scholarly journals Ethical Issues in Decision-making Regarding the Elderly Affected by Coronavirus Disease 2019: An Expert Opinion

2020 ◽  
Vol 15 ◽  
Author(s):  
David Martínez-Sellés ◽  
Helena Martínez-Sellés ◽  
Manuel Martínez-Sellés

The coronavirus disease 2019 (COVID-19) pandemic is resulting in ethical decisions regarding resource allocation. Prioritisation reflects established practices that regulate the distribution of finite resources when demand exceeds supply. However, discrimination based on sex, race or age has no role in prioritisation unless clearly justified. The risk posed by COVID-19 is higher for elderly people than for younger people, so older adults should be prioritised in preventive measures. In the case of people who already have COVID-19, healthcare professionals might prioritise those most likely to survive. Making decisions based on chronological age alone is not justified; in addition to age, other aspects that determine theoretical life expectancy must be taken into account. Individualised correct prioritisation in the allocation of scarce resources is essential to good clinical practice.

1998 ◽  
Vol 52 (1) ◽  
pp. 33-40
Author(s):  
Paul A. Holmes ◽  
Mary J. Meehan

Reports the results of a survey that sought to measure the “ethical awareness” of healthcare professionals at a number of area hospitals and nursing homes. Notes that the survey was helpful in isolating areas for needed inservices on ethical issues. Indicates that in creating the ethical environment necessary for the making of ethical decisions, pastoral care staff can offer encouragement to administrators in assessing the ethical awareness of the hospital's employees in such a way that not only clinical staff, but support staff and administrators as well, become more aware that many “non-clinical” situations are also the arena for ethical decision-making.


2018 ◽  
Vol 8 (3) ◽  
pp. 362.2-362
Author(s):  
Anna-Maria Bielinska ◽  
Stephanie Archer ◽  
Catherine Urch ◽  
Ara Darzi

IntroductionDespite evidence that advance care planning in older hospital inpatients improves the quality of end-of-life care (Detering 2010) future care planning (FCP) with older adults remains to be normalised in hospital culture. It is therefore crucial to understand the attitudes of healthcare professionals to FCP in older patients in the hospital setting. Co-design with patients carers and healthcare professionals can generate more detailed meaningful data through better conversations.AimsTo co-design a semi-structured interview (SSI) topic guide to explore healthcare professionals’ attitudes to FCP with older adults in hospital.MethodsA multi-professional research group including a panel of patient and carer representatives co-designed an in-depth topic guide for a SSI exploring healthcare professionals’ attitudes to FCP with older adults in hospital.ResultsThe co-designed topic guide encourages participants to explore personal and system-level factors that may influence attitudes to FCP and practice in hospital amongst healthcare staff. Co-designed topics for inclusion in the SSI schedule include:Potential differences between specialist and generalist approaches to FCPThe influence of perceived hierarchy and emergency–decision making ability in professionals on FCP discussionsThe relevance to transitions of careAttitudes to FCP beyond the biomedical paradigm including perceived well–being and psychosocial aspects of careDigital FCP tools including patient–led FCP.ConclusionCo-designing qualitative research with older people and multi-disciplinary professionals may narrow translational gaps in implementing FCP by setting joint research priorities. Data generated from a co-designed study may expand understanding of hospital-based anticipatory decision-making with older adults.Reference. Detering KM, Hancock AD, Reade MC, Silvester W. The impact of advance care planning on end of life care in elderly patients: randomised controlled trial. BMJ23 March 2010;340:c1345.


Author(s):  
Snehasish Mishra

Biomedical engineering is an advanced and relatively new field in the healthcare sector. Owing to the very nature of the various professional challenges faced by healthcare professionals, the moral and ethical values seem to have taken the backburner. The factors contributing to it may include a sound knowledge of the healthcare professional on the legally-permissible ethical values, and the desperate situations requiring precise split-moment decision-making. No technological advancement without a human face is worth it, and hence, during the course of the degree, a biomedical engineering student needs to be exposed to various ethical issues through theory, live cases and demonstrations. Being intrinsically multi- and inter-disciplinary, biomedical engineering lacks precise ethical rules that delineate and delimit professional responsibility, thus blurring the ethical understanding of biomedical engineering. The solution seems to lie in giving due place to human virtues. In the coming days, bioethical issues are expected to be increasingly complicated and dominating the decision-making process owing to the advancements in sciences, and the ever-complicated cases handled by healthcare professionals. A global healthcare and ethics-related online open-access portal may serve as a common platform for all the stakeholders in the interest and ethical growth of biomedical engineering in particular and medical sciences in general.


Author(s):  
Jean-Louis Vincent ◽  
Jacques Creteur

Acute cardiac syndromes are common and responsible for considerable mortality and morbidity. Decision making in such patients can be difficult clinically but can also be complex and challenging from an ethical perspective. This chapter reviews some of the ethical problems, including organ donation and withholding/withdrawing, that can occur in the acutely ill adult cardiac patient, starting with a brief look at the ethical principles that should guide our decision making: beneficence, non-maleficence, autonomy, and distributive justice. The role of advance directives and considerations related to family presence during cardiopulmonary resuscitation will also be discussed. With the increasing incidence and prevalence of coronary artery disease worldwide, the number of patients with cardiac arrest and requiring acute cardiac care is going to increase, and doctors will increasingly be faced with difficult ethical decisions associated with these patients. Open discussion and debate about these issues and good communication among patients, family members, and members of the health care team are essential to ensure that all patients receive the best possible end-of-life care.


1998 ◽  
Vol 5 (3) ◽  
pp. 206-217 ◽  
Author(s):  
Kaye Spence

This article examines the involvement of neonatal nurses in ethical issues, achieved through a survey of Australian neonatal nurses. The aim was to discover if nurses were involved in ethical decisions, to examine various categories of neonates and the concerns that nurses felt about them, and to determine the extent to which nurses saw themselves as advocates. A response rate of 65% was achieved from nurses in two states who worked in intensive care and special care nurseries. The findings show that nurses were more likely to be involved in clinical decision making than in ethical decision making, showed the greatest concern for infants who had an uncertain prognosis, and saw themselves as advocates for their patients. The issues surrounding these findings are examined.


2011 ◽  
pp. 308-312
Author(s):  
Jim Grieves

Ethics is the study of moral issues and choices. In organizations, such a study inevitably involves consideration of decision-making practices and interpersonal relationships. This in turn may require the investigation of complex combinations of influences which include personality characteristics, values, and moral principles as well as organizational mechanisms and the cultural climate that rewards and reinforces ethical or unethical behavioral practices. Organizations ignore ethical issues at their peril as we know from recent examples of: • past claims of brutality, poor wages, and 15-hour days in the Asian sweatshops run by Adidas, Nike and GAP, • banks that rate their customers by the size of their accounts, • the race for commercial control by private firms, universities, and charities claiming exclusive development rights over natural processes in the human body and patents sought by organizations, overwhelmingly from rich countries, on hundreds of thousands of animal and plant genes, including those in staple crops such as rice and wheat, • a lack of people management skills and supervision which was said to be responsible for the falsification of some important quality control data of an experimental mixed plutonium and uranium fuel at the Sellafield nuclear reprocessing scandal which led to cancelled orders and the resignation of its chief executive. We can all think of other examples that have hit the headlines to indicate that modern business management must recognize its responsibility to provide an ethical framework to guide action. This is the case in respect to human resources policy, health and safety policy, marketing policy, operations management, and environmental management. Ethical policymaking has become the watchword for both national and local government. Ethics is now taught in the police force in order to be proactive and combat discrimination. Concern is now expressed in all forms of decision making from genetic modification of foods and the patenting of human organs to the ethical decisions of pharmaceutical companies or the marketing dilemmas of global corporations. Despite these developments, we continue to find many examples of decision makers making bad ethical decisions and people who blow the whistle on many of those actions. On the positive side, we have seen how so called green organizations have proved that ethics and profit are not incompatible goals.


2021 ◽  
pp. 499-528
Author(s):  
Catherine Oppenheimer ◽  
Julian C. Hughes

This chapter describes the ethical issues that arise in the setting of mental illness, and particularly dementia, in old age. It affirms the importance of understanding each older person as an individual, embedded in a unique history and in relationships which sustain their identity even in the face of cognitive decline. Autonomy and paternalism are discussed, and the alternative concept of ‘parentalism’ introduced. Decision-making capacity and competence are extensively analysed from both philosophical and practical viewpoints, with particular reference to the Mental Capacity Act 2005, and to mechanisms for decision-making for noncompetent patients. Topics briefly treated include predictive diagnosis and mild cognitive impairment, end-of-life care, truth telling, sexuality, and the UN Convention on the Rights of Persons with Disabilities. The text is aimed at old age psychiatrists and other practitioners in the field, as well as at those with an interest in ethical issues in old age.


2021 ◽  
pp. medethics-2021-107333
Author(s):  
Luca Valera ◽  
María A. Carrasco ◽  
Ricardo Castro

The COVID-19 pandemic highlights the relevance of adequate decision making at both public health and healthcare levels. A bioethical response to the demand for medical care, supplies and access to critical care is needed. Ethically sound strategies are required for the allocation of increasingly scarce resources, such as rationing critical care beds. In this regard, it is worth mentioning the so-called ‘last bed dilemma’. In this paper, we examine this dilemma, pointing out the main criteria used to solve it and argue that we cannot face these ethical issues as though they are only a dilemma. A more complex ethical view regarding the care of COVID-19 patients that is focused on proportional and ordinary treatments is required. Furthermore, discussions and forward planning are essential because deliberation becomes extremely complex during an emergency and the physicians’ sense of responsibility may be increased if it is faced only as a moral dilemma.


2005 ◽  
Vol 15 (3) ◽  
pp. 363-383 ◽  
Author(s):  
Bryan Church ◽  
James C. Gaa ◽  
S. M. Khalid Nainar ◽  
Mohamed M. Shehata

Abstract:According to a widely credited model in the business ethics literature, ethical decisions are a function of two kinds of factors, personal (individual) and situational, and these factors interact with each other. According to a contrary view of decision making that is widely held in some areas of business research, individuals’ decisions about ethical issues (and subsequent actions) are purely a function of their self-interest.The laboratory experiment reported in this paper provides a test of the person-situation interactionist model, using the general theoretical and experimental framework used in the experimental economics literature. One individual and two situational factors relating to moral intensity were examined which may influence decisions to misrepresent information in the course of business activities.The individual and one situational variable were significantly related to participants’ actions. The interactions among individual and situation variables were not individually significant, although the model including interactions had a much higher level of statistical significance. Gender was significant, both directly and in interaction with moral development, suggesting that it may be worthy of further examination.


2021 ◽  
Vol 8 ◽  
Author(s):  
Stefano D'Errico ◽  
Martina Padovano ◽  
Matteo Scopetti ◽  
Federico Manetti ◽  
Martina Zanon ◽  
...  

The pandemic from COVID-19 causes a health threat for many countries and requires an internationally coordinated response due to the high spread of the infection. The current local and international situation gives rise to logistical and ethical considerations regarding the imbalance between needs for assistance and availability of health resources in the continuation of the emergency. A shortage condition will require healthcare professionals to choose between patients who will have access to respiratory support and those who will have to continue without. The sharing of criteria for the introduction of patients to the different therapeutic paths is fundamental to prevent the onset of ethical issues. The present paper analyzes the critical issues related to the scarcity of healthcare resources and the limitation of access to intensive care with the aim of proposing ethically sustainable principles for the management of the current pandemic situation.


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