End the Global War against Covid-19: The Ubiquity, Dangers and Alternatives of Military Language
Prof. Jing-Bao Nie | University of Otago | New Zealand
From China to the US, from Asia and Europe to South America, from peaceful New Zealand to peace-keeping United Nations organisations, military language pervades the discourses of leadership, healthcare, media and social media on how to respond to Covid-19. Such language helps highlight the threat of novel coronavirus and mobilise broad sections of the population to action. However, war metaphors have serious dangers, both overt and hidden. They contribute to increase stigma, justify death and militarise society. Above all, the goals of medicine and public health – healing and caring – radically contradict with dominion and the violence wars glorify. In the global settings, military language undermines translational solidarity and trust, the very foundation of transnational cooperation the world desperately needs to contain the pandemic effectively. Thus, to better respond to Covid-19 or any other public health issue, it is necessary to abolish militaristic language and use more ethically sound alternatives such as the journey and solidarity metaphors.
When preparing for the worst might be even worse - uncovering the dynamics of silent triage in Switzerland during the Corona pandemic
Dr. Settimio Monteverde | University of Zurich and FH Berne | Switzerland
In the face of the threatening increase of patients needing Intensive care unit support during the Covid-19 pandemic waves, most Swiss hospitals, fostered by Swiss Cantonal health authorities and the state, have mandated a concentration of ICU-resources in the face of imminent scarcity. In parallel, hospitals maximized both reserve capacities and coordination efforts to increase the effectiveness of ICU resources use while demanding the stop of elective surgery in parallel. thus try to prevent an explicit triage. These measures were concordant both with the ethical guidelines of the Swiss Academy of Medical Sciences on triage and other professional bodies. Yet, officially, a triage situation has never taken place while scarcity of resources, lower quality of care, shift of indications and excess mortality became obvious in the second COVID wave in Switzerland, flanked by efforts of different Cantons to “avoid” an overloading of the ICU by imposing gatekeeping mechanisms (e.g., restricted access to hospital for people living in nursing homes, deferral of “non-essential” treatment, deferral of extra-cantonal patients).
Departing from our clinical ethical experiences and available data in Switzerland and other European countries, we reflect on the concept of a “silent triage” as an implicit rationing instead of applying transparent, explicit triage criteria as explicit rationing to save as many lives as possible in in a non-discriminatory way.
The recent history of (not) applying ethically founded and consented triage criteria sheds light on the foundational debate on and mechanisms of explicit versus implicit rationing. A more comprehensive concept of triage might be needed encompassing all the possible implications and opportunity costs of triaging at the “sharp end” of ICU and making the precedents of ICU triage “at the blunt end” accessible to overt discussion and ethical debate.
UNEVEN WORLDWIDE DISTRIBUTION OF COVID-19 VACCINES: AN ETHICAL PERSPECTIVE
Dr. Yael Zonenszain | Anahuac University | Mexico
The pandemic caused by the Sars-Cov-2 virus, which afflicts the world today, has exposed the inequities between rich and developing countries. There has been an unequal distribution of vaccines against the disease throughout the world, leaving large populations helpless against the virus. This article presents the current scene of the vaccine distribution mechanisms, the ethical principles on which they are based, and an analysis of the problem viewed from the principle of distributive justice and from the contribution of cosmopolitanism, as a philosophical proposal
Shared vulnerability between care providers and the incarcerated during the COVID-19 pandemic.
Prof. Jeffrey Farroni | The University of Texas Medical Branch at Galveston | United States
Our institution provides patient care for our state prison system. The COVID-19 pandemic imposed burdens on our correctional managed care enterprise beyond what was experienced in “free-world” hospitals due the confined spaces, restrictive movements and patient vulnerabilities. Mitigating measures such as social distancing, access to personal protective equipment, and hand hygiene are particularly challenging to implement in this context. Limited resources, increased patient demand and staff shortages also contributed to moral distress amongst the care teams. Care providers found themselves not only relying on each other, but on their patients to meet these challenges.
We wanted to understand the impact that the COVID-19 pandemic had on the care that incarcerated individuals received from the provider perspective. We conducted moral distress debrief sessions (semi-structured) for about forty units within the correctional managed care system. We spoke with both leadership and front-line care providers. We also implemented a survey to all correctional care providers to better understand their wellness needs.
We observed that challenges were overcome partly by a sense of solidarity not only with the care providers but with the incarcerated as well. We identified areas of improvement such as communication, stress reduction, and the need for ethical inquiry.
As a result of this work, we are developing a comprehensive wellness program for our correctional managed care enterprise with the goal of increasing our capacity for empathic care.
Ethical concerns in COVID-19 research: thematic analysis of the views and experiences of health research ethics committees in South Africa
Prof. Theresa Burgess | Stellenbosch University, Faculty of Medicine and Health Sciences | South Africa
The COVID-19 pandemic presented significant challenges to research ethics committee (RECs) in balancing urgency of review of COVID-19 research with careful consideration of risks and benefits. In the African context, RECs were further challenged by historical mistrust of research and potential impacts on COVID-19 related research participation and vaccine hesitancy. We explored the perspectives and experiences of RECs regarding the procedural and ethical, legal and health equity challenges of COVID-19 research in South Africa.
We conducted in-depth interviews with 21 REC chairpersons or members from seven RECs at large academic health institutions across South Africa that were actively involved in the review of COVID-19 related research. In-depth interviews (60-125 min) were conducted in English using an in-depth interview guide, until data saturation was achieved. An inductive approach to thematic analysis was used to analyse data.
Three key categories were identified: REC processes and procedures, research ethics issues and health equity issues. Key themes for REC processes and procedures included RECs innovation during vulnerable pandemic times, solidarity and its impact on REC processes, and a consistently cautious approach to mutual recognition of REC reviews. Research ethics themes included opportunistic research, the rapidly evolving research ethics landscape, extreme vulnerability of research participants, and complexities of stakeholder engagement. Overlapping research ethics and health equity issues emerged.
Numerous, significant ethical complexities and challenges were identified by South African RECs Further comparative analysis between different countries is needed to develop the discourse around COVID-19 research ethics issues.