and rights-based principles of allocation. Three approaches that were suggested in the German discussion, are presented, the lottery principle, the first come first served principle and the probability to survive principle. Arguments in favour and against each principle are discussed. The focus is on the utilitarian probability to survive principle, which was adopted in German legislation in 2022, and its discriminatory potential against people with disability. The essay suggests ways to mitigate the concerns of discrimination related to the probability to survive principle. It concludes that resolving the triage dilemma requires a balanced approach between utilitarian and rights-based concerns, which promotes both maximising the number of patients surviving and the right not to be discriminated against and be treated equally. It calls for a further debate on how many ethical values such as equity, fairness and non-discrimination we are willing to sacrifice for a higher number of survivors and when we are willing to sacrifice survivors to secure ethical values.
Collapse
Affiliation(s)
- Elena Ana Francesca Göttert
- Institute for Ethics, History and Philosophy of Medicine, Medizinische Hochschule Hannover, Hannover, Germany
| |
Collapse
|
2
|
Moore CM, Pan CX, Roseman K, Stephens MM, Bien-Aime C, Morgan AC, Ross W, Castillo MC, Palathra BC, Jones CA, Ailey S, Tuffrey-Wijne I, Smeltzer SC, Tobias J. Top Ten Tips Palliative Care Clinicians Should Know About Navigating the Needs of Adults with Intellectual Disabilities. J Palliat Med 2022; 25:1857-1864. [PMID: 36083260 DOI: 10.1089/jpm.2022.0384] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
As many people with intellectual disabilities (ID) live longer, the need for access to quality palliative care (PC) rises. People with ID realize significant barriers and inequities in accessing health care and PC. The need for integrated disability and PC services with extensive collaboration is great. The following tips are for PC clinicians caring for people with ID, their families, caregivers, and the community. While patient-centered care is difficult to distill into "tips," this article, written by an interdisciplinary team of PC and ID specialists, offers resources and references to improve the care provided to people with ID and serious illnesses.
Collapse
Affiliation(s)
- Caitlyn M Moore
- Jefferson College of Nursing, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Inpatient Palliative Care and Hospice, Main Line Health, Radnor, Pennsylvania, USA
| | - Cynthia X Pan
- Division of Geriatrics and Palliative Care Medicine, New York-Presbyterian Queens Hospital, Flushing, New York, USA.,Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Karin Roseman
- Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Jefferson Continuing Care Program, Jefferson Health, Philadelphia, Pennsylvania, USA
| | - Mary M Stephens
- Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Jefferson Continuing Care Program, Jefferson Health, Philadelphia, Pennsylvania, USA
| | - Casey Bien-Aime
- Pastoral Care Department, Lankenau Medical Center, Wynnewood, Pennsylvania, USA
| | - Ann C Morgan
- New York State Office for People with Developmental Disabilities, Region 6, Queens, New York, USA
| | - Wendy Ross
- Jefferson Center for Autism and Neurodiversity, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Matthew C Castillo
- Division of Geriatrics and Palliative Care Medicine, New York-Presbyterian Queens Hospital, Flushing, New York, USA
| | - Brigit C Palathra
- Division of Geriatrics and Palliative Care Medicine, New York-Presbyterian Queens Hospital, Flushing, New York, USA.,Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Christopher A Jones
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Sarah Ailey
- Department of Community, Systems, and Mental Health Nursing, Rush University, College of Nursing, Chicago, Illinois, USA
| | - Irene Tuffrey-Wijne
- Center for Health and Social Care Research, Kingston University, University of London, London, United Kingdom
| | - Suzanne C Smeltzer
- M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, Pennsylvania, USA
| | - Jane Tobias
- Jefferson College of Nursing, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| |
Collapse
|
3
|
Tönsing KM, Dada S, Bastable K, Samuels A. Health information and education needs for youth with complex communication needs during the Covid-19 pandemic: rehabilitation professionals' perspectives. Disabil Rehabil 2022; 45:1619-1628. [PMID: 35508419 DOI: 10.1080/09638288.2022.2069872] [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: 11/03/2022]
Abstract
PURPOSE The worldwide Covid-19 pandemic has highlighted inequities faced by persons with complex communication needs (CCN) in accessing health information and education. This study reports on the perspectives of South African rehabilitation professionals regarding access to health information and education for youth with CCN. MATERIALS AND METHODS Two asynchronous online written focus groups were conducted with 15 rehabilitation professionals. Participants' contributions were thematically analysed. RESULTS Participants reported that youth with CCN faced a variety of challenges when accessing health information, related, amongst others, to the format and quality of the information. Participants reported on strategies they had successfully used to support comprehension of health information and the youth's communication during healthcare encounters. Participants suggested various Covid-19-related and general health topics of value to youth, as well as a variety of multimodal and multilingual presentation formats to make health information accessible. This information was used in the development of accessible health information resources that are now freely available on the authors' institutional website. CONCLUSIONS The results confirmed that there is an urgent need to make accessible health information available in order to include South Africans with CCN in health services during the pandemic and beyond. Implications for rehabilitationHealth information and education (including information and education provided with respect to the Covid-19 pandemic) has often not been accessible to youth with complex communication needs (CCN).South African rehabilitation professionals reported on a variety of challenges that youth with CCN face when attempting to access health information and education, but also reported on strategies that had helped to support them in this.They also highlighted Covid-19-related and general health topics that would be of value to youth, and suggested a variety of information formats and strategies to make health information more accessible.This information can assist in the design of appropriate and accessible health information resources for youth with CCN and other individuals who experience communication challenges.
Collapse
Affiliation(s)
- Kerstin Monika Tönsing
- Centre for Augmentative and Alternative Communication, University of Pretoria, Pretoria, South Africa
| | - Shakila Dada
- Centre for Augmentative and Alternative Communication, University of Pretoria, Pretoria, South Africa
| | - Kirsty Bastable
- Centre for Augmentative and Alternative Communication, University of Pretoria, Pretoria, South Africa
| | - Alecia Samuels
- Centre for Augmentative and Alternative Communication, University of Pretoria, Pretoria, South Africa
| |
Collapse
|
4
|
Linehan C, Birkbeck G, Araten-Bergman T, Baumbusch J, Beadle-Brown J, Bigby C, Bradley V, Brown M, Bredewold F, Chirwa M, Cui J, Godoy Gimenez M, Gomeiro T, Kanova Š, Kroll T, Li H, MacLachlan M, Narayan J, Nearchou F, Nolan A, O'Donovan MA, Santos FH, Šiška J, Stainton T, Tideman M, Tossebro J. COVID-19 IDD: Findings from a global survey exploring family members’ and paid staff’s perceptions of the impact of COVID-19 on individuals with intellectual and developmental disabilities (IDD) and their caregivers. HRB Open Res 2022; 5:27. [PMID: 35615436 PMCID: PMC9111363 DOI: 10.12688/hrbopenres.13497.1] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2022] [Indexed: 12/23/2022] Open
Abstract
Background: A growing body of evidence attests to the disproportionate impact of COVID-19 on persons with intellectual and developmental disabilities (IDD) during the pandemic. This study asked caregivers about their perceptions of how COVID-19 impacted them and the people they support. Method: An online survey was conducted in 12 countries during August-September 2020 and sought information on demographics, support practices, information and training, experiences of COVID-19, social distancing, and wellbeing, as measured by the DASS12. This study reports on 3,754 family members, direct support professionals, and managers who participated in the survey. Results: Caregivers observed increases in depression/anxiety, stereotyped behaviours, aggression towards others and weight gain in the person(s) they supported. They also reported difficulties supporting the person(s) to access healthcare. Families reported reducing or ceasing employment and absorbed additional costs when supporting their family member. Direct support professionals experienced changes in staff shifts, staff absences, increased workload and hiring of casual staff. Caregivers’ wellbeing revealed high levels of stress, depression, and less so anxiety. The strongest predictor of wellbeing among families was observation of changes in mood in the person(s) they supported, while for direct support professionals, the strongest predictors of wellbeing were reorganisation of staff shifts and increases in new direct support staff. Discussion: Findings support the contention of this population experiencing a disproportionate burden during the COVID-19 pandemic, reflecting historical inequities in access to healthcare and other human rights violations which are now protected under the United Nations Convention on the Rights of Persons with Disabilities.
Collapse
Affiliation(s)
- Christine Linehan
- UCD Centre for Disability Studies, University College Dublin, Belfield, Dublin 4, Ireland
| | - Gail Birkbeck
- UCD Centre for Disability Studies, University College Dublin, Belfield, Dublin 4, Ireland
- Business Information Systems, O'Rahilly Building, University College Cork, Cork, Ireland
| | - Tal Araten-Bergman
- Living with Disability Research Centre, School of Allied Health, Human Services & Sport,, La Trobe University, Bundoora Vic 3086, Australia
| | - Jennifer Baumbusch
- Canadian Institute for Inclusion and Citizenship, University of British Columbia, 2080 West Mall, Vancouver, BC Canada V6T 1Z2, Canada
| | | | - Christine Bigby
- Living with Disability Research Centre, School of Allied Health, Human Services & Sport,, La Trobe University, Bundoora Vic 3086, Australia
| | - Valerie Bradley
- Human Services Research Institute, 2336 Massachusetts Ave,, Cambridge, MA, MA 02140, USA
| | - Michael Brown
- School of Nursing and Midwifery, Queen's University, Belfast, BT9 7BL, UK
| | - Femmianne Bredewold
- University of Humanistic Studies, Kromme Nieuwegracht 29, Utrecht, 3512 HD, The Netherlands
| | - Masauso Chirwa
- School of Humanities and Social Sciences, Department of Social Work & Sociology, University of Zambia, Great East Road Campus, P.O.Box 32379, Lusaka, 10101, Zambia
| | - Jialiang Cui
- Department of Social Work, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - Marta Godoy Gimenez
- Department of Psychology, University of Almeria, La Canada de San Urbano, Almeria, 04120, Spain
| | - Tiziano Gomeiro
- ANFFAS Trentino Onlus DAD© project group, Trento, Trentino, 38121, Italy
| | - Šárka Kanova
- Department of Education, University of West Bohemia, Plzeň 3, 301 00, Czech Republic
| | - Thilo Kroll
- UCD School of Nursing, Midwifery, and Health Systems, University College Dublin, Belfield, Dublin 4, Ireland
| | - Henan Li
- Human Services Research Institute, 2336 Massachusetts Ave,, Cambridge, MA, MA 02140, USA
| | - Mac MacLachlan
- School of Psychology, Maynooth University, Maynooth, Ireland
| | - Jayanthi Narayan
- Inclusive Education at Faculty of Health, Education and Society, University of Northampton, Northampton, UK
| | - Finiki Nearchou
- UCD School of Psychology, University College Dublin, Belfield, Dublin, Ireland
| | - Adam Nolan
- UCD Centre for Disability Studies, University College Dublin, Belfield, Dublin 4, Ireland
| | - Mary-Ann O'Donovan
- Centre for Disability Studies, Sydney Medical School, Faculty of Medicine and Health,, University of Sydney, Sydney, Camperdown NSW 2050, Australia
| | - Flavia H Santos
- UCD School of Psychology, University College Dublin, Belfield, Dublin, Ireland
| | - Jan Šiška
- Department of Special Education,, Charles University, Praha 1, 116 39, Czech Republic
| | - Tim Stainton
- Canadian Institute for Inclusion and Citizenship, University of British Columbia, 2080 West Mall, Vancouver, BC Canada V6T 1Z2, Canada
| | - Magnus Tideman
- Department of Social Sciences, Ersta Sköndal Bräcke University, Sköndal, Sweden
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Jan Tossebro
- Department of Social Work, Norwegian University of Science and Technology, Trondheim, Norway
| |
Collapse
|