Ethical Challenges Related to the Novel Coronavirus (COVID-19) Outbreak: Interviews With Professionals From Saudi Arabia

Stigma and inequality in the management of coronavirus disease-2019 (COVID-19)- patients among healthcare providers in Saudi Arabia and associated beliefs: A cross sectional study

BACKGROUND

Stigma and discrimination (SAD) can greatly impact the management of Coronavirus Disease-19 (COVID-19) patients. Studies examining SAD in managing COVID-19 patients in Saudi Arabia (SA) are limited. This study examined the discrimination and inequality in treating COVID-19 patients and the associated beliefs among healthcare workers (HCWs) during the pandemic.

METHODS

This was a cross sectional study using an online self-administrated questionnaire by 414 HCWs from September 2022 to January 2023.

RESULTS

Of the 414 participants, 53.4% aged 18-30 years, were males (53.4%), mostly Saudi (82.1%), and residents of western SA (90.8%). Almost one-third of the participants (32.1%) were physicians, and 23.7% were pharmacists. 53.1% of the HCWs had work experience < 5 years, 49.3% either had a current/previous COVID-19 infection and 10.1% (n = 42) reported treating ≥ 2000 COVID-19 patients. Most of the participants had not received training on avoiding discrimination against COVID-19 patients (n = 246; 59.4%) and denied receiving any incentives from their institution (n = 294; 71%) or community (n = 248; 59.9%) during the pandemic. Less than 20% of the HCWs had observed some sort of discrimination in providing care for COVID-19 patients. The responses significantly differed by nationality, educational level, specialty, workplace and COVID-19 infection status (P < 0.05). Approximately, 20% of the participants held negative beliefs about COVID-19 patients and these responses varied significantly by nationality, work experience, workplace, gender, and age (p < 0.05). Cross-tabulation and regression analyses showed some differences by gender, workplace, specialty and COVID-19 infection status.

CONCLUSIONS

There was a low prevalence of negative beliefs about COVID-19 patients and a low prevalence of discriminatory behaviors in providing care for these patients in SA. Training and governmental regulations could further lower the prevalence of SAD against COVID-19 patients.

Potential treatments of COVID-19: Drug repurposing and therapeutic interventions

The coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The infection is caused when Spike-protein (S-protein) present on the surface of SARS-CoV-2 interacts with human cell surface receptor, Angiotensin-converting enzyme 2 (ACE2). This binding facilitates SARS-CoV-2 genome entry into the human cells, which in turn causes infection. Since the beginning of the pandemic, many different therapies have been developed to combat COVID-19, including treatment and prevention. This review is focused on the currently adapted and certain other potential therapies for COVID-19 treatment, which include drug repurposing, vaccines and drug-free therapies. The efficacy of various treatment options is constantly being tested through clinical trials and in vivo studies before they are made medically available to the public.

Ethical uncertainty and COVID-19: exploring the lived experiences of senior physicians at a major medical centre

Given the wide-reaching and detrimental impact of COVID-19, its strain on healthcare resources, and the urgent need for-sometimes forced-public health interventions, thorough examination of the ethical issues brought to light by the pandemic is especially warranted. This paper aims to identify some of the complex moral dilemmas faced by senior physicians at a major medical centre in Saudi Arabia, in an effort to gain a better understanding of how they navigated ethical uncertainty during a time of crisis. This qualitative study uses a semistructured interview approach and reports the findings of 16 interviews. The study finds that participants were motivated by a profession-based moral obligation to provide care during the toughest and most uncertain times of the pandemic. Although participants described significant moral dilemmas during their practice, very few identified challenges as ethical in nature, and in turn, none sought formal ethics support. Rather, participants took on the burden of resolving ethical challenges themselves-whenever possible-rationalising oft fraught decisions by likening their experiences to wartime action or by minimising attention to the moral. In capturing these accounts, this paper ultimately contemplates what moral lessons can, and must be, learnt from this experience.

Defining ethical challenge(s) in healthcare research: a rapid review

BACKGROUND

Despite its ubiquity in academic research, the phrase 'ethical challenge(s)' appears to lack an agreed definition. A lack of a definition risks introducing confusion or avoidable bias. Conceptual clarity is a key component of research, both theoretical and empirical. Using a rapid review methodology, we sought to review definitions of 'ethical challenge(s)' and closely related terms as used in current healthcare research literature.

METHODS

Rapid review to identify peer-reviewed reports examining 'ethical challenge(s)' in any context, extracting data on definitions of 'ethical challenge(s)' in use, and synonymous use of closely related terms in the general manuscript text. Data were analysed using content analysis. Four databases (MEDLINE, Philosopher's Index, EMBASE, CINAHL) were searched from April 2016 to April 2021.

RESULTS

393 records were screened, with 72 studies eligible and included: 53 empirical studies, 17 structured reviews and 2 review protocols. 12/72 (17%) contained an explicit definition of 'ethical challenge(s), two of which were shared, resulting in 11 unique definitions. Within these 11 definitions, four approaches were identified: definition through concepts; reference to moral conflict, moral uncertainty or difficult choices; definition by participants; and challenges linked to emotional or moral distress. Each definition contained one or more of these approaches, but none contained all four. 68/72 (94%) included studies used terms closely related to synonymously refer to 'ethical challenge(s)' within their manuscript text, with 32 different terms identified and between one and eight different terms mentioned per study.

CONCLUSIONS

Only 12/72 studies contained an explicit definition of 'ethical challenge(s)', with significant variety in scope and complexity. This variation risks confusion and biasing data analysis and results, reducing confidence in research findings. Further work on establishing acceptable definitional content is needed to inform future bioethics research.