Bioethical Concerns During the COVID-19 Pandemic: What Did Healthcare Ethics Committees and Institutions State in Spain?

Objectives: Each new wave of the COVID-19 pandemic invites the possible obligation to prioritize individuals' access to vital resources, and thereby leads to unresolved and important bioethical concerns. Governments have to make decisions to protect access to the health system with equity. The prioritization criteria during a pandemic are both a clinical and legal-administrative decision with ethical repercussion. We aim to analyse the prioritization protocols used in Spain during the pandemic which, in many cases, have not been updated.Method: We carried out a narrative review of 27 protocols of prioritization proposed by healthcare ethics committees, scientific societies and institutions in Spain for this study. The review evaluated shared aspects and unique differences and proffered a bioethical reflection.Results: The research questions explored patient prioritization, the criteria applied and the relative weight assigned to each criterion. There was a need to use several indicators, being morbidity and mortality scales the most commonly used, followed by facets pertaining to disease severity and functional status. Although age was initially considered in some protocols, it cannot be the sole criterion used when assigning care resources.Conclusions: In COVID-19 pandemic there is a need for a unified set of criteria that guarantees equity and transparency in decision-making processes. Establishing treatment indications is not the aim of such criteria, but instead prioritizing access to care resources. In protocols of prioritization, the principle of efficiency must vary according to the principle of equity and the criteria used to guarantee such equity.

Current overview of assistance bioethics committees in Chile

The article examines and analyzes the functioning of healthcare ethics committees in Chile. For this, through an extensive bibliographic review, parameters were established that allow indicating improvements to the system that regulates the Ethical-Assistance Committees (CEA) in the Latin American nation, based on a case study that corresponds to the University of Chile.

Creare e coordinare una rete regionale di comitati etici per la pratica clinica. Risultati e lezioni apprese da uno studio qualitativo svolto in Veneto / Establishing and coordinating a regional network of healthcare ethics committees. Findings and lessons learnt from a qualitative research in the Veneto Region (Italy)

Mentre i comitati etici per la ricerca sono diffusi in tutta Italia, comitati etici esclusivamente dedicati alla pratica clinica sono piuttosto rari. Un’eccezione significativa è costituita dalla Regione Veneto, ove il governo regionale ha promosso fin dal 2004 la creazione di una rete di oltre 20 comitati etici per la pratica clinica (CEPC), al servizio di una popolazione di circa 5 milioni di abitanti. Questa notevole esperienza, tuttavia, non era stata finora studiata. Per colmare tale lacuna, sono stati progettati e realizzati quattro focus group (FG), al fine di indagare le opinioni di componenti esperti di questa tipologia di comitati, relativamente al modo in cui operano, alla rilevanza del lavoro svolto dai CEPC e ai bisogni da soddisfare per migliorare la qualità del servizio. L’analisi qualitativa di quanto emerso dai FG ha portato all’identificazione di tre temi principali, che sono presentati e discussi, vista la rilevanza che potrebbero avere per simili reti: 1) una dicotomia tra la rilevanza dei CEPC, sperimentata dai componenti dei comitati stessi, e lo scetticismo che circonda questi organismi; 2) una mancanza di omogeneità tra comitati, sia in merito alla loro attività principale, sia rispetto al loro rapporto con la direzione e al modo in cui sono selezionati i componenti; 3) la consapevolezza che i CEPC hanno bisogno di coordinamento e supporto. Dopo aver proposto un’interpretazione di questi temi, vengono offerte alcune raccomandazioni alle istituzioni sanitarie che volessero istituire una rete di CEPC che contribuisca a radicare e rafforzare la riflessione etica all’interno del mondo sanitario. ---------- While research ethics committees (RECs) are well established and widespread all over Italy, self-standing healthcare ethics committees (HECs) are relatively rare. A notable exception is the Veneto Region, where the Regional Government has promoted the creation of a network of over 20 HECs since 2004, serving a population of approximately 5 million inhabitants. This remarkable undertaking has not, however, been studied yet. To fill this gap, four focus groups (FGs) have been designed and carried out to investigate the opinions of expert HEC members as to the way HECs operate, the relevance of the work performed by the committees, and their most important needs in order to improve the quality of the services they provide. The qualitative content analysis has led to the identification of three main recurrent themes, which are presented and critically discussed, since they may be relevant for similar networks: 1) a dichotomy between the perceived importance of the ethics committee by HEC members and the widespread scepticism or indifference among healthcare professionals; 2) a lack of homogeneity among committees, as to their main activity, their relationship with the management of the hosting institution, and the way HEC members are recruited; 3) the awareness that these HECs need stronger coordination and support. After proposing an interpretation of these main themes, we conclude by giving recommendations to healthcare institutions wishing to set up a network of HECs with the aim of rooting and straightening ethical reflection within the healthcare setting.