By Arthur L. Caplan and Jerrold L. Abraham. We responded to the review in JME by Monrad about ethical issues in vaccine trials, in which the discussion was limited to secondary vaccine trials (i.e. testing additional vaccines after one or more vaccines have been approved). We are concerned that the ethics of ongoing primary vaccine […]
Category: Clinical ethics
PPE in the hospital: ethical decision-making that balances health professional wellbeing and duty to care
By Rosalind McDougall, Lynn Gillam, Danielle Ko, Isabella Holmes, Clare Delany Prior to the COVID-19 pandemic, clinicians in well-resourced healthcare systems usually had the information and resources they needed to appropriately protect themselves while still providing optimal care for patients. However, achieving both staff protection and high quality patient care has now become difficult in […]
Mechanical ventilators: the evidence of effectiveness
By Jonathan J. Darrow and Jing Luo As government leaders move to relax physical distancing requirements related to severe acute respiratory coronavirus 2 (SARS-CoV-2), a central assumption is that mechanical ventilators will form part of the safety net needed to sustain life in those afflicted with the disease it causes, Covid-19. Ventilators have been described as […]
Utilizing parents to hand-bag ventilate when resources are scarce: Is it ethical?
By Emily E. Barsky and Sadath Sayeed Amidst the COVID-19 pandemic, many nations are coping with what resource limited settings are all too familiar with—ventilator scarcity. In low-income countries, people— and particularly children— frequently die of reversible, acute respiratory failure due to across-the-board resource scarcity. Some such settings have responded to this by allowing parents […]
Be careful what you wish for: ICU is no panacea
By Angela Ballantyne, Wendy Rogers, Vikki Entwistle, Cindy Towns In current debates about allocation of scarce ICU resources, we suggest there is undue optimism about the ‘good’ of intensive care unit (ICU) access. Most critical COVID-19 patients who receive access to a ventilator will still die. The minority who survive will likely leave with significant […]
Prioritizing justice in ventilator allocation
By L. Syd M Johnson As the Covid-19 pandemic intensified worldwide, grim reports out of Italy’s embattled and overwhelmed hospitals foretold the need to plan for rationing ventilators in the event that the number of patients requiring them exceeded the number available. Hospitals, ethics committees, and government agencies around the US began planning for the […]
DNACPRs and advance care planning in the COVID19 pandemic: key lessons
By Catriona McMillan and Victoria Sobolewska Patient-doctor discussions surrounding do not attempt cardio-pulmonary resuscitation (DNACPR) orders amidst the COVID-19 pandemic have caused widespread, understandable panic in the UK, set against a backdrop of proportionately higher elderly deaths, discussions surrounding resource allocation (particularly with reference to ventilators), and emerging stories of rising care home deaths. Here, […]
COVID-19: In focussing on intensive care we must not lose sight of the wider professional duty to care for all patients.
By Anne Slowther and Sara Mitchell As the number of cases and number of deaths from COVID-19 continues to rise exponentially much of the health care response, and subsequent bioethics commentary, has focussed on provision of intensive care for critically ill patients who require ventilation. This is understandable given the mismatch between the number of people […]
Personal Protective Equipment for front-line health workers: an ethical imperative
By Elizabeth Fenton Covid-19 poses risks to health care workers that exceed those posed to members of the public. Repeated exposure to infected patients increases their risk of infection, and might also make their symptoms more severe if they become infected. Although reported numbers vary, in Italy approximately 9% of COVID-19 cases are health workers, […]
Clinical ethics in a public health crisis: supporting our clinician colleagues at the frontline
By Rosalind McDougall. Clinical ethicists around the world are responding to COVID-19 in an effort to support our clinician colleagues at the frontline. The clinical ethics community is compiling resources, developing ethical guidelines, and contributing to hospital policy as the scale of the crisis increases. The hope is that ethics can offer a structured way […]