Healthcare-associated infections due to multidrug-resistant organisms continue to increase in incidence. To control the transmission of these pathogens, such as methicillin-resistant Staphylococcus aureus , some have advocated active surveillance cultures of all hospitalized patients, followed by institution of contact precautions. While there has been extensive debate about the effectiveness of this approach in reducing infections, little attention has been given to the ethical issues raised by the intervention. Active surveillance for multidrug-resistant organisms is a quality improvement measure and ethical implications (...) arise through the potential to inadvertently cause harm. Unintended adverse effects may include decreased contact with healthcare workers, increased depression and anxiety, and increased rates of noninfectious adverse events among patients placed in contact precautions. The potential risks and benefits are not distributed fairly; patients placed in contact precautions are exposed to the risks, while those not isolated experience the benefit. Ethical challenges involve a conflict between the interests of the individual patient and the patient population not already colonized with the organism. For healthcare systems, active surveillance increases the complexity of bed management, exacerbating problems with patient placement, patient throughput, emergency department overcrowding and ambulance diversion for some hospitals. It also poses ethical dilemmas regarding societal resource allocation. Investing in an unproven or marginally beneficial quality improvement activity such as this must be balanced against other public health priorities competing for scarce resources. CiteULike Connotea Del.icio.us What's this? (shrink)

The COVID-19 pandemic has, of necessity, demanded the rapid incorporation of virtual technologies which, suddenly, have superseded the physical medical encounter. These imperatives have been implemented in advance of evaluation, with unclear risks to patient care and the nature of medical practice that might be justifiable in the context of a pandemic but cannot be extrapolated as a new standard of care. Models of care fit for purpose in a pandemic should not be generalized to reconfigure medical care as virtual (...) by default, and personal by exception at the conclusion of the emergency. (shrink)

Predicting terrorist attacks with prediction markets has been accused of being immoral. While some of these concerns are about the likely effectiveness of prediction markets on terrorism (PMsoT), this paper discusses the three main reasons why even effective prediction markets on terrorism might be considered immoral. We argue that these three reasons establish only that PMsoT cause offense and/or fleeting mild harm, and that, even taken together, they do not constitute serious harm. The moral issues considered are that PMsoT: 1) (...) create character-affecting perverse incentives, 2) desensitise society to tragic events, and 3) disrespect important ideals. In addition to arguing against the force of these three potential moral problems, it is also argued that societies and governments already endorse intelligence-gathering methods that are clearly more immoral than PMsoT in the relevant respects. We also argue that some circumstances require governments to cause non-serious harm to some people in order to protect and promote the rights and welfare of its citizens. We conclude that a government’s obligation to protect and promote the rights and welfare of its citizens outweighs the non-serious harm that could be caused by effective PMsoT. As a result, we recommend that the likelihood of PMsoT being effective is investigated more closely. (shrink)