{"id":340,"date":"2020-07-15T09:11:49","date_gmt":"2020-07-15T09:11:49","guid":{"rendered":"https:\/\/blogs.bmj.com\/covid-19\/?p=340"},"modified":"2020-07-15T09:11:49","modified_gmt":"2020-07-15T09:11:49","slug":"utilizing-parents-to-hand-bag-ventilate-when-resources-are-scarce-is-it-ethical","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/covid-19\/2020\/07\/15\/utilizing-parents-to-hand-bag-ventilate-when-resources-are-scarce-is-it-ethical\/","title":{"rendered":"Utilizing parents to hand-bag ventilate when resources are scarce: Is it ethical?"},"content":{"rendered":"<p>By Emily E. Barsky and Sadath Sayeed<\/p>\n<p>Amidst the COVID-19 pandemic, many nations are coping with what resource limited settings are all too familiar with\u2014ventilator scarcity. \u00a0In low-income countries, people\u2014 and particularly children\u2014 frequently die of reversible, acute respiratory failure due to across-the-board resource scarcity. \u00a0Some such settings have responded to this by allowing parents to be active participants in medical care provisions\u2014 specifically, providing hand-bag ventilation to their children. \u00a0Medical staff place an endotracheal tube but rather than connecting it to a ventilator, they connect it to an Ambu bag and ask parents to compresses and releases the bag to inflate and deflate the child\u2019s lungs, hopefully resulting in adequate gas exchange for survival.<\/p>\n<p>This ethically fraught practice of parental hand-bag ventilation is predictably anguishing to observe for those of us accustomed to clinical resource abundance. \u00a0It is morally jarring to see mothers crouched next to intubated children, tirelessly performing hand-bag ventilation hour after hour, clinging to a desperate hope of recovery. It is even more horrifying to learn the following day that a child passed away after ventilation stopped when the mother fell asleep. \u00a0It is easy to conclude that this shift in responsibility is indefensible, unfairly displacing burden and guilt onto family members with overwhelming odds of a devastating outcome.<\/p>\n<p><em>Yet it is worth pausing to ask: if your own child or loved one faced this terrible dilemma, would it be unreasonable to want to participate in hand-bag ventilation in an attempt to save your child, if the only alternative was death?<\/em> \u00a0The era of COVID-19 brings this closer to home than many of us ever anticipated.<\/p>\n<p>In this article, we aim to encourage deeper reflection on this complex predicament.\u00a0 We argue that despite a strongly plausible intuition suggesting the impermissibility of parental participation in hand-bag ventilation, it may still be defensible. \u00a0Our analysis leads us to an ethically provocative, context-sensitive algorithm for allowing parental participation in hand-bag ventilation, while situating this micro-ethical dilemma within the larger problematic quest for global health equity.<\/p>\n<p>It is our hope that this article stimulates both discussion regarding the practice of parental hand bag ventilation and much needed empirical work in this area. \u00a0Finally, we hope this line of discussion sheds light more broadly on chronic, global issues of rationing and resource scarcity that are currently and acutely being felt by so many.<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Paper title<\/strong>: <a href=\"https:\/\/jme.bmj.com\/content\/46\/7\/459\">Parental Manual Ventilation in Resource Limited Settings: An Ethical Controversy<\/a><\/p>\n<p><strong>Author(s)<\/strong>: Emily E. Barsky<sup>1,2<\/sup>, Sadath Sayeed<sup>2,3<\/sup><\/p>\n<p><strong>Affiliations: <\/strong><\/p>\n<p><sup>1 <\/sup>Division of Pulmonary Medicine, Department of Medicine, Boston Children\u2019s Hospital, Boston, Massachusetts, USA<\/p>\n<p><sup>2 <\/sup>Harvard Medical School, Boston, Massachusetts, USA<\/p>\n<p><sup>3 <\/sup>Department of Global Health and Social Medicine, Harvard Medical School, and Division of Newborn Medicine, Department of Medicine, Boston Children\u2019s Hospital, Boston, Massachusetts, USA<\/p>\n<p><strong>Competing interests: <\/strong>None<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>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\u2014ventilator scarcity. \u00a0In low-income countries, people\u2014 and particularly children\u2014 frequently die of reversible, acute respiratory failure due to across-the-board resource scarcity. \u00a0Some such settings have responded to this by allowing parents [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/covid-19\/2020\/07\/15\/utilizing-parents-to-hand-bag-ventilate-when-resources-are-scarce-is-it-ethical\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":383,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[99,100,96,95,119],"tags":[],"class_list":["post-340","post","type-post","status-publish","format-standard","hentry","category-clinical-ethics","category-distributive-justice","category-journal-of-medical-ethics","category-pandemic","category-resource"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Utilizing parents to hand-bag ventilate when resources are scarce: Is it ethical? - Coronavirus (COVID-19) Blog Posts Collection - BMJ Journals<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/medical-ethics\/2020\/07\/14\/utilizing-parents-to-hand-bag-ventilate-when-resources-are-scarce-is-it-ethical\/\" \/>\n<meta property=\"og:locale\" content=\"en_GB\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Utilizing parents to hand-bag ventilate when resources are scarce: Is it ethical? - Coronavirus (COVID-19) Blog Posts Collection - BMJ Journals\" \/>\n<meta property=\"og:description\" content=\"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\u2014ventilator scarcity. \u00a0In low-income countries, people\u2014 and particularly children\u2014 frequently die of reversible, acute respiratory failure due to across-the-board resource scarcity. \u00a0Some such settings have responded to this by allowing parents [...]Read More...\" \/>\n<meta property=\"og:url\" content=\"https:\/\/blogs.bmj.com\/medical-ethics\/2020\/07\/14\/utilizing-parents-to-hand-bag-ventilate-when-resources-are-scarce-is-it-ethical\/\" \/>\n<meta property=\"og:site_name\" content=\"Coronavirus (COVID-19) Blog Posts Collection - BMJ Journals\" \/>\n<meta property=\"article:published_time\" content=\"2020-07-15T09:11:49+00:00\" \/>\n<meta name=\"author\" content=\"caitlinalder\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"caitlinalder\" \/>\n\t<meta name=\"twitter:label2\" content=\"Estimated reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"2 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2020\\\/07\\\/14\\\/utilizing-parents-to-hand-bag-ventilate-when-resources-are-scarce-is-it-ethical\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/covid-19\\\/2020\\\/07\\\/15\\\/utilizing-parents-to-hand-bag-ventilate-when-resources-are-scarce-is-it-ethical\\\/\"},\"author\":{\"name\":\"caitlinalder\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/covid-19\\\/#\\\/schema\\\/person\\\/6a90f3ceca251b386830821ec8125be0\"},\"headline\":\"Utilizing parents to hand-bag ventilate when resources are scarce: Is it ethical?\",\"datePublished\":\"2020-07-15T09:11:49+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/covid-19\\\/2020\\\/07\\\/15\\\/utilizing-parents-to-hand-bag-ventilate-when-resources-are-scarce-is-it-ethical\\\/\"},\"wordCount\":476,\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/covid-19\\\/#organization\"},\"articleSection\":[\"Clinical ethics\",\"Distributive justice\",\"Journal of Medical Ethics\",\"Pandemic\",\"Resource\"],\"inLanguage\":\"en-GB\"},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/covid-19\\\/2020\\\/07\\\/15\\\/utilizing-parents-to-hand-bag-ventilate-when-resources-are-scarce-is-it-ethical\\\/\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2020\\\/07\\\/14\\\/utilizing-parents-to-hand-bag-ventilate-when-resources-are-scarce-is-it-ethical\\\/\",\"name\":\"Utilizing parents to hand-bag ventilate when resources are scarce: Is it ethical? - Coronavirus (COVID-19) Blog Posts Collection - BMJ Journals\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/covid-19\\\/#website\"},\"datePublished\":\"2020-07-15T09:11:49+00:00\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2020\\\/07\\\/14\\\/utilizing-parents-to-hand-bag-ventilate-when-resources-are-scarce-is-it-ethical\\\/#breadcrumb\"},\"inLanguage\":\"en-GB\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2020\\\/07\\\/14\\\/utilizing-parents-to-hand-bag-ventilate-when-resources-are-scarce-is-it-ethical\\\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2020\\\/07\\\/14\\\/utilizing-parents-to-hand-bag-ventilate-when-resources-are-scarce-is-it-ethical\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\\\/\\\/blogs.bmj.com\\\/covid-19\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Utilizing parents to hand-bag ventilate when resources are scarce: Is it ethical?\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/covid-19\\\/#website\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/covid-19\\\/\",\"name\":\"Coronavirus (COVID-19) Blog Posts Collection - BMJ Journals\",\"description\":\"This centralised hub collects coronavirus (COVID-19) blog post and medical information from across the BMJ&#039;s journal blogs. 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