COVID-19 and the ethics of quarantine: a lesson from the Eyam plague

From polarity to plurality: Perceptions of COVID-19 and policy measures in England and Scotland

AIM

The aim of this study was to uncover perspectives on the COVID-19 pandemic and the responses implemented by the UK and Scottish Governments to help control the spread of infection. Such understanding could help to inform future responses to pandemics at individual, community and national levels.

METHOD

Q methodology was used to elicit perspectives from people in England and Scotland with different experiences of the pandemic including public health officials, key workers, those on furlough, those who were unvaccinated or vaccinated to different levels, those who were 'shielding' because they were at higher risk and people with different scientific expertise. Participants rank-ordered phrases about different aspects of COVID-19 according to their viewpoint. Factor analysis was then conducted in conjunction with interview material from the same respondents.

RESULTS

A four-factor solution was statistically supported and was interpretable alongside the qualitative accounts of participants loading on these factors. These four perspectives are titled Dangerous and Unaccountable Leadership, Fear and Anger at Policy and Public responses, Governing Through a Crisis and Injustices Exposed.

CONCLUSION

The four perspectives demonstrate plurality and nuance in views on COVID-19 and the associated policies and restrictions, going beyond a binary narrative that has been apparent in popular and social media. The four perspectives include some areas of common ground, as well as disagreement. We argue that understanding the detail of different perspectives might be used to build cohesion around policy initiatives in future.

PATIENT OR PUBLIC CONTRIBUTION

The development of the statement set, which is rank-ordered by participants in a Q study, and factor interpretations were informed by views of the general public. The statement set was initially developed using existing publicly available material based on members of the general public experiencing the pandemic first hand. It was then piloted with members of the public experiencing different challenges as a result of COVID-19 and the subsequent lockdown and updated based on feedback. Finally, interpretations of the identified factors were presented publicly and edited according to their feedback.

The PHERCC Matrix. An Ethical Framework for Planning, Governing, and Evaluating Risk and Crisis Communication in the Context of Public Health Emergencies

Risk and crisis communication (RCC) is a current ethical issue subject to controversy, mainly due to the tension between individual liberty (a core component of fairness) and effectiveness. In this paper we propose a consistent definition of the RCC process in public health emergencies (PHERCC), which comprises six key elements: evidence, initiator, channel, publics, message, and feedback. Based on these elements and on a detailed analysis of their role in PHERCC, we present an ethical framework to help design, govern and evaluate PHERCC strategies. The framework aims to facilitate RCC, incorporating effectiveness, autonomy, and fairness. It comprises five operational ethical principles: openness, transparency, inclusivity, understandability, and privacy. The resulting matrix helps understanding the interplay between the PHERCC process and the principles of the framework. The paper includes suggestions and recommendations for the implementation of the PHERCC matrix.

A reflection on health and disease amid COVID-19 pandemic

Coronavirus disease 2019 pandemic is persisting for more than a year and it's still far from being controlled. It is making a big impact not only on physical illness but also on mental and social aspects. In this situation, we need to reflect on current medical society's view of disease and health. The dominant paradigm in contemporary medicine is the reductionist view of disease and the biomedical model of health. As a result, the healthcare system seems to be more focused on virus eradication than on patient care. We need to look back on this position in view of humanities and ethics and broaden our perspective to an ecological view of disease and the sociomedical model of health. The quarantine and health care policy also needs to be re-built with more focus on patient care.

Where the public health principles meet the individual: a framework for the ethics of compulsory outpatient treatment in psychiatry

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.

Solidarity and polarisation regarding COVID-19 and related risks - A thematic analysis of comments from an international survey

COVID-19 represents a risk to people's life and societies in their current shapes and functions, with institutionalised responses redefining everyday life. Crises in society can induce fear and tensions that can unite and divide people, inducing acts of solidarity and polarisation. The study explored articulations of solidarity and polarisation in relation to the COVID-19 pandemic and related risks. A Foucault-inspired thematic analysis was pursued on qualitative data from an international survey about COVID-19 and social media. The analysis resulted in four themes illustrating articulations of solidarity and polarisation related to the COVID-19 pandemic. The analysis showed solidarity and polarisation as each other's premise and contradiction. Socialisation into a ‘new normal’ was characterised by the balance between solidarity and polarisation as well as aspirations to enhance future solidarity. The study illustrated that social media functioned as social technology for control and manipulation towards social normalisation. However, it was also used to voice attempts to rectify (or overthrow) the dominant medico-political discourse and norms with own preferences, opinions and a functioning daily life. In short, the articulations and social media uses could be interpreted as expressions of power and counter-power.

Risk Attitude in Multicriteria Decision Analysis: A Compromise Approach

In fields on which decisions need to be taken including health, as we are seeing nowadays in the COVID-19 crisis, decision-makers face multiple criteria and results with a random component. In stochastic multicriteria decision-making models, the risk attitude of the decision maker is a relevant factor. Traditionally, the shape of a utility function is the only element that represents the decision maker's risk attitude. The eduction process of multi-attribute utility functions implies some operational drawbacks, and it is not always easy. In this paper, we propose a new element with which the decision maker's risk attitude can be implemented: the selection of the stochastic efficiency concept to be used during a decision analysis. We suggest representing the risk attitude as a conflict between two poles: risk neutral attitude, associated with best expectations, and risk aversion attitude, associated with a lower uncertainty. The Extended Goal Programming formulation has inspired the parameter that is introduced in a new risk attitude formulation. This parameter reflects the trade-off between the two classical poles with respect to risk attitude. Thus, we have produced a new stochastic efficiency concept that we call Compromise Efficiency.