scholarly journals Balancing health worker well-being and duty to care: an ethical approach to staff safety in COVID-19 and beyond

2020 ◽  
pp. medethics-2020-106557 ◽  
Author(s):  
Rosalind J McDougall ◽  
Lynn Gillam ◽  
Danielle Ko ◽  
Isabella Holmes ◽  
Clare Delany
Keyword(s):  
Decision Making ◽  
Clinical Work ◽  
Well Being ◽  
Decision Makers ◽  
Ethical Challenges ◽  
Healthcare Staff ◽  
Front Line ◽  
Specific Setting ◽  
Healthcare Work ◽  
Staff Protection

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 (PPE) 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.

scholarly journals Adopting an ethical approach to migration health policy, practice and research

2021 ◽  
Vol 6 (7) ◽  
pp. e006425
Author(s):  
Kristine Husøy Onarheim ◽  
Kolitha Wickramage ◽  
David Ingleby ◽  
Supriya Subramani ◽  
Ingrid Miljeteig
Keyword(s):  
Decision Making ◽  
Health Policy ◽  
Policy Making ◽  
Ethical Issues ◽  
Health Workers ◽  
Decision Makers ◽  
Ethical Challenges ◽  
Ethical Frameworks ◽  
Ethical Approach ◽  
Trade Offs

Migration health is affected by decision making at levels ranging from global to local, both within and beyond the health sector. These decisions impact seeking, entitlements, service delivery, policy making and knowledge production on migration health. It is key that ethical challenges faced by decision makers are recognised and addressed in research and data, clinical practice and policy making on migration health. An ethical approach can provide methods to identify ethical issues, frameworks for systematising information and suggesting ethically acceptable solutions, and guidance on procedural concerns and legitimate decision making processes. By unpacking dilemmas, conflicts of interests and values at stake, an ethical approach is relevant for all who make decisions about migration health policy and practice. Adopting an ethical approach to migration health benefits governments, organisations, policy makers, health workers, data managers, researchers and migrants themselves. First, it highlights the inherent normative questions and trade-offs at stake in migration health. Second, it assists decision makers in deciding what is the ethically justifiable thing to do through an ‘all things considered’ approach. Third, ethical frameworks and technical guidance set normative and practical standards for decision makers facing ethical questions – from ‘bedside rationing’ to collection of big data or in policy making – that can ensure that migrants’ interests are considered. Fourth, there is a need for greater transparency and accountability in decision making, as well as meaningful participation of migrant groups. An ethical approach connects to public health, economic and human rights arguments and highlights the urgent need to mainstream concerns for migrants in global and national health responses.

Working with Children in End-of-Life Decision Making

2009 ◽  
Vol 16 (6) ◽  
pp. 743-758 ◽  
Author(s):  
Joanne Whitty-Rogers ◽  
Marion Alex ◽  
Cathy MacDonald ◽  
Donna Pierrynowski Gallant ◽  
Wendy Austin
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
Decision Makers ◽  
Ethical Challenges ◽  
Children And Families ◽  
Best Interest ◽  
Surrogate Decision Makers ◽  
Surrogate Decision ◽  
End Of Life Decision

Traditionally, physicians and parents made decisions about children’s health care based on western practices. More recently, with legal and ethical development of informed consent and recognition for decision making, children are becoming active participants in their care. The extent to which this is happening is however blurred by lack of clarity about what children — of diverse levels of cognitive development — are capable of understanding. Moreover, when there are multiple surrogate decision makers, parental and professional conflict can arise concerning children’s ‘best interest’. Giving children a voice and offering choice promotes their dignity and quality of life. Nevertheless, it also presents with many challenges. Case studies using pseudonyms and changed situational identities are used in this article to illuminate the complexity of ethical challenges facing nurses in end-of-life care with children and families.

Who Makes the Call --- and How?

2018 ◽  
Author(s):  
Camilla Kao ◽  
Che-I Kao
Keyword(s):  
Decision Making ◽  
Health And Safety ◽  
Mission Statements ◽  
Well Being ◽  
Decision Makers ◽  
Culture Of Safety ◽  
Gray Area ◽  
Definition Of

Recently we proposed that mission statements incorporating the concept of reducing uncertainty could provide a framework for learning the bread and depth of information that exists about health and safety. We briefly explained the definition of uncertainty in the context of health and safety, with the unifying principle being that everything you learn about safety is about exerting greater control. Acquiring more knowledge about an experiment, using equipment appropriately, designing experiments well, executing procedures well, and obtaining appropriate training are all mechanisms for increasing control.<div><br></div><div>Both researchers and their institutions can be the actors exerting control. But who should make the risk-based decisions related to the design of an experiment? Insecurity about the consequences of our own decisions frequently makes us want to have someone else decide a matter about safety, especially when that matter involves a gray area. Here we explain why researchers should be the main decision-makers about the safety of their experiments, with the researchers striving to thoroughly and creatively reduce the uncertainty of the well-being of themselves, their colleagues, and the environment. Even more, after comprehending the unifying principle outlined above for <b>learning</b> information about safety, researchers should make their primary goal in safety to be conceiving mechanisms for exerting greater control over their experiments that <b>go beyond</b> the mechanisms that health and safety practitioners teach. The essay ends by discussing how decision-making by researchers can improve the culture of safety.</div>

scholarly journals Using gross ecosystem product (GEP) to value nature in decision making

2020 ◽  
Vol 117 (25) ◽  
pp. 14593-14601 ◽  
Author(s):  
Zhiyun Ouyang ◽  
Changsu Song ◽  
Hua Zheng ◽  
Stephen Polasky ◽  
Yi Xiao ◽  
...  
Keyword(s):  
Decision Making ◽  
Ecosystem Services ◽  
Large Scale ◽  
Well Being ◽  
Decision Makers ◽  
Green Growth ◽  
Economic Information ◽  
The World ◽  
Chinese Province ◽  
Compensation Payments

Gross domestic product (GDP) summarizes a vast amount of economic information in a single monetary metric that is widely used by decision makers around the world. However, GDP fails to capture fully the contributions of nature to economic activity and human well-being. To address this critical omission, we develop a measure of gross ecosystem product (GEP) that summarizes the value of ecosystem services in a single monetary metric. We illustrate the measurement of GEP through an application to the Chinese province of Qinghai, showing that the approach is tractable using available data. Known as the “water tower of Asia,” Qinghai is the source of the Mekong, Yangtze, and Yellow Rivers, and indeed, we find that water-related ecosystem services make up nearly two-thirds of the value of GEP for Qinghai. Importantly most of these benefits accrue downstream. In Qinghai, GEP was greater than GDP in 2000 and three-fourths as large as GDP in 2015 as its market economy grew. Large-scale investment in restoration resulted in improvements in the flows of ecosystem services measured in GEP (127.5%) over this period. Going forward, China is using GEP in decision making in multiple ways, as part of a transformation to inclusive, green growth. This includes investing in conservation of ecosystem assets to secure provision of ecosystem services through transregional compensation payments.

scholarly journals Article 5: The Role of Parents in the Proxy Informed Consent Process in Medical Research involving Children

2020 ◽  
Vol 28 (3) ◽  
pp. 521-546
Author(s):  
Sheila Varadan
Keyword(s):  
Decision Making ◽  
Informed Consent ◽  
Medical Research ◽  
Well Being ◽  
Ethical Challenges ◽  
Research Setting ◽  
Role Of Parents ◽  
Article 5 ◽  
The Relationship

Abstract Medical research involving child subjects has led to advances in medicine that have dramatically improved the lives, health and well-being of children. Yet, determining when and under what conditions a child should be enrolled in medical research remains an ethically vexing question in research ethics. At the crux of the issue is the free and informed consent of the child participant. A child, who is presumed legally incompetent, or lacks sufficient understanding to exercise autonomous decision-making, will not be able to express free and informed consent in the research setting. Rather than exclude all such children from medical research, a parent (or legal guardian) is designated as a proxy to consent on the child’s behalf. However, the concept of proxy informed consent and the framework for its implementation present practical and ethical challenges for researchers, particularly in navigating the relationship between proxy decision-makers and child subjects in the medical research setting. Article 5 of the uncrc may offer guidance on this point: (1) it places boundaries around how parental authority should be exercised; (2) it offers a model for parent-child decision-making that is participatory, collaborative and linked to the child’s enjoyment of rights under the uncrc; (3) it respects and supports the autonomy of child participants by recognising their evolving capacities to give informed consent. This paper concludes that greater consideration should be given to Article 5 as a complementary framework for researchers engaged in medical research involving children.

Satisficing in Political Decision Making

2019 ◽  
Author(s):  
Daniel Stevens
Keyword(s):  
Decision Making ◽  
Decision Rule ◽  
Survey Design ◽  
Well Being ◽  
Cognitive Effort ◽  
Decision Makers ◽  
Future Research ◽  
Positive Effects ◽  
Cognitive Limitations ◽  
Survey Responses

The idea of satisficing as a decision rule began with Herbert Simon. Simon was dissatisfied with the increasingly dominant notion of individuals as rational decision-makers who choose alternatives that maximize expected utility on two grounds. First, he viewed the maximizing account of decision-making as unrealistic given that individuals have cognitive limitations and varying motivations that limit cognitive ability and effort. Second, he argued that individuals do not even choose alternatives as if they are maximizing (i.e., that the maximizing account has predictive validity). Instead, he offered a theory of individuals as satisficers: decision-makers who consider a limited number of alternatives, expending limited cognitive effort, until they find one that is “good enough.” At this point, he argued, the consideration of alternatives stops. The satisficing decision rule has influenced several subfields of political science. They include elite decision-making on military conflicts, the economy, and public policy; ideas of what the mass public needs to know about politics and the extent to which deficits in political knowledge are consequential; and understanding of survey responses and survey design. Political and social psychologists have also taken Simon’s idea and argued that satisficing rather than maximizing is a personality trait—stable characteristics of individuals that make them predisposed toward one or other type of alternative search when making decisions. Research in these subfields additionally raises normative questions about the extent to which satisficing is not only a common way of making decisions but a desirable one. Satisficing seems superior to maximizing in several respects. For example, it has positive effects on aspects of decision-makers’ well-being and is more likely to result in individuals voting their interests in elections. There are, however, a number of directions in which future research on satisficing could be taken forward. These include a fuller incorporation of the interaction of affect and cognition, clearer tests of alternative explanations to satisficing, and more focus and understanding on the effects of the Internet and the “information age.”

scholarly journals What should be done to support the mental health of healthcare staff treating COVID-19 patients?

2020 ◽  
Vol 217 (4) ◽  
pp. 537-539 ◽  
Author(s):  
Derek K. Tracy ◽  
Mark Tarn ◽  
Rod Eldridge ◽  
Joanne Cooke ◽  
James D.F. Calder ◽  
...  
Keyword(s):  
Mental Health ◽  
Well Being ◽  
Evidence Base ◽  
Moral Injury ◽  
Evidence Based ◽  
Healthcare Staff ◽  
Model Of Care ◽  
Front Line ◽  
Mental Health Support ◽  
Health Support

SummaryThere is an urgent need to provide evidence-based well-being and mental health support for front-line clinical staff managing the COVID-19 pandemic who are at risk of moral injury and mental illness. We describe the evidence base for a tiered model of care, and practical steps on its implementation.

scholarly journals Decision-making about children's mental health care: ethical challenges

2004 ◽  
Vol 10 (4) ◽  
pp. 301-311 ◽  
Author(s):  
Moli Paul
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Decision Making ◽  
Young People ◽  
Health Services ◽  
Decision Makers ◽  
Duty Of Care ◽  
Ethical Challenges ◽  
Children And Young People ◽  
Legal Challenges

Children and young people are usually referred to specialist child and adolescent mental health services (CAMHS) by adults because of concerns raised by other adults. Most CAMHS consider them from a developmental perspective and as individuals in the context of their families and other relationships/systems. In this article I discuss ethical and legal challenges posed by making decisions with and about children and young people within CAMHS, with particular reference to duty of care; the rights of minors' and parents'; capacity and consent; and disagreement between decision-makers. It is important to involve children and young people in decision-making, and I suggest ways of acheiving this.

Who Makes the Call --- and How?

2018 ◽  
Author(s):  
Camilla Kao ◽  
Che-I Kao
Keyword(s):  
Decision Making ◽  
Health And Safety ◽  
Mission Statements ◽  
Well Being ◽  
Decision Makers ◽  
Culture Of Safety ◽  
Gray Area ◽  
Definition Of

Recently we proposed that mission statements incorporating the concept of reducing uncertainty could provide a framework for learning the bread and depth of information that exists about health and safety. We briefly explained the definition of uncertainty in the context of health and safety, with the unifying principle being that everything you learn about safety is about exerting greater control. Acquiring more knowledge about an experiment, using equipment appropriately, designing experiments well, executing procedures well, and obtaining appropriate training are all mechanisms for increasing control.<div><br></div><div>Both researchers and their institutions can be the actors exerting control. But who should make the risk-based decisions related to the design of an experiment? Insecurity about the consequences of our own decisions frequently makes us want to have someone else decide a matter about safety, especially when that matter involves a gray area. Here we explain why researchers should be the main decision-makers about the safety of their experiments, with the researchers striving to thoroughly and creatively reduce the uncertainty of the well-being of themselves, their colleagues, and the environment. Even more, after comprehending the unifying principle outlined above for <b>learning</b> information about safety, researchers should make their primary goal in safety to be conceiving mechanisms for exerting greater control over their experiments that <b>go beyond</b> the mechanisms that health and safety practitioners teach. The essay ends by discussing how decision-making by researchers can improve the culture of safety.</div>

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