1
|
Yasin JCM, Barlem ELD, da Silveira RS, Ruivo ÉDG, Longaray AA, Brehmer LCF. Ethical issues experienced by nurses during COVID-19 in university hospitals. Rev Esc Enferm USP 2023; 57:e20230117. [PMID: 37882697 PMCID: PMC10601890 DOI: 10.1590/1980-220x-reeusp-2023-0117en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 08/01/2023] [Indexed: 10/27/2023] Open
Abstract
OBJECTIVE To identify the ethical issues experienced by nurses in the care for patients with COVID-19 and the factors that influence their occurrence. METHOD This is a cross-sectional, quantitative study, carried out between February and May 2022 with 101 nurses from two university hospitals, through the socio-occupational Ethical issues Experienced by Nurses in Emergency Questionnaire, adapted and validated for Brazilians. Descriptive statistical analysis, Pearson's correlation test and linear regression were performed, adopting p-value. RESULTS Ethical issues related to concern and stress in caring for infected patients were evidenced, being influenced by perception of social stigmatization (p = .003) and perception of hospital measures (p = .000). Agreement with infection control measures (4.46) and perception of hospital measures against COVID-19 (3.26) were factors with the highest mean between the constructs. CONCLUSION Nurses are faced with ethical issues in the face of concern and stress in caring for patients with COVID-19, who are affected by social issues and assistance. It is essential to support them, promoting their mental and social well-being to deal with new emergency situations.
Collapse
|
2
|
Cong Y, Dwyer J. The Duty to Care is Not Dead Yet. Asian Bioeth Rev 2023; 15:505-515. [PMID: 37808446 PMCID: PMC10555964 DOI: 10.1007/s41649-023-00254-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/23/2023] [Accepted: 06/02/2023] [Indexed: 10/10/2023] Open
Abstract
The COVID-19 pandemic exposed social shortcomings and ethical failures, but it also revealed strengths and successes. In this perspective article, we examine and discuss one strength: the duty to care. We understand this duty in a broad sense, as more than a duty to treat individual patients who could infect health care workers. We understand it as a prima facie duty to work to provide care and promote health in the face of risks, obstacles, and inconveniences. Although at least one survey suggested that health care workers would not respond to a SARS-like outbreak according to a duty to care, we give reasons to show that the response was better than expected. The reasons we discuss lead us to consider normative accounts of the duty to care based on the adoption of social roles. Then, we consider one view of the relationship between empirical claims and normative claims about the duty to care in the COVID-19 pandemic. Here, we draw insight from Mengzi, with an emendation from Dewey. Our perspective leaves many question to research, but one point seems clear: there will be future pandemics and the need for health care workers who respond.
Collapse
Affiliation(s)
- Yali Cong
- Department of Medical Ethics and Law, School of Health Humanities, Peking University Health Science Center, Beijing, China
| | - James Dwyer
- Center for Bioethics and Humanities, Upstate Medical University, Syracuse, NY USA
| |
Collapse
|
3
|
Chiu CH, Wei CJ, Sheu ML, Liu YP, Chang CC, Chen CY. Obligation or getaway? A qualitative inquiry into medical professionalism under COVID-19 among medical students and new physicians in a Taiwan hospital. BMJ Open 2022; 12:e059656. [PMID: 36323470 PMCID: PMC9638741 DOI: 10.1136/bmjopen-2021-059656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES During the COVID-19 outbreak, medical educators' main concern has been how to prepare new physicians and medical students to meet their obligations as healthcare providers under novel circumstances. This study aims at exploring how trainees perceive their commitments as physicians under the threat of a pandemic. DESIGN A qualitative method was employed. Researchers interviewed medical students under clerkship training (fifth and sixth-year medical students) and new physicians undergoing postgraduate year (PGY) and specialty training. SETTING A university hospital in Taipei, Taiwan. PARTICIPANTS The team conducted three focus groups for participants in three separate training stages: clerks, PGY students (PGYs), and residents. Researchers collected data from 31 March to 2 April 2020 and analysed the thematic analysis results. RESULTS Seventeen medical students and new physicians took part in the focus groups, five of whom (31.25%) were female. Participants consisted of four residents, six PGYs, and seven medical students. Through their responses, the authors determined four major dimensions with corresponding subdimensions that significantly affected their sense of medical professionalism, including medical knowledge and clinical skills, sense of duty towards public health, teamwork and protection of patient rights. CONCLUSIONS We therefore concluded that participants grew to accept their roles after acquiring the knowledge and skills needed to care for patients with COVID-19. Alternative teaching arrangements and their impact on trainees' clinical performance require further discussion.
Collapse
Affiliation(s)
- Chiung-Hsuan Chiu
- School of Health Care Administration, Taipei Medical University, Taipei, Taiwan
| | - Chung-Jen Wei
- Department of Public Health, Fu Jen Catholic University, New Taipei, Taiwan
| | - Mei-Ling Sheu
- School of Health Care Administration, Taipei Medical University, Taipei, Taiwan
| | - Yueh-Ping Liu
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Medical Affairs, Ministry of Health and Welfare, Taipei, Taiwan
| | - Chun-Chao Chang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Education, Taipei Medical University Hospital, Taipei, Taiwan
| | - Chien-Yu Chen
- Department of Education, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Graduate Institute of Humanities in Medicine, College of Humanities and Social Science, Taipei Medical University, Taipei, Taiwan
- Department of Medical Education and Humanities, School of Medicine, Colledge of Medicine, Taipei Medical University, Taipei, Taiwan
| |
Collapse
|
4
|
Drewett GP, Gibney G, Ko D. Practical ethical challenges and moral distress among staff in a hospital COVID-19 screening service. Intern Med J 2021; 51:1513-1516. [PMID: 34541765 PMCID: PMC8653007 DOI: 10.1111/imj.15471] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 07/08/2021] [Accepted: 07/12/2021] [Indexed: 12/29/2022]
Abstract
The COVID-19 pandemic has led to unprecedented disruptions to established models of healthcare and healthcare delivery, creating a host of new ethical challenges for healthcare institutions, their leadership and their staff. Hospitals and other large organisations have an obligation to understand and recognise the downstream effects that highly unusual situations and professionally demanding policy may have on workers tasked with its implementation, in order to institute risk-mitigation strategies and provide additional support where required. In our experience, targeted ethics-based forums that provide a non-confrontational platform to discuss and explore the ethical dilemmas that may have arisen have been well received, and can also serve as useful and immediate feedback mechanisms to managers and leadership. Using two case illustrations, this article examines some of the ethical challenges and dilemmas faced by these staff, based on discussions of shared experience during a clinical ethics forum for the Screening Clinic staff at Austin Health, Melbourne, Victoria.
Collapse
Affiliation(s)
- George P Drewett
- Department of Infectious Diseases, Austin Health, Melbourne, Victoria, Australia.,COVID-19 Screening Clinic, Austin Health, Melbourne, Victoria, Australia.,Department of Clinical Ethics, Austin Health, Melbourne, Victoria, Australia
| | - Grace Gibney
- Department of Infectious Diseases, Austin Health, Melbourne, Victoria, Australia.,COVID-19 Screening Clinic, Austin Health, Melbourne, Victoria, Australia
| | - Danielle Ko
- Department of Clinical Ethics, Austin Health, Melbourne, Victoria, Australia
| |
Collapse
|
5
|
Della Croce Y, Nicole-Berva O. Civil Disobedience in Times of Pandemic: Clarifying Rights and Duties. CRIMINAL LAW AND PHILOSOPHY 2021; 17:155-174. [PMID: 34341677 PMCID: PMC8318054 DOI: 10.1007/s11572-021-09592-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/16/2021] [Indexed: 06/13/2023]
Abstract
This paper seeks to investigate and assess a particular form of relationship between the State and its citizens in the context of the COVID-19 pandemic, namely that of obedience to the law and its related right of protest through civil disobedience. We do so by conducting an analysis and normative evaluation of two cases of disobedience to the law: (1) healthcare professionals refusing to attend work as a protest against unsafe working conditions, and (2) citizens who use public demonstration and deliberately ignore measures of social distancing as a way of protesting against lockdown. While different in many aspects, both are substantially similar with respect to one element: their respective protesters both rely on unlawful actions in order to bring change to a policy they consider unjust. We question the extent to which healthcare professionals may participate in civil disobedience with respect to the duty of care intrinsic to the medical profession, and the extent to which opponents of lockdown and confinement measures may reasonably engage in protests without endangering the lives and basic rights of non-dissenting citizens. Drawing on a contractualist normative framework, our analysis leads us to conclude that while both cases qualify as civil disobedience in the descriptive sense, only the case of healthcare professionals qualifies as morally justified civil disobedience.
Collapse
Affiliation(s)
- Yoann Della Croce
- Department of Political Science and International Relations, University of Geneva, 40 Boulevard du Pont d’Arve, 1205 Geneva, Switzerland
| | - Ophelia Nicole-Berva
- Department of Political Science and Social Sciences, European University Institute, 9 Via dei Roccettini, 50014 Domenico di Fiesole, Italy
| |
Collapse
|
6
|
Lipworth W. Beyond Duty: Medical "Heroes" and the COVID-19 Pandemic. JOURNAL OF BIOETHICAL INQUIRY 2020; 17:723-730. [PMID: 33169270 PMCID: PMC7651815 DOI: 10.1007/s11673-020-10065-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 10/05/2020] [Indexed: 06/11/2023]
Abstract
When infectious disease outbreaks strike, health facilities acquire labels such as "war zones" and "battlefields" and healthcare professionals become "heroes" on the "front line." But unlike soldiers, healthcare professionals often take on these dangerous roles without any prior intention or explicit expectation that their work will place them in grave personal danger. This inevitably raises questions about their role-related obligations and whether they should be free to choose not to endanger themselves. In this article, I argue that it is helpful to view this situation not only through the lens of "professional duty" but also through the lens of "role-related conflicts." Doing so has the advantage of avoiding exceptionalism and allowing us to draw lessons not only from previous epidemics but also from a wide range of far more common role-related dilemmas in healthcare.
Collapse
Affiliation(s)
- Wendy Lipworth
- Sydney Health Ethics, University of Sydney, Medical Foundation Building (K25), Sydney, NSW, 2006, Australia.
| |
Collapse
|
7
|
McDougall RJ, Gillam L, Ko D, Holmes I, Delany C. Balancing health worker well-being and duty to care: an ethical approach to staff safety in COVID-19 and beyond. JOURNAL OF MEDICAL ETHICS 2020:medethics-2020-106557. [PMID: 32978305 PMCID: PMC7520818 DOI: 10.1136/medethics-2020-106557] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 09/07/2020] [Accepted: 09/11/2020] [Indexed: 06/11/2023]
Abstract
The COVID-19 pandemic has highlighted the risks that can be involved in healthcare work. In this paper, we explore the issue of staff safety in clinical work using the example of personal protective equipment (PPE) in the COVID-19 crisis. We articulate some of the specific ethical challenges around PPE currently being faced by front-line clinicians, and develop an approach to staff safety that involves balancing duty to care and personal well-being. We describe each of these values, and present a decision-making framework that integrates the two. The aim of the framework is to guide the process of balancing these two values when staff safety is at stake, by facilitating ethical reflection and/or decision-making that is systematic, specific and transparent. It provides a structure for individual reflection, collaborative staff discussion, and decision-making by those responsible for teams, departments and other groups of healthcare staff. Overall the framework guides the decision maker to characterise the degree of risk to staff, articulate feasible options for staff protection in that specific setting and identify the option that ensures any decrease in patient care is proportionate to the increase in staff well-being. It applies specifically to issues of PPE in COVID-19, and also has potential to assist decision makers in other situations involving protection of healthcare staff.
Collapse
Affiliation(s)
- Rosalind J McDougall
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Lynn Gillam
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- Children's Bioethics Centre, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Danielle Ko
- Department of Palliative Care, Austin Health, Heidelberg, Victoria, Australia
- Department of Quality and Patient Safety, Austin Health, Heidelberg, Victoria, Australia
| | - Isabella Holmes
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Clare Delany
- Children's Bioethics Centre, Royal Children's Hospital, Parkville, Victoria, Australia
- Department of Medical Education, University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
8
|
Yalçın Bahat P, Aldıkaçtıoğlu Talmaç M, Bestel A, Topbas Selcuki NF, Karadeniz O, Polat I. Evaluating the effects of the COVID-19 pandemic on the physical and mental well-being of obstetricians and gynecologists in Turkey. Int J Gynaecol Obstet 2020; 151:67-73. [PMID: 32602562 PMCID: PMC9087761 DOI: 10.1002/ijgo.13287] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 06/11/2020] [Accepted: 06/26/2020] [Indexed: 12/15/2022]
Abstract
Objective To apply online surveying to assess the general physical and mental well‐being of obstetricians/gynecologists (OB/GYNs) working in COVID‐19 designated hospitals in Turkey. Methods A prospective survey‐based study using an online survey platform. Three hundred participants working at COVID‐19 designated hospitals in Turkey identified from a hospital database were sent a link to the survey by email between April 29 and May 20, 2020. Results A total of 253 OB/GYNs (31 consultants and 222 residents) completed the survey, for a response rate of 84.3%. Of respondents, 191 (76.4%) were anxious about coming into contact with pregnant women infected with COVID‐19. 74.4% stated that they were afraid of getting sick. 64.8% reported that they had fallen into despair at times because of the pandemic. 66.5% stated that their family lives were affected. 72.4% started living separately from their families because of the pandemic. Conclusion Despite the difficulties in patient care during the pandemic, OB/GYNs continued providing for their patients, which reflected positively on their perceptions of the profession. The importance of trust in the national healthcare system, presence of adequate PPE, finding a suitable coping mechanism, and family support were essential for Turkish OB/GYNs during the COVID‐19 pandemic. ClinicalTrials.gov identifier: NCT04327531. Turkish obstetricians/gynecologists reported anxiety and stress caused by the current situation and future implications of the COVID‐19 pandemic. Turkish obstetricians/gynecologists reported anxiety and stress caused by the current situation and future implications of the COVID‐19 pandemic.
Collapse
Affiliation(s)
- Pınar Yalçın Bahat
- Department of Obstetrics and Gynecology, Istanbul Kanuni Sultan Suleyman Training and Research Hospital, Health Sciences University, Istanbul, Turkey
| | - Merve Aldıkaçtıoğlu Talmaç
- Department of Obstetrics and Gynecology, Istanbul Kanuni Sultan Suleyman Training and Research Hospital, Health Sciences University, Istanbul, Turkey
| | - Ayşegül Bestel
- Department of Obstetrics and Gynecology, Istanbul Kanuni Sultan Suleyman Training and Research Hospital, Health Sciences University, Istanbul, Turkey
| | - Nura F Topbas Selcuki
- Department of Obstetrics and Gynecology, Istanbul Sisli Hamidiye Etfal Training and Research Hospital, Health Sciences University, Istanbul, Turkey
| | - Ozan Karadeniz
- Department of Obstetrics and Gynecology, Istanbul Kanuni Sultan Suleyman Training and Research Hospital, Health Sciences University, Istanbul, Turkey
| | - Ibrahim Polat
- Department of Obstetrics and Gynecology, Istanbul Kanuni Sultan Suleyman Training and Research Hospital, Health Sciences University, Istanbul, Turkey
| |
Collapse
|
9
|
Nasir A, Shaukat K, Hameed IA, Luo S, Alam TM, Iqbal F. A Bibliometric Analysis of Corona Pandemic in Social Sciences: A Review of Influential Aspects and Conceptual Structure. IEEE ACCESS : PRACTICAL INNOVATIONS, OPEN SOLUTIONS 2020; 8:133377-133402. [PMID: 34812340 PMCID: PMC8545329 DOI: 10.1109/access.2020.3008733] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 07/06/2020] [Indexed: 05/07/2023]
Abstract
Corona pandemic has affected the whole world, and it is a highly researched area in biological sciences. As the current pandemic has affected countries socially and economically, the purpose of this bibliometric analysis is to provide a holistic review of the corona pandemic in the field of social sciences. This study aims to highlight significant, influential aspects, research streams, and themes. We have reviewed 395 journal articles related to coronavirus in the field of social sciences from 2003 to 2020. We have deployed 'biblioshiny' a web-interface of the 'bibliometrix 3.0' package of R-studio to conduct bibliometric analysis and visualization. In the field of social sciences, we have reported influential aspects of coronavirus literature. We have found that the 'Morbidity and Mortality Weekly Report' is the top journal. The core article of coronavirus literature is 'Guidelines for preventing health-care-associated pneumonia'. The most commonly used word, in titles, abstracts, author's keywords, and keywords plus, is 'SARS'. Top affiliation is 'The University of Hong Kong'. Hong Kong is a leading country based on citations, and the USA is on top based on total publications. We have used a conceptual framework to identify potential research streams and themes in coronavirus literature. Four research streams are found by deploying a co-occurrence network. These research streams are 'Social and economic effects of epidemic disease', 'Infectious disease calamities and control', 'Outbreak of COVID 19,' and 'Infectious diseases and the role of international organizations'. Finally, a thematic map is used to provide a holistic understanding by dividing significant themes into basic or transversal, emerging or declining, motor, highly developed, but isolated themes. These themes and subthemes have proposed future directions and critical areas of research.
Collapse
Affiliation(s)
- Adeel Nasir
- Department of Management SciencesLahore College for Women UniversityLahore54000Pakistan
| | - Kamran Shaukat
- School of Electrical Engineering and ComputingThe University of NewcastleCallaghanNSW2308Australia
- Punjab University College of Information Technology, University of the PunjabLahore54590Pakistan
| | - Ibrahim A. Hameed
- Department of ICT and Natural SciencesNorwegian University of Science and Technology7491TrondheimNorway
| | - Suhuai Luo
- School of Electrical Engineering and ComputingThe University of NewcastleCallaghanNSW2308Australia
| | - Talha Mahboob Alam
- Department of Computer ScienceUniversity of Engineering and TechnologyLahore54890Pakistan
| | - Farhat Iqbal
- Punjab University College of Information Technology, University of the PunjabLahore54590Pakistan
| |
Collapse
|
10
|
Solnica A, Barski L, Jotkowitz A. The healthcare worker at risk during the COVID-19 pandemic: a Jewish ethical perspective. JOURNAL OF MEDICAL ETHICS 2020; 46:441-443. [PMID: 32424060 PMCID: PMC7242871 DOI: 10.1136/medethics-2020-106294] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 04/27/2020] [Accepted: 05/04/2020] [Indexed: 06/11/2023]
Abstract
The current COVID-19 pandemic has raised many questions and dilemmas for modern day ethicists and healthcare providers. Are physicians, nurses and other healthcare workers morally obligated to put themselves in harm's way and treat patients during a pandemic, occurring a great risk to themselves, their families and potentially to other patients? The issue was relevant during the 1918 influenza epidemic and more recently severe acute respiratory syndrome epidemic in 2003. Since the risk to the healthcare workers was great, there was tension between the ethical duty and responsibility to treat and the risk to one's own life. This tension was further noted during the 2014 Ebola outbreak in West Africa that left hundreds of healthcare workers dead. The AMA Code of Ethics states that physicians are to 'provide urgent medical care during disasters…even in the face of greater than usual risk to physicians' own safety, health or life.'1 Classic Jewish sources have dealt with this question as well. There is an obligation 'to not stand by idly when your friends life is in danger'; however, the question arises as to whether there are limits to this obligation? Is one required to risk one's own life to save another's? There is a consensus that one is not required but the question open to debate is whether it is praiseworthy to do so. However, regarding healthcare workers, there is agreement for ethical, professional and societal reasons that they are required to put themselves in harm's way to care for their patients.
Collapse
Affiliation(s)
- Amy Solnica
- Henrietta Szold School of Nursing, Faculty of Medicine, Hebrew University, Jerusalem, Israel
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Jerusalem, Israel
| | - Leonid Barski
- Ben-Gurion University of the Negev, Faculty of Health Sciences, Beer Sheva, Israel
- Department of Medicine, Soroka University Medical Center, Beer Sheva, Israel
| | - Alan Jotkowitz
- Ben-Gurion University of the Negev, Faculty of Health Sciences, Beer Sheva, Israel
- Department of Medicine, Soroka University Medical Center, Beer Sheva, Israel
| |
Collapse
|
11
|
McConnell D. Balancing the duty to treat with the duty to family in the context of the COVID-19 pandemic. JOURNAL OF MEDICAL ETHICS 2020; 46:360-363. [PMID: 32332154 PMCID: PMC7211094 DOI: 10.1136/medethics-2020-106250] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 04/04/2020] [Indexed: 05/26/2023]
Abstract
Healthcare systems around the world are struggling to maintain a sufficient workforce to provide adequate care during the COVID-19 pandemic. Staffing problems have been exacerbated by healthcare workers (HCWs) refusing to work out of concern for their families. I sketch a deontological framework for assessing when it is morally permissible for HCWs to abstain from work to protect their families from infection and when it is a dereliction of duty to patients. I argue that it is morally permissible for HCWs to abstain from work when their duty to treat is outweighed by the combined risks and burdens of that work. For HCWs who live with their families, the obligation to protect one's family from infection contributes significantly to those burdens. There are, however, a range of complicating factors including the strength of duty to treat which varies according to the HCW's role, the vulnerability of family members to the disease, the willingness of family members to risk infection and the resources available to the HCW to protect their family. In many cases, HCWs in 'frontline' roles with a weak duty to treat and families at home will be morally permitted to abstain from work given the risks posed by COVID-19; therefore, society should provide additional incentives to maintain sufficient staff in these roles.
Collapse
|
12
|
Perni S, Milligan MG, Saraf A, Vivenzio T, Marques A, Baker MA, Kosak T, Bartlett S, Physic MA, Batchelder MR, McBride S, Bredfeldt J, Cail DW, Kearney MC, Whitehouse C, Orio P, Walsh G, Haas‐Kogan DA, Martin NE. Treating the SARS-CoV-2-positive patient with cancer: A proposal for a pragmatic and transparent ethical process. Cancer 2020; 126:3896-3899. [PMID: 32463478 PMCID: PMC7283895 DOI: 10.1002/cncr.32962] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 04/23/2020] [Indexed: 12/30/2022]
Abstract
The treatment of patients with cancer who test positive for severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) poses unique challenges. In this commentary, the authors describe the ethical rationale and implementation details for the creation of a novel, multidisciplinary treatment prioritization committee, including physicians, frontline staff, an ethicist, and an infectious disease expert. Organizational obligations to health care workers also are discussed. The treatment prioritization committee sets a threshold of acceptable harm to patients from decreased cancer control that is justified to reduce risk to staff. The creation of an ethical, consistent, and transparent decision‐making process involving such frontline stakeholders is essential as departments across the country are faced with decisions regarding the treatment of SARS‐CoV‐2–positive patients with cancer. This commentary describes the ethical rationale and implementation details for a novel, multidisciplinary, treatment prioritization committee that makes treatment decisions regarding patients with cancer who are positive for severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). This consistent, ethical, and transparent process could be adapted to any oncology department in which there is risk disparity between physician decision makers and the frontline staff who are implementing these decisions.
Collapse
Affiliation(s)
- Subha Perni
- Harvard Radiation Oncology ProgramHarvard UniversityBostonMassachusettsUSA
- Department of Radiation OncologyBrigham and Women's Hospital, Dana‐Farber Cancer Institute, Harvard Medical School, Harvard UniversityBostonMassachusettsUSA
| | - Michael G. Milligan
- Harvard Radiation Oncology ProgramHarvard UniversityBostonMassachusettsUSA
- Department of Radiation OncologyBrigham and Women's Hospital, Dana‐Farber Cancer Institute, Harvard Medical School, Harvard UniversityBostonMassachusettsUSA
| | - Anurag Saraf
- Harvard Radiation Oncology ProgramHarvard UniversityBostonMassachusettsUSA
- Department of Radiation OncologyBrigham and Women's Hospital, Dana‐Farber Cancer Institute, Harvard Medical School, Harvard UniversityBostonMassachusettsUSA
| | - Todd Vivenzio
- Department of Radiation OncologyBrigham and Women's Hospital, Dana‐Farber Cancer Institute, Harvard Medical School, Harvard UniversityBostonMassachusettsUSA
| | - Amy Marques
- Division of Infectious DiseasesDepartment of MedicineBrigham and Women's HospitalBostonMassachusettsUSA
| | - Meghan A. Baker
- Division of Infectious DiseasesDepartment of MedicineBrigham and Women's HospitalBostonMassachusettsUSA
- Department of Population MedicineHarvard Medical SchoolHarvard Pilgrim Health Care InstituteHarvard UniversityBostonMassachusettsUSA
| | - Tara Kosak
- Department of Radiation OncologyBrigham and Women's Hospital, Dana‐Farber Cancer Institute, Harvard Medical School, Harvard UniversityBostonMassachusettsUSA
| | - Sarah Bartlett
- Department of Radiation OncologyBrigham and Women's Hospital, Dana‐Farber Cancer Institute, Harvard Medical School, Harvard UniversityBostonMassachusettsUSA
| | - Michelle A. Physic
- Department of Radiation OncologyBrigham and Women's Hospital, Dana‐Farber Cancer Institute, Harvard Medical School, Harvard UniversityBostonMassachusettsUSA
| | - Monica R. Batchelder
- Department of Radiation OncologyBrigham and Women's Hospital, Dana‐Farber Cancer Institute, Harvard Medical School, Harvard UniversityBostonMassachusettsUSA
| | - Sean McBride
- Department of Radiation OncologyMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Jeremy Bredfeldt
- Department of Radiation OncologyBrigham and Women's Hospital, Dana‐Farber Cancer Institute, Harvard Medical School, Harvard UniversityBostonMassachusettsUSA
| | - Daniel W. Cail
- Department of Radiation OncologyBrigham and Women's Hospital, Dana‐Farber Cancer Institute, Harvard Medical School, Harvard UniversityBostonMassachusettsUSA
| | - Meghan C. Kearney
- Department of Radiation OncologyBrigham and Women's Hospital, Dana‐Farber Cancer Institute, Harvard Medical School, Harvard UniversityBostonMassachusettsUSA
| | - Colleen Whitehouse
- Department of Radiation OncologyBrigham and Women's Hospital, Dana‐Farber Cancer Institute, Harvard Medical School, Harvard UniversityBostonMassachusettsUSA
| | - Peter Orio
- Department of Radiation OncologyBrigham and Women's Hospital, Dana‐Farber Cancer Institute, Harvard Medical School, Harvard UniversityBostonMassachusettsUSA
| | - Gerard Walsh
- Department of Radiation OncologyBrigham and Women's Hospital, Dana‐Farber Cancer Institute, Harvard Medical School, Harvard UniversityBostonMassachusettsUSA
| | - Daphne A. Haas‐Kogan
- Department of Radiation OncologyBrigham and Women's Hospital, Dana‐Farber Cancer Institute, Harvard Medical School, Harvard UniversityBostonMassachusettsUSA
| | - Neil E. Martin
- Department of Radiation OncologyBrigham and Women's Hospital, Dana‐Farber Cancer Institute, Harvard Medical School, Harvard UniversityBostonMassachusettsUSA
| |
Collapse
|
13
|
Antommaria A. Conflicting Duties and Reciprocal Obligations During a Pandemic. J Hosp Med 2020; 15:284-286. [PMID: 32379030 DOI: 10.12788/jhm.3425] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 04/01/2020] [Indexed: 11/20/2022]
Affiliation(s)
- Armand Antommaria
- Ethics Center and the Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, Ohio
| |
Collapse
|
14
|
Kam JK, Chan E, Lee A, Wei VW, Kwok KO, Lui D, Yuen RK. Student nurses' ethical views on responses to the severe acute respiratory syndrome outbreak. Nurs Ethics 2020; 27:924-934. [PMID: 32216574 DOI: 10.1177/0969733019895804] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Fifteen years have passed since the outbreak of severe acute respiratory syndrome in Hong Kong. At that time, there were reports of heroic acts among professionals who cared for these patients, whose bravery and professionalism were highly praised. However, there are concerns about changes in new generation of nursing professionals. OBJECTIVE We aimed to examine the attitude of nursing students, should they be faced with severe acute respiratory syndrome patients during their future work. RESEARCH DESIGN A questionnaire survey was carried out to examine the attitude among final-year nursing students to three ethical areas, namely, duty of care, resource allocation, and collateral damage. ETHICAL CONSIDERATIONS This study was carried out in accordance with the requirements and recommendations of the Central Research and Ethics Committee, School of Health Sciences at Caritas Institute of Higher Education. FINDINGS Complete responses from 102 subjects were analyzed. The overwhelming majority (96.1%) did not agree to participate in the intubation of severe acute respiratory syndrome patients if protective measures, that is, N95 mask and gown, were not available. If there were insufficient N95 masks for all the medical, nursing, and allied health workers in the hospital (resource allocation), 37.3% felt that the distribution of N95 masks should be by casting lot, while the rest disagreed. When asked about collateral damage, more than three-quarters (77.5%) said that severe acute respiratory syndrome patients should be admitted to intensive care unit. There was sex difference in nursing students' attitude toward severe acute respiratory syndrome care during pregnancy and influence of age in understanding intensive care unit care for these patients. Interestingly, 94.1% felt that there should be a separate intensive care unit for severe acute respiratory syndrome patients. CONCLUSION As infection control practice and isolation facilities improved over the years, relevant knowledge and nursing ethical issues related to infectious diseases should become part of nursing education and training programs, especially in preparation for outbreaks of infectious diseases or distress.
Collapse
Affiliation(s)
| | - Eric Chan
- Caritas Institute of Higher Education, Hong Kong
| | | | | | - Kin On Kwok
- The Chinese University of Hong Kong, Hong Kong
| | | | - Robert Kn Yuen
- Holy Spirit Seminary College of Theology and Philosophy, Hong Kong
| |
Collapse
|
15
|
|
16
|
Ellaway RH, Bates J, Teunissen PW. Ecological theories of systems and contextual change in medical education. MEDICAL EDUCATION 2017; 51:1250-1259. [PMID: 28857233 DOI: 10.1111/medu.13406] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 04/18/2017] [Accepted: 06/25/2017] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Contemporary medical practice is subject to many kinds of change, to which both individuals and systems have to respond and adapt. Many medical education programmes have their learners rotating through different training contexts, which means that they too must learn to adapt to contextual change. Contextual change presents many challenges to medical education scholars and practitioners, not least because of a somewhat fractured and contested theoretical basis for responding to these challenges. There is a need for robust concepts to articulate and connect the various debates on contextual change in medical education. Ecological theories of systems encompass a range of concepts of how and why systems change and how and why they respond to change. The use of these concepts has the potential to help medical education scholars explore the nature of change and understand the role it plays in affording as well as limiting teaching and learning. METHODS This paper, aimed at health professional education scholars and policy makers, explores a number of key concepts from ecological theories of systems to present a comprehensive model of contextual change in medical education to inform theory and practice in all areas of medical education. RESULTS The paper considers a range of concepts drawn from ecological theories of systems, including biotic and abiotic factors, panarchy, attractors and repellers, basins of attraction, homeostasis, resilience, adaptability, transformability and hysteresis. Each concept is grounded in practical examples from medical education. CONCLUSION Ecological theories of systems consider change and response in terms of adaptive cycles functioning at different scales and speeds. This can afford opportunities for systematic consideration of responses to contextual change in medical education, which in turn can inform the design of education programmes, activities, evaluations, assessments and research that accommodates the dynamics and consequences of contextual change.
Collapse
Affiliation(s)
- Rachel H Ellaway
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Joanna Bates
- Faculty of Medicine, Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | - Pim W Teunissen
- Faculty of Health, School of Health Professions Education (SHE), Medicine and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
17
|
Choi JS, Kim JS. Factors influencing emergency nurses’ ethical problems during the outbreak of MERS-CoV. Nurs Ethics 2016; 25:335-345. [DOI: 10.1177/0969733016648205] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Whenever there has been a worldwide contagious disease outbreak, there have been reports of infection and death of healthcare workers. Particularly because emergency nurses have contact with patients on the front line, they experience ethical problems in nursing while struggling with infectious diseases in an unfavorable environment. Objective: The objective of this study was to explore emergency nurses’ ethical problems and to identify factors influencing these problems during the outbreak of Middle East respiratory syndrome–coronavirus in Korea. Design and sample: For this cross-sectional study, a questionnaire survey was conducted with emergency nurses working in six hospitals selected through convenience sampling from the hospitals designated for Middle East respiratory syndrome–coronavirus patients in the capital area. Methods: Data were collected from 169 emergency nurses in Korea during August 2015. Ethical considerations: This research was approved by the Institutional Review Board of G University in Korea. Results: The findings of this study suggest that during the Middle East respiratory syndrome–coronavirus outbreak, emergency nurses experienced ethical problems tied to a mind-set of avoiding patients. Three factors were found to influence emergency nurses’ ethical problems (in order of influence): cognition of social stigmatization, level of agreement with infection control measures, and perceived risk. Conclusion: Through this study, we obtained information on emergency nurses’ ethical problems during the Middle East respiratory syndrome–coronavirus outbreak and identified the factors that influence them. As found in this study, nurses’ ethical problems were influenced most by cognitions of social stigmatization. Accordingly, to support nurses confidently care for people during future health disasters, it is most urgent to promote appropriate public consciousness that encourages healthcare workers.
Collapse
|
18
|
Jecker NS, Dudzinski DM, Diekema DS, Tonelli M. Ebola Virus Disease: Ethics and Emergency Medical Response Policy. Chest 2015; 148:794-800. [PMID: 25855946 PMCID: PMC7094606 DOI: 10.1378/chest.15-0135] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Caring for patients affected with Ebola virus disease (EVD) while simultaneously preventing EVD transmission represents a central ethical challenge of the EVD epidemic. To address this challenge, we propose a model policy for resuscitation and emergent procedure policy of patients with EVD and set forth ethical principles that lend support to this policy. The policy and principles we propose bear relevance beyond the EVD epidemic, offering guidance for the care of patients with other highly contagious, virulent, and lethal diseases. The policy establishes (1) a limited code status for patients with confirmed or suspected EVD. Limited code status means that a code blue will not be called for patients with confirmed or suspected EVD at any stage of the disease; however, properly protected providers (those already in full protective equipment) may initiate resuscitative efforts if, in their clinical assessment, these efforts are likely to benefit the patient. The policy also requires that (2) resuscitation not be attempted for patients with advanced EVD, as resuscitation would be medically futile; (3) providers caring for or having contact with patients with confirmed or suspected EVD be properly protected and trained; (4) the treating team identify and treat in advance likely causes of cardiac and respiratory arrest to minimize the need for emergency response; (5) patients with EVD and their proxies be involved in care discussions; and (6) care team and provider discretion guide the care of patients with EVD. We discuss ethical issues involving medical futility and the duty to avoid harm and propose a utilitarian-based principle of triage to address resource scarcity in the emergency setting.
Collapse
Affiliation(s)
- Nancy S Jecker
- Department of Bioethics and Humanities, Seattle Children's Hospital, Seattle, WA.
| | - Denise M Dudzinski
- Department of Bioethics and Humanities, Seattle Children's Hospital, Seattle, WA
| | - Douglas S Diekema
- School of Medicine, University of Washington; and the Emergency Department, Seattle Children's Hospital, Seattle, WA; Department of Pediatrics, Seattle Children's Hospital, Seattle, WA
| | - Mark Tonelli
- Department of Pulmonary and Critical Care Medicine, Seattle Children's Hospital, Seattle, WA
| |
Collapse
|
19
|
Solano T, Gilbert GL, Kerridge IH, Nayyar V, Berry A. Ethical considerations in the management of Ebola virus disease. Med J Aust 2015; 203:193-5e.1. [PMID: 26268293 DOI: 10.5694/mja15.00168] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 06/23/2015] [Indexed: 11/17/2022]
Abstract
Is it ethically appropriate in some circumstances for HCWs to decline to care for patients with EVD? How should treatment decisions be made regarding limitation of therapy for patients with EVD? There are two main ethical questions regarding the critical care of patients with EVD in an Australian setting: Is it ethically appropriate in some circumstances for HCWs to decline to care for patients with EVD? How should treatment decisions be made regarding limitation of therapy for patients with EVD? The key concern is ensuring that no patient is denied therapy that should be provided, while preventing unnecessary risk to HCWs. It is imperative to develop an approach that facilitates rigorous, evidence-based and ethically justifiable decision making, which should include a predetermined, institutionally endorsed process for assessing difficult clinical scenarios as they arise.
Collapse
|
20
|
Charney RL, Rebmann T, Flood RG. Hospital Employee Willingness to Work during Earthquakes Versus Pandemics. J Emerg Med 2015; 49:665-74. [PMID: 26371972 DOI: 10.1016/j.jemermed.2015.07.030] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 07/20/2015] [Accepted: 07/25/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Research indicates that licensed health care workers are less willing to work during a pandemic and that the willingness of nonlicensed staff to work has had limited assessment. OBJECTIVE We sought to assess and compare the willingness to work in all hospital workers during pandemics and earthquakes. METHODS An online survey was distributed to Missouri hospital employees. Participants were presented with 2 disaster scenarios (pandemic influenza and earthquake); willingness, ability, and barriers to work were measured. T tests compared willingness to work during a pandemic vs. an earthquake. Multivariate linear regression analyses were conducted to describe factors associated with a higher willingness to work. RESULTS One thousand eight hundred twenty-two employees participated (15% response rate). More willingness to work was reported for an earthquake than a pandemic (93.3% vs. 84.8%; t = 17.1; p < 0.001). Significantly fewer respondents reported the ability to work during a pandemic (83.5%; t = 17.1; p < 0.001) or an earthquake (89.8%; t = 13.3; p < 0.001) compared to their willingness to work. From multivariate linear regression, factors associated with pandemic willingness to work were as follows: 1) no children ≤3 years of age; 2) older children; 3) working full-time; 4) less concern for family; 5) less fear of job loss; and 6) vaccine availability. Earthquake willingness factors included: 1) not having children with special needs and 2) not working a different role. CONCLUSION Improving care for dependent family members, worker protection, cross training, and job importance education may increase willingness to work during disasters.
Collapse
Affiliation(s)
- Rachel L Charney
- Division of Emergency Medicine, Department of Pediatrics, Saint Louis University, Saint Louis, Missouri
| | - Terri Rebmann
- Institute for Biosecurity, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri
| | - Robert G Flood
- Division of Emergency Medicine, Department of Pediatrics, Saint Louis University, Saint Louis, Missouri
| |
Collapse
|
21
|
Evans NG. Balancing the Duty to Treat Patients with Ebola Virus Disease with the Risks to Dialysis Personnel. Clin J Am Soc Nephrol 2015; 10:2263-7. [PMID: 26251324 DOI: 10.2215/cjn.03730415] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
In 2014, the author was invited to present at the American Society for Nephrology's annual conference in Philadelphia on the ethics of treating patients with Ebola virus disease. The argument was made that the status of health care workers, including nephrologists, was the dominant ethical standard that generated both the duty to treat and the conflicts between this commitment and other ethical commitments that arise in public health emergencies. Conflicts between duty to treat and personal safety, duty to community, and duty to colleagues were illustrated, and suggestions for designing ethics into medical practice were given. This article is a summary of that presentation.
Collapse
Affiliation(s)
- Nicholas G Evans
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania and UPMC Center for Health Security, Baltimore, Maryland
| |
Collapse
|
22
|
Charney R, Rebmann T, Flood RG. Working after a tornado: a survey of hospital personnel in Joplin, Missouri. Biosecur Bioterror 2014; 12:190-200. [PMID: 25014654 DOI: 10.1089/bsp.2014.0010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
In 2011, an EF5 tornado hit Joplin, MO, requiring complete evacuation of 1 hospital and a patient surge to another. We sought to assess the resilience of healthcare workers in these hospitals as measured by number reporting to work, willingness to work, personal disaster preparedness, and childcare responsibilities following the disaster. In May 2013, a survey was distributed to healthcare workers at both Joplin hospitals that asked them to report their willingness to work and personal disaster preparedness following various disaster scenarios. For those with childcare responsibilities, scheduling, costs, and impact of hypothetical alternative childcare programs were considered in the analyses. A total of 1,234 healthcare workers completed the survey (response rate: 23.4%). Most (87.8%) worked the week following the Joplin tornado. Healthcare workers report more willingness to work during a future earthquake or tornado compared to their pre-Joplin tornado attitudes (86.2 vs 88.4%, t=-4.3, p<.001; 88.4 vs 90%, t=-3.1, p<.01, respectively), with no change during other scenarios. They expressed significantly higher post-tornado personal disaster preparedness, but only preevent preparedness was a significant predictor of postevent preparedness. Nearly half (48.5%, n=598) had childcare responsibilities; 61% (n=366) had childcare needs the week of the tornado, and 54% (n=198) required the use of alternative childcare. If their hospital had provided alternative childcare, 51% would have used it and 42% felt they would have been more willing to report to work. Most healthcare workers reported to work following this disaster, demonstrating true resilience. Disaster planners should be aware of these perceptions as they formulate their own emergency operation plans.
Collapse
|
23
|
Taylor HA, Rutkow L, Barnett DJ. Willingness of the local health department workforce to respond to infectious disease events: empirical, ethical, and legal considerations. Biosecur Bioterror 2014; 12:178-85. [PMID: 24963648 DOI: 10.1089/bsp.2014.0009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
According to the Institute of Medicine, the local health department workforce is at the hub of the public health emergency preparedness system. A growing body of research has pointed to troubling attitudinal gaps among local health department workers, a vital response cohort, regarding willingness to respond to emergent infectious disease threats, ranging from naturally occurring pandemics to bioterrorism events. A summary of relevant literature on the empirical evidence, ethical norms, and legal standards applicable to the willingness of public health professionals to respond to an infectious disease emergency is presented. Recommendations are proposed for future work to be done to bring the relevant empirical, ethical, and legal considerations together to develop practical guidance for the local response to infectious disease emergencies.
Collapse
|
24
|
Active Learning, Bioterrorism Clinics, and Continuing Professional Education: An Ideal Combination. Prehosp Disaster Med 2012. [DOI: 10.1017/s1049023x00015466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
25
|
Bennett B, Carney T. Law, ethics and pandemic preparedness: the importance of cross-jurisdictional and cross-cultural perspectives. Aust N Z J Public Health 2010; 34:106-12. [DOI: 10.1111/j.1753-6405.2010.00492.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
26
|
Editorial Comments–Anticipated Behaviors of Emergency Prehospital Medical Care Providers during an Influenza Pandemic. Prehosp Disaster Med 2010; 25:26-7. [DOI: 10.1017/s1049023x00007615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
27
|
Calain P, Fiore N, Poncin M, Hurst SA. Research Ethics and International Epidemic Response: The Case of Ebola and Marburg Hemorrhagic Fevers. Public Health Ethics 2009. [DOI: 10.1093/phe/phn037] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
|
28
|
Vawter DE, Garrett JE, Prehn AW, Gervais KG. Health care workers' willingness to work in a pandemic. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2008; 8:21-23. [PMID: 18802851 DOI: 10.1080/15265160802318204] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Dorothy E Vawter
- Minnesota Center for Health Care Ethics, 601 25th Ave S, Minneapolis, MN 55454, USA.
| | | | | | | |
Collapse
|