This paper seeks to investigate and assess a particular form of relationship between the State and its citizens in the context of the COVID-19 pandemic, namely that of obedience to the law and its related right of protest through civil disobedience. We do so by conducting an analysis and normative evaluation of two cases of disobedience to the law: (1) healthcare professionals refusing to attend work as a protest against unsafe working conditions, and (2) citizens who use public demonstration and (...) deliberately ignore measures of social distancing as a way of protesting against lockdown. While different in many aspects, both are substantially similar with respect to one element: their respective protesters both rely on unlawful actions in order to bring change to a policy they consider unjust. We question the extent to which healthcare professionals may participate in civil disobedience with respect to the duty of care intrinsic to the medical profession, and the extent to which opponents of lockdown and confinement measures may reasonably engage in protests without endangering the lives and basic rights of non-dissenting citizens. Drawing on a contractualist normative framework, our analysis leads us to conclude that while both cases qualify as civil disobedience in the descriptive sense, only the case of healthcare professionals qualifies as morally justified civil disobedience. (shrink)

The exposure of doctors, nurses and other medical professionals to risks in the context of epidemics is significant. While traditional medical ethics offers the thought that these dangers may limit the extent to which a duty to care is applicable in such situations, it has less to say about what we might owe to medical professionals who are disadvantaged in these contexts. Luck egalitarianism, a responsibility-sensitive theory of distributive justice, appears to fare particularly badly in that regard. If we want (...) to maintain that medical professionals are responsible for their decisions to help, cure and care for the vulnerable, luck egalitarianism seems to imply that their claim of justice to medical attention in case of infection is weak or non-existent. The article demonstrates how a recent interpretation of luck egalitarianism offers a solution to this problem. Redefining luck egalitarianism as concerned with responsibility for creating disadvantages, rather than for incurring disadvantage as such, makes it possible to maintain that medical professionals are responsible for their choices and that those infected because of their choice to help fight epidemics have a full claim of justice to medical attention. (shrink)

BackgroundThe COVID-19 pandemic introduced new challenges to provide care and educate junior doctors (resident physicians). We sought to understand the positive and negative experiences of first-year resident physicians and describe potential ethical issues from their stories.MethodWe used narrative inquiry (NI) methodology and applied a semistructured interview guide with questions pertaining to ethical principles and both positive and negative aspects of the pandemic. Sampling was purposive. Interviews were audio recorded and transcribed. Three members of the research team coded transcripts in duplicate (...) to elicit themes. Discrepancies were resolved through discussion to attain consensus. A composite story with threads was constructed.Results11 residents participated across several programmes. Three main themes emerged from the participants’ stories: (1) complexities in navigating intersecting healthcare and medical education systems, (2) balancing public health and the public good versus the individual and (3) fair health systems planning/healthcare delivery. Within these themes, participants’ journeys through the first wave were elicited through the threads of (1) engage us, (2) because we see the need for the duty to treat and (3) we are all in this together.DiscussionCases of the ethical issues that took place during the COVID-19 pandemic may serve as a foundation on which ethics teaching and future pandemic planning can take place. Principles of clinical ethics and their limitations, when applied to public health issues, could help in contrasting clinical ethics with public health ethics.ConclusionEfforts to understand how resident physicians can navigate public health emergencies along with the ethical issues that arise could benefit both residency education and healthcare systems. (shrink)

AbstractDespite the fact that people usually believe that individual health rights have an intrinsic value, they have, in fact, only extrinsic value. They are context dependent. While in normal conditions the current societies try to guarantee individual health rights, the challenge arises in emergency situations. Ones of them are pandemics including current covid-19 pandemic. Emergency situations challenge individual health rights due to insufficient medical resources and non-random criteria of selection of patients. However, there are some reasons to assume that societal (...) and technological processes in the near future will threaten permanently individual health rights in normal conditions. Such processes include progress in commonly available human enhancement technologies, and progress in robotics and automation. In this paper I show how individual health rights will be challenged in both scenarios including catastrophic events and future technological progress. In both cases, the idea of assisted dying is discussed as possibly the unique healthcare principle available for people whose individual health rights will be limited or canceled due to catastrophes or technological and financial exclusion. The special case of future space missions is also discussed as an example of an extreme environment affecting the way moral norms are viewed in health care ethics. (shrink)

The recent Covid-19 pandemic has brought a broad range of ethical problems to the forefront, raising fundamental questions about the role of government in response to such outbreaks, the scarcity and allocation of health care resources, the unequal distribution of health risks and economic impacts, and the extent to which individual freedom can be restricted. In this clear introduction to the topic Iwao Hirose explores these ethical questions and analyzes the central issues in the ethics of pandemic response and preparedness (...) such as: The general nature of pandemics and the ethics of preparedness Ethical questions about general goals of pandemic response and preparedness The distribution of scarce resources, e.g., ventilators, hospital beds, antiviral drugs and vaccines Restrictions on individual freedom Ethical questions in the wake of pandemics, including contact-tracing, vaccine passports and socioeconomic inequalities. With the use of real-life examples and a clear philosophical approach, The Ethics of Pandemics is a much-needed introduction to some of the most important ethical issues surrounding pandemics. It is essential reading for students of ethics, bioethics, and political philosophy and will also be of interest to those working in related areas such as public policy, public health, health law, nursing and life sciences. (shrink)

Healthcare systems around the world are struggling to maintain a sufficient workforce to provide adequate care during the COVID-19 pandemic. Staffing problems have been exacerbated by healthcare workers (HCWs) refusing to work out of concern for their families. I sketch a deontological framework for assessing when it is morally permissible for HCWs to abstain from work to protect their families from infection and when it is a dereliction of duty to patients. I argue that it is morally permissible for HCWs (...) to abstain from work when their duty to treat is outweighed by the combined risks and burdens of that work. For HCWs who live with their families, the obligation to protect one’s family from infection contributes significantly to those burdens. There are, however, a range of complicating factors including the strength of duty to treat which varies according to the HCW’s role, the vulnerability of family members to the disease, the willingness of family members to risk infection and the resources available to the HCW to protect their family. In many cases, HCWs in ‘frontline’ roles with a weak duty to treat and families at home will be morally permitted to abstain from work given the risks posed by COVID-19; therefore, society should provide additional incentives to maintain sufficient staff in these roles. (shrink)

Avian Flu Pandemic – Flight of the Healthcare Worker? Content Type Journal Article Pages 365-385 DOI 10.1007/s10730-009-9114-9 Authors Robert B. Shabanowitz, Geisinger Medical Center, Dept. of OB/GYN 100 North Academy Avenue Danville PA 17822-2920 USA Judith E. Reardon, Geisinger Medical Center Center for Health Research 100 North Academy Avenue Danville PA 17822-3003 USA Journal HEC Forum Online ISSN 1572-8498 Print ISSN 0956-2737 Journal Volume Volume 21 Journal Issue Volume 21, Number 4.

Abstract2020 saw the rapid onset of a global pandemic caused by the SARS‐CoV‐2 virus. For healthcare systems worldwide, the pandemic called upon quick organization ensuring treatment and containment measures for the new virus disease. Nurses were seen as constituting a vital instrumental professional component in this study. Due to the pandemic's unpredictable and potentially dangerous nature, nurses have faced unprecedented risks and challenges. Based on interviews and free text comment from a survey, this study explores how ethical challenges related to (...) “being a nurse” during the COVID‐19 pandemic was experienced and understood by Danish hospital‐based nurses. Departing from anthropologist Jarett Zigon's notion of moral breakdown, the study demonstrates how the rapid onset of the pandemic constitutes a moral breakdown raising ethical demands for nurses. Analytically we identify three different ethical demands experienced by the nurses. These ethical demands are Nursing and societal ethical demands, Nursing and personal ethical demands, and Nursing and conflicting ethical demands. These demands represent not only very different understandings of ethical demands but also different understandings of ethical acts that are seen as necessary to respond to these demands. (shrink)

The 2003 SARS pandemic heralded the return of quarantine as a vital part of twenty-first century public health practice. Over the last two decades, MERS, Ebola, and other emerging infectious diseases each posed unique challenges for applying quarantine ethics lessons learned from the 2003 SARS-CoV-1 outbreak. In an increasingly interdependent and connected global world, the use of quarantine to contain the spread of SARS-CoV-2, or COVID-19, similarly poses new and unexpected ethical challenges. In this essay, we look beyond standard debates (...) about the ethics of quarantine and state power to explore a key quarantine principle, Reciprocity, and how it is being negotiated by healthcare workers, volunteers, and citizens in the context of the Wuhan, China, quarantine. We analyze Reciprocity through the lens of two Wuhan case studies: healthcare workers, particularly nurses, who are simultaneously essential workers and quarantined citizens, asked by their hospital administration to shave their heads because adequate PPE was not available, and citizen-to-citizen mutual aid societies attempting to fill gaps in essential supplies left unfilled by the state. We analyze social media and video-blogs from Wuhan, on the platforms of Douyin and Sina Weibo, to understand how people define and respond to ethical and legal obligations in the wake of COVID-19. It is no surprise that quarantine principles from the 2003 SARS outbreak are inadequate for COVID-19 and that both infectious disease outbreak responses and ethics must adapt to the virtual age. We offer ideas to strengthen and clarify Reciprocal obligations for the state, hospital administrators, and citizens as the globe prepares for the next wave of COVID-19 circulating now. (shrink)

Volume 20, Issue 9, September 2020, Page 78-80.

Dr Caitríona L Cox’s recent article expounds the far-reaching implications of the ‘Healthcare Hero’ metaphor. She presents a detailed overview of heroism in the context of clinical care, revealing that healthcare workers, when portrayed as heroes, face challenges in reconciling unreasonable expectations of personal sacrifice without reciprocity or ample structural support from institutions and the general public. We use narrative medicine, a field primarily concerned with honouring the intersubjective narratives shared between patients and providers, in our attempt to deepen the (...) discussion about the ways Healthcare Heroes engenders military metaphor, antiscience discourse, and xenophobia in the USA. We argue that the militarised metaphor of Healthcare Heroes not only robs doctors and nurses of the ability to voice concerns for themselves and their patients, but effectively sacrifices them in a utilitarian bargain whereby human life is considered the expendable sacrifice necessary to ‘open the U.S. economy’. Militaristic metaphors in medicine can be dangerous to both doctors and patients, thus, teaching and advocating for the critical skills to analyse and alter this language prevents undue harm to providers and patients, as well as our national and global communities. (shrink)

The COVID-19 pandemic exposed social shortcomings and ethical failures, but it also revealed strengths and successes. In this perspective article, we examine and discuss one strength: the duty to care. We understand this duty in a broad sense, as more than a duty to treat individual patients who could infect health care workers. We understand it as a prima facie duty to work to provide care and promote health in the face of risks, obstacles, and inconveniences. Although at least one (...) survey suggested that health care workers would not respond to a SARS-like outbreak according to a duty to care, we give reasons to show that the response was better than expected. The reasons we discuss lead us to consider normative accounts of the duty to care based on the adoption of social roles. Then, we consider one view of the relationship between empirical claims and normative claims about the duty to care in the COVID-19 pandemic. Here, we draw insight from Mengzi, with an emendation from Dewey. Our perspective leaves many question to research, but one point seems clear: there will be future pandemics and the need for health care workers who respond. (shrink)

Volume 20, Issue 9, September 2020, Page 76-78.

Recently, the discussion regarding the physicians’ “Right of Conscience” has been on the rise. This issue is often confined to the “reproductive health” arena within the political context. The recent dispute of the Bush-Obama administrations regarding the legal protections of health workers who refuse to provide care that violates their personal beliefs is an example of the political aspects of this dispute. The involvement of the political system automatically shifts the discussion regarding physicians’ ROC into the narrow area of “reproductive (...) health laws.” Indeed, the immediate association that comes to mind when thinking about the practical implications of this dispute is related to the reproductive health arena. This is partly because of the historical context of the first “conscience clauses,” initially enacted by Congress and state legislatures in the mid-1970s; in fact, most of these clauses provided specific exemptions for abortion and few exempted sterilization as well. (shrink)

The duty to provide care is foundational to the nursing profession and the work of nurses. Unfortunately, violence against nurses at the hands of recipients of care is increasingly common. While employers, labor unions, and professional associations decry the phenomenon, the decision to withdraw care, even from someone who is violent or abusive, is never easy. The scant guidance that exists suggests that the duty to care continues until the risk of harm to the nurse is unreasonable, however, “reasonableness” remains (...) undefined in the literature. In this paper, I suggest that reasonable risk, and the resulting strength of the duty to provide care in situations where violence is present, hinge on the vulnerability of both nurse and recipient of care. For the recipient, vulnerability increases with the level of dependency and incapacity. For the nurse, vulnerability is related to the risk and implications of injury. The complex interplay of contextual vulnerabilities determines whether the risk a nurse faces at the hands of a violent patient is reasonable or unreasonable. This examination will enhance our understanding of professional responsibilities and can help to clarify the strengths and limitations of the nurse's duty to care. (shrink)

From the ethics perspective, “duty of care” is a difficult and contested term, fraught with misconceptions and apparent misappropriations. However, it is a term that clinicians use frequently as they navigate COVID-19, somehow core to their understanding of themselves and their obligations, but with uncertainty as to how to translate or operationalize this in the context of a pandemic. This paper explores the “duty of care” from a legal perspective, distinguishes it from broader notions of duty on professional and personal (...) levels, and proposes a working taxonomy for practitioners to better understand the concept of “duty” in their response to COVID-19. (shrink)

Malm and colleagues (2008) consider (and reject) five arguments putatively justifying the idea that healthcare workers (HCWs) have a duty to treat (DTT) during a pandemic. We do not have sufficient...

BackgroundNormally, physicians understand they have a duty to treat patients, and they perform accordingly consistent with codes of medical practice, standards of care, and inner moral motivation. In the case of COVID-19 pandemic in a developing country such as Bangladesh, however, the fact is that some physicians decline either to report for duty or to treat patients presenting with COVID-19 symptoms. At issue ethically is whether such medical practitioners are to be automatically disciplined for dereliction of duty and gross negligence; (...) or, on the contrary, such physicians may legitimately claim a professional right of autonomous judgment, on the basis of which professional right they may justifiably decline to treat patients.MethodsThis ethical issue is examined with a view to providing some guidance and recommendations, insofar as the conditions of medical practice in an under-resourced country such as Bangladesh are vastly different from medical practice in an industrialized nation such as the USA. The concept of moral dilemma as discussed by philosopher Michael Shaw Perry and philosopher Immanuel Kant’s views on moral appeal to “emergency” are considered pertinent to sorting through the moral conundrum of medical care during pandemic.ResultsOur analysis allows for conditional physician discretion in the decision to treat COVID-19 patients, i.e., in the absence of personal protective equipment (PPE) combined with claim of duty to family. Physicians are nonetheless expected to provide a minimum of initial clinical assessment and stabilization of a patient before initiating transfer of a patient to a “designated” COVID-19 hospital. The latter is to be done in coordination with the national center control room that can assure admission of a patient to a referral hospital prior to ambulance transport.ConclusionsThe presence of a moral dilemma (i.e., conflict of obligations) in the pandemic situation of clinical care requires institutional authorities to exercise tolerance of individual physician moral decision about the duty to care. Hospital or government authority should respond to such decisions without introducing immediate sanction, such as suspension from all clinical duties or termination of licensure, and instead arrange for alternative clinical duties consistent with routine medical care. (shrink)

Doctors form an essential part of an effective response to the COVID-19 pandemic. We argue they have a duty to participate in pandemic response due to their special skills, but these skills vary between different doctors, and their duties are constrained by other competing rights. We conclude that while doctors should be encouraged to meet the demand for medical aid in the pandemic, those who make the sacrifices and increased efforts are owed reciprocal obligations in return. When reciprocal obligations are (...) not met, doctors are further justified in opting out of specific tasks, as long as this is proportionate to the unmet obligation. (shrink)

The COVID-19 pandemic has highlighted the risks that can be involved in healthcare work. In this paper, we explore the issue of staff safety in clinical work using the example of personal protective equipment in the COVID-19 crisis. We articulate some of the specific ethical challenges around PPE currently being faced by front-line clinicians, and develop an approach to staff safety that involves balancing duty to care and personal well-being. We describe each of these values, and present a decision-making framework (...) that integrates the two. The aim of the framework is to guide the process of balancing these two values when staff safety is at stake, by facilitating ethical reflection and/or decision-making that is systematic, specific and transparent. It provides a structure for individual reflection, collaborative staff discussion, and decision-making by those responsible for teams, departments and other groups of healthcare staff. Overall the framework guides the decision maker to characterise the degree of risk to staff, articulate feasible options for staff protection in that specific setting and identify the option that ensures any decrease in patient care is proportionate to the increase in staff well-being. It applies specifically to issues of PPE in COVID-19, and also has potential to assist decision makers in other situations involving protection of healthcare staff. There are no data in this work. (shrink)

Dr Caitríona L Cox’s recent article expounds the far-reaching implications of the ‘Healthcare Hero’ metaphor. She presents a detailed overview of heroism in the context of clinical care, revealing that healthcare workers, when portrayed as heroes, face challenges in reconciling unreasonable expectations of personal sacrifice without reciprocity or ample structural support from institutions and the general public. We use narrative medicine, a field primarily concerned with honouring the intersubjective narratives shared between patients and providers, in our attempt to deepen the (...) discussion about the ways Healthcare Heroes engenders military metaphor, antiscience discourse, and xenophobia in the USA. We argue that the militarised metaphor of Healthcare Heroes not only robs doctors and nurses of the ability to voice concerns for themselves and their patients, but effectively sacrifices them in a utilitarian bargain whereby human life is considered the expendable sacrifice necessary to ‘open the U.S. economy’. Militaristic metaphors in medicine can be dangerous to both doctors and patients, thus, teaching and advocating for the critical skills to analyse and alter this language prevents undue harm to providers and patients, as well as our national and global communities. (shrink)

The Patient Protection and Affordable Care Act of 2010 purportedly assures almost all Americans of the right to health insurance coverage. The long-term success of this legislation in improving the public’s health in the United States will likely hinge in no small part on the degree to which statutorily establishing a right to health insurance coverage translates into actual timely, meaningful access to health services, particularly physician services, for specific individuals.

When infectious disease outbreaks strike, health facilities acquire labels such as “war zones” and “battlefields” and healthcare professionals become “heroes” on the “front line.” But unlike soldiers, healthcare professionals often take on these dangerous roles without any prior intention or explicit expectation that their work will place them in grave personal danger. This inevitably raises questions about their role-related obligations and whether they should be free to choose not to endanger themselves. In this article, I argue that it is helpful (...) to view this situation not only through the lens of “professional duty” but also through the lens of “role-related conflicts.” Doing so has the advantage of avoiding exceptionalism and allowing us to draw lessons not only from previous epidemics but also from a wide range of far more common role-related dilemmas in healthcare. (shrink)

Solnicaet alargue that “Jewish law and modern secular approaches based on professional responsibilities obligate physicians to care for all patients even those with communicable diseases”. The authors base their viewpoint on the opinion of Rabbi Eliezer Waldenberg and apply it to suggest that physicians are obligated to endanger themselves during epidemics, such as COVID-19. It is argued that Solnicaet al’s analysis of Rabbi Waldenberg’s text and their conclusion that healthcare workers are obligated to endanger themselves while treating patient who suffer (...) from contagious illness during epidemics according to Jewish law suffer from various shortcomings. Indeed, Jewish law looks favourably on healthcare workers who take a reasonable risk in treating their patients in the context of epidemics. However, it is considered a voluntary supererogatory act—not obligatory. Solnicaet almay express a legitimate ethical viewpoint. However, it does not seem to represent the mainstream approach of what Jewish law would demand as obligatory from its practitioners. (shrink)

The next pandemic will erupt, not from the jungle, but from the disease factories of hospitals, refugee camps and cities. Wendy Orent, How Plagues Really Work,.

Die COVID-19 Pandemie stellt eine beträchtliche Herausforderung für die Kapazität und Funktionalität der Intensivversorgung dar. Dies betrifft nicht nur Ressourcen, sondern vor allem auch die körperlichen und psychischen Grenzen von Pflegefachpersonen. Der Frage, wie sich Fürsorge und Selbstsorge von Pflegefachpersonen auf Intensivstationen im Rahmen der COVID-19 Pandemie zueinander verhalten, wurde bislang im öffentlichen und wissenschaftlichen Diskurs keine Aufmerksamkeit geschenkt. Der vorliegende Beitrag reflektiert dieses Verhältnis mit Hilfe des Ethikkodex des International Council of Nurses, unter besonderer Berücksichtigung der Prinzipienethik und der (...) Care-Ethik nach Joan Tronto und zeigt einen Korridor ethisch vertretbarer Pflege auf.Die Arbeit leistet damit einen wichtigen Beitrag zu einer differenzierten ethischen Betrachtung der Rechte und Verantwortlichkeiten von Pflegefachpersonen als moralischen Akteuren innerhalb des Pandemiegeschehens in Deutschland. Damit schafft er eine erste Voraussetzung für einen breiten gesellschaftlichen und politischen Diskurs, der über die Pandemie hinaus dringend notwendig ist, um die Situation der Pflegefachpersonen und der Gepflegten nachhaltig zu verbessern. (shrink)

Definition of the problem The COVID-19 pandemic poses a considerable challenge to the capacity and functionality of intensive care. This concerns not only resources but, above all, the physical and psychological boundaries of nursing professionals. The question of how care for others and self-care of nurses in intensive care units are related to each other in the context of the COVID-19 pandemic has not been addressed in public and scientific discourse so far. Arguments The present contribution reflects this relationship with (...) reference to the Code of Ethics of the International Council of Nurses, particularly considering principlism and the Care Ethics according to Joan Tronto. As a result, it shows a corridor of ethically justifiable care with several borders, above all: self-care must not be given up completely for the benefit of care for others, and a categorical subordination of care for others to self-care is ethically not justifiable. Conclusion The article makes an important contribution to a differentiated ethical consideration of the rights and responsibilities of intensive care nurses as moral actors within the pandemic in Germany. It, thus, provides a first starting point for a broad social and political discourse which is urgently needed not only during but also after the pandemic in order to improve the situation of intensive care nurses and those who are cared for. (shrink)

AimTo examine the views of Guinean lay people and healthcare providers regarding the acceptability of HCPs’ refusal to provide care to Ebola patients.MethodFrom October to December 2015, lay people and HCPs in Conakry, Guinea, were presented with 54 sample case scenarios depicting a HCP who refuses to provide care to Ebola patients and were instructed to rate the extent to which this HCP’s decision is morally acceptable. The scenarios were composed by systematically varying the levels of four factors: the risk (...) of getting infected, the HCP’s working conditions, the HCP’s family responsibilities and the HCP’s professional status.ResultsFive clusters were identified: 18% of the participants expressed the view that HCPs have an unlimited obligation to provide care to Ebola patients; 38% held that HCPs’ duty to care is a function of HCPs’ working conditions; 9% based their judgments on a combination of risk level, family responsibilities and working conditions; 23% considered that HCPs do not have an obligation to provide care and 12% did not take a position.ConclusionOnly a small minority of Guinean lay people and HCPs consider that HCPs’ refusal to provide care to Ebola patients is always unacceptable. The most commonly endorsed position is that HCPs’ duty to provide care to Ebola patients is linked to society’s reciprocal duty to provide them with the working conditions needed to fulfil their professional duty. (shrink)

Vaccine hesitancy or refusal has been one of the major obstacles to herd immunity against Covid-19 in high-income countries and one of the causes for the emergence of variants. The refusal of people who are eligible for vaccination to receive vaccination creates an ethical dilemma between the duty of healthcare professionals (HCPs) to care for patients and their right to be taken care of. This paper argues for an extended social contract between patients and society wherein vaccination against Covid-19 is (...) conceived as essential for the protection of the right of healthcare providers to be taken care of. Thus, a duty of care is only valid when those who can receive vaccination actually receive it. Whenever that is not the case, the continuing functioning of HCPs can only be perceived as supererogatory and not obligatory. (shrink)