Ethical issues around triage have been at the forefront of debates during the Covid‐19 pandemic. This essay compares both discussion and guidelines around triage and the reality of what happened in the United States and in Europe, both in anticipation of and during the first wave of the pandemic. Why did the issue generate so many vivid debates in the United States and so few in most European countries, although the latter were also affected by the rationing of health care (...) resources? Are countries with socialized health care systems better equipped to face the hard choices of triaging? Important lessons in transparency, trust, and accountability for policy‐makers can be drawn from this comparison, demonstrating that fostering public involvement and ethical debate remains a critical element for the sustained acceptance of any triage plan. (shrink)

In today’s pandemic, many countries have experienced shortages of medical resources and many healthcare providers have often been faced with dramatic decisions about how to allocate beds, intensive care, or ventilators. Despite recognizing the need for triage, responses are not the same everywhere, and opinions and practices differ around what guidelines should be used, how they should be implemented, and who should ultimately decide. To some extent, triage issues reflect community values, revealing a given society’s moral standards and ideals. Our (...) goal is to study two countries which share many common features—Italy and France—as they deal with the pandemic, revealing the moral organization of medicine and healthcare, the power structures, and the nature of the disruptions in each context. (shrink)

While triage protocols share a common goal—maximizing life by selecting patients who would most benefit from critical care—there are many variations in the selection of criterion to respond to situ...

This paper examines parents experiences of medical decision-making and coping with having a critically ill baby in the Neonatal Intensive Care Unit (NICU) from a cross-cultural perspective (France vs. U.S.A.). Though parents experiences in the NICU were very similar despite cultural and institutional differences, each system addresses their needs in a different way. Interviews with parents show that French parents expressed overall higher satisfaction with the care of their babies and were better able to cope with the loss of their (...) child than American parents. Central to the French parents perception of autonomy and their sense of satisfaction were the strong doctor–patient relationship, the emphasis on medical certainty in prognosis versus uncertainty in the American context, and the sentimental work" provided by the team. The American setting, characterized by respect for parental autonomy, did not necessarily translate into full parental involvement in decision-making, and it limited the rapport between doctors and parents to the extent of parental isolation. This empirical comparative approach fosters a much-needed critique of philosophical principles by underscoring, from the parents perspective, the lack of emotional work" involved in the practice of autonomy in the American unit compared to the paternalistic European context. Beyond theoretical and ethical arguments, we must reconsider the practice of autonomy in particularly stressful situations by providing more specific means to cope, translating the impersonal language of rights" and decision-making into trusting, caring relationships, and sharing the responsibility for making tragic choices. (shrink)

Adopting an interdisciplinary perspective, this volume explores the reality of the principle of human dignity – a core value which is increasingly invoked in our societies and legal systems. This book provides a systematic overview of the legal and philosophical concept in sixteen countries representing different cultural and religious contexts and examines in particular its use in a developing case law. Whilst omnipresent in the context of bioethics, this book reveals its wider use in healthcare more generally, treatment of prisoners, (...) education, employment, and matters of life and death in many countries. In this unique comparative work, contributing authors share a multidisciplinary analysis of the use of the principle of dignity in Europe, Africa, South and North America and Asia. By revealing the ambivalence of human dignity in a wide range of cultures and contexts and through the evolving reality of case law, this book is a valuable resource for students, scholars and professionals working in bioethics, medicine, social sciences and law. Ultimately, it will make all those who invoke the principle of human dignity more aware of its multi-layered character and force us all to reflect on its ability to further social justice within our societies. (shrink)

The American Journal of Bioethics, Volume 12, Issue 7, Page 54-56, July 2012.

The paper by Earp, Lewis, and Hart offers a strong criticism of the so-called “war on drugs.” The authors very convincingly argue that the war “has worsened many aspects of public health whi...