BackgroundGeneral practitioners often act as gatekeeper, authorizing patients’ access to hospital care. This gatekeeping role became even more important during the current COVID-19 crisis as uncertainties regarding COVID-19 made estimating the desirability of hospital referrals complex, both for COVID and non-COVID suspected patients. This study explored Dutch general practitioners’ experiences and ethical dilemmas faced in decision making about hospital referrals in times of the COVID-19 pandemic.MethodsSemi-structured interviews with Dutch general practitioners working in the Netherlands were conducted. Participants were recruited via (...) purposive sampling. Thematic analysis was conducted using content coding.ResultsFifteen interviews were conducted, identifying four themes: one overarching regarding COVID-19 uncertainties, and three themes about experienced ethical dilemmas: the patients’ self-determination vs. the general practitioners’ paternalism, the general practitioners’ duty of care vs. the general practitioners’ autonomy rights, the general practitioners’ duty of care vs. adequate care provision.ConclusionsLack of knowledge about COVID-19, risks to infect loved ones, scarcity of hospital beds and loneliness of patients during hospital admission were central in dilemmas experienced. When developing guidelines for future crises, this should be taken into account. (shrink)

Volume 20, Issue 7, July 2020, Page 204-207.

Allocating access to unapproved COVID-19 drugs available via Pre-Approval Access pathways or Emergency Use Authorization raises unique challenges at the intersection of clinical care and research....

In this article, I explain what makes a global bioethics “feminist” and why I think this development makes a better bioethics. Before defending this assertion explicitly, I engage in some preliminary work. First, I attempt to define global bioethics, showing why the so-called feminist sameness-difference debate [are men and women fundamentally the same or fundamentally different?] is of relevance to this attempt. I then discuss the difference between rights-based feminist approaches to global bioethics and care-based feminist approaches to global bioethics. (...) Next, I agree with a significant number of feminist bioethicists that care is a more fundamental moral value and practice than justice. Finally, I conclude that feminists’ insights about care, even more than rights, can bring us closer to achieving an inclusive, diverse, and fair feminist global bioethics. (shrink)

Volume 20, Issue 7, July 2020, Page 133-135.

Volume 20, Issue 7, July 2020, Page 77-80.

Volume 20, Issue 7, July 2020, Page 196-198.

Volume 20, Issue 7, July 2020, Page 145-147.

Volume 20, Issue 7, July 2020, Page 106-109.

Volume 20, Issue 7, July 2020, Page 163-166.

Volume 20, Issue 7, July 2020, Page 193-195.

This critical essay evaluates the potential integration of distinct kinds of expertise in policymaking, especially during situations of critical emergencies, such as the COVID-19 pandemic. This article relies on two case studies: herd immunity and restricted access to ventilators for disabled people. These case studies are discussed as examples of experts’ recommendations that have not been widely accepted, though they were made within the boundaries of expert epistemic authority. While the fundamental contribution of biomedical experts in devising public health policies (...) during the COVID-19 pandemic is fully recognized, this paper intends to discuss potential issues and limitations that may arise when adopting a strict expert-based approach. By drawing attention to the interests of minorities, the paper also claims a broader notion of “relevant expertise.” This critical essay thus calls for the necessity of wider inclusiveness and representativeness in the process underlying public health policymaking. (shrink)

Volume 20, Issue 7, July 2020, Page 199-201.

BackgroundThe COVID-19 pandemic has magnified pre-existing challenges in healthcare in Africa. Long-standing health inequities, embedded in the continent over centuries, have been laid bare and have raised complex ethical dilemmas. While there are very few clinical ethics committees in Africa, the demand for such services exists and has increased during the COVID-19 pandemic. The views of African healthcare professionals or bioethicists on the role of CECs in Africa have not been explored or documented previously. In this study, we aim to (...) explore such perspectives, as well as the challenges preventing the establishment of CECs in Africa.MethodsTwenty healthcare professionals and bioethicists from Africa participated in this qualitative study that utilized in-depth semi-structured interviews with open-ended questions. Themes were identified through thematic analysis of interviews and open-ended responses.ResultsKenya and South Africa are the only countries on the continent with formal established CECs. The following themes emerged from this qualitative study: Lack of formal CECs and resolution of ethical dilemmas; Role of CECs during COVID-19; Ethical dilemmas presented to CECs pre-COVID-19; Lack of awareness of CECs; Lack of qualified bioethicists or clinical ethicists; Limited resources to establish CECs; Creating interest in CECs and networking.ConclusionsThis study illustrates the importance of clinical ethics education among African HCPs and bioethicists, more so now when COVID-19 has posed a host of clinical and ethical challenges to public and private healthcare systems. The challenges and barriers identified will inform the establishment of CECs or clinical ethics consultation services in the region. The study results have triggered an idea for the creation of a network of African CECs. (shrink)

Volume 20, Issue 7, July 2020, Page 190-192.

Volume 20, Issue 7, July 2020, Page 103-106.

Volume 20, Issue 7, July 2020, Page 207-209.

Volume 20, Issue 7, July 2020, Page 202-204.

Volume 20, Issue 7, July 2020, Page 95-97.

Volume 20, Issue 7, July 2020, Page 139-141.

BackgroundThe Covid-19 pandemic caused situations where, in some hospitals, there were more patients in need of urgent treatment in intensive care units than were available. In particular, there were not sufficient ventilators or critical care resources for all patients in danger of dying from respiratory failure or other organ failures.DiscussionAs the “first come, first served” criterion was not considered adequate, more nuanced and fairer clinical criteria were proposed to assess whom to treat first. One type of patients that has not (...) been considered in the literature so far is that of “important patients”, individuals that many people might consider worthy of priority treatment for the contribution they made or might make to society as a whole.SummaryIn this article, we discuss the moral insights behind the possible treatment of “important patients” and suggest a supererogatory solution of voluntary renunciation/withdrawal. Details of the proposal are explained, and potential objections are addressed. (shrink)

Volume 20, Issue 7, July 2020, Page 92-94.

Volume 20, Issue 7, July 2020, Page 1-5.

Volume 20, Issue 7, July 2020, Page 160-162.

This paper proposes communities of practice (CoP) as a process to build moral resilience in healthcare settings. We introduce the starting point of moral distress that arises from ethical challenges when actions of the healthcare professional are constrained. We examine how situations such as the current COVID-19 pandemic can exponentially increase moral distress in healthcare professionals. Then, we explore how moral resilience can help cope with moral distress. We propose the term collective moral resilience to capture the shared capacity arising (...) from mutual engagement and dialogue in group settings, towards responding to individual moral distress and towards building an ethical practice environment. Finally, we look at CoPs in healthcare and explore how these group experiences can be used to build collective moral resilience. (shrink)

As the USA contends with another surge in COVID-19 cases, hospitals may soon need to answer the unresolved question of who lives and dies when ventilator demand exceeds supply. Although most triage policies in the USA have seemingly converged on the use of clinical need and benefit as primary criteria for prioritisation, significant differences exist between institutions in how to assign priority to patients with identical medical prognoses: the so-called ‘tie-breaker’ situations. In particular, one’s status as a frontline healthcare worker (...) has been a proposed criterion for prioritisation in the event of a tie. This article outlines two major grounds for reconsidering HCW prioritisation. The first recognises trust as an indispensable element of clinical care and mistrust as a hindrance to any public health strategy against the virus, thus raising concerns about the outward appearance of favouritism. The second considers the ways in which proponents of HCW prioritisation deviate from the very ‘ethics frameworks’ that often preface triage policies and serve to guide resource allocation—a rhetorical strategy that may undermine the very ethical foundations on which triage policies stand. By appealing to trust and consistency, we re-examine existing arguments in favour of HCW prioritisation and provide a more tenable justification for adjudicating on tie-breaker events during crisis standards of care. (shrink)

Volume 20, Issue 7, July 2020, Page 112-114.

Volume 20, Issue 7, July 2020, Page 125-128.

This article aimed to explore issues of concern related to quarantine, its social consequences and influences, challenging its effects on human behavioral expressions during social isolation. The advent of the coronavirus disease 2019 (COVID-19) pandemic impacted human lives in multifarious ways, threatening the meaning of normalcy. Quarantine, lockdown, isolation, and other terms reflecting conditions limiting human freedoms have become synonymous in importance to safety, security, and survival. To understand human defiance in the face of maintaining limited mobility during the COVID-19 (...) pandemic, reimagining situations of “unfreedoms” is explained as thinking of changes to inspire and improve the meaning of living lives meaningfully. During the pandemic, issues regarding healthcare practices and social behaviors focused much attention on interactive challenges that enhance ways to mitigate the spread of contagious diseases. Illuminating these issues, discussing concerns and highlighting recommendations to engage in alternative approaches and practices, heightens the declaration of efficiency of quarantine outcomes and effectiveness. Implications are proposed with the hope that they may lead the way forward in exercising contemporary healthcare practices. (shrink)