scholarly journals Fallacy of the last bed dilemma

2021 ◽  
pp. medethics-2021-107333
Author(s):  
Luca Valera ◽  
María A. Carrasco ◽  
Ricardo Castro
Keyword(s):  
Public Health ◽  
Decision Making ◽  
Critical Care ◽  
Medical Care ◽  
Ethical Issues ◽  
Moral Dilemma ◽  
Scarce Resources ◽  
Ethical View

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.

Pandemic Disease, Public Health, and Ethics

2019 ◽  
pp. 796-811 ◽  
Author(s):  
Maxwell Smith ◽  
Ross Upshur
Keyword(s):  
Public Health ◽  
Ethical Issues ◽  
Ethical Challenges ◽  
Pandemic Preparedness ◽  
Scarce Resources ◽  
Ethical Frameworks ◽  
Health Measures ◽  
Care Workers ◽  
The Face ◽  
Conducting Research

Infectious disease pandemics raise significant and novel ethical challenges to the organization and practice of public health. This chapter provides an overview of the salient ethical issues involved in preparing for and responding to pandemic disease, including those arising from deploying restrictive public health measures to contain and curb the spread of disease (e.g., isolation and quarantine), setting priorities for the allocation of scarce resources, health care workers’ duty to care in the face of heightened risk of infection, conducting research during pandemics, and the global governance of preventing and responding to pandemic disease. It also outlines ethical guidance from prominent ethical frameworks that have been developed to address these ethical issues and concludes by discussing some pressing challenges that must be addressed if ethical reflection is to make a meaningful difference in pandemic preparedness and response.

Law and ethics in intensive care

2020 ◽  
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Intensive Care Medicine ◽  
Ethical Issues ◽  
Daily Basis ◽  
Scarce Resources ◽  
Ethical Concerns ◽  
Law And Ethics ◽  
Invasive Management ◽  
Legal And Ethical Issues

The practice of intensive care medicine raises multiple legal and ethical issues on a daily basis, making it increasingly difficult to know whom to admit and when, at what stage invasive management should be withdrawn, and who, importantly, should decide? These profound dilemmas, already complicated in a setting of scarce resources, mandate an understanding of law and ethics for those working in intensive care medicine. Clinically focused, the book explains the relevance of landmark rulings to aid the day-to-day decision making of critical care professionals. A spectrum of ethical and legal controversies in critical care are addressed to demonstrate how law and ethics affect the care available to patients, and how patients’ responses to advances in treatment in turn influence legal and ethical concerns. Discussion of conflict resolution advises on the options that are open to doctors when agreement on treatment decisions or withdrawal cannot be reached. The literature and variations surrounding ‘Do not attempt resuscitation’ (DNAR) decisions are outlined. This edition also provides an up-to-date analysis of issues such as futility and deprivation of liberty.

scholarly journals Ethical Issues in Scarce Resource Allocation in a Global Pandemic: Relevance to Craniofacial Surgery

FACE ◽  
2020 ◽  
Vol 1 (1) ◽  
pp. 41-43
Author(s):  
Christian J. Vercler
Keyword(s):  
Public Health ◽  
Ethical Issues ◽  
Biomedical Ethics ◽  
Ethical Responsibility ◽  
Individual Member ◽  
Protective Equipment ◽  
Ethical Guidelines ◽  
Life And Death ◽  
Scarce Resources ◽  
Global Pandemic

The response to the COVID-19 pandemic has necessitated a shift in how we apply the principles of biomedical ethics. The historical foundation of the ethical responsibility of the physician to the patient rests on the of that individual relationship. The patient comes first. However, in a pandemic, a public health ethics takes over, and the focus changes to what each individual member of society’s responsibility is to the collective. The greatest good for the greatest number trumps a given individual’s needs. Ethicists have focused primarily on creating guidelines that apply to allocating scarce life-and-death-determining resources. Very little attention has been paid to scarce resources that are more mundane, such as personal protective equipment (PPE) or operating room (OR) time. I present here a summary of the most recent ethical guidelines for allocation of scarce resources, note some concerns with these approaches, and discuss some of the shortcomings of applying these frameworks to the practice of craniofacial surgeons.

How Ethics in Public Health Administration Leadership Leverages Connectedness in the age of COVID 19

2022 ◽  
Vol 2 (1) ◽  
pp. 0-0
Keyword(s):  
Public Health ◽  
Decision Making ◽  
Ethical Decision Making ◽  
Ethical Issues ◽  
Social Systems ◽  
Moral Character ◽  
Value Systems ◽  
Organizational Cultures ◽  
Health Administration ◽  
Organizational Decision Making

Ethics is critical in emergency response to public health and patient care in ways that create a variety of challenging dilemmas and decisions. Understanding ethical codes around medical care, especially during the emergence of COVID 19, has made leadership's role in perpetuating ethical organizational cultures in healthcare vital. Ethical leadership and ethical organizational cultures transform and unite social systems around everyday purposes of ethical decision-making, leveraging organizational connectedness. Leadership value systems mitigate subjectivity constituting ethical themes of moral character and virtues to advance organizational trust. Leadership value systems reduce subjectivity, forming ethical issues of moral character and virtues to promote organizational confidence and moral organizational decision-making. This paper employs the use of content analysis from the literature to take disjointed approaches and combine them into a cohesive understanding of leadership dynamics on organizational ethics in healthcare.

Ethics

Oncology ◽  
2017 ◽  
pp. 728-738
Author(s):  
Natalia S. Ivascu ◽  
Sheida Tabaie ◽  
Ellen C. Meltzer
Keyword(s):  
Decision Making ◽  
Critical Care ◽  
Informed Consent ◽  
Ethical Issues ◽  
Surrogate Decision Making ◽  
Ethical Problems ◽  
Decision Making Capacity ◽  
Surgical Critical Care ◽  
Surrogate Decision ◽  
Special Circumstances

In all areas of medicine physicians are confronted with a myriad ethical problems. It is important that intensivists are well versed on ethical issues that commonly arise in the critical care setting. This chapter will serve to provide a review of common topics, including informed consent, decision-making capacity, and surrogate decision-making. It will also highlight special circumstances related to cardiac surgical critical care, including ethical concerns associated with emerging technologies in cardiac care.

Information-sharing ethical dilemmas and decision-making for public health nurses in Japan

2014 ◽  
Vol 22 (5) ◽  
pp. 533-547 ◽  
Author(s):  
Chisato Suzuki ◽  
Katsumasa Ota ◽  
Masami Matsuda
Keyword(s):  
Public Health ◽  
Decision Making ◽  
Information Sharing ◽  
Ethical Issues ◽  
Ethical Dilemmas ◽  
Daily Practice ◽  
Group Interview ◽  
Public Health Nurses ◽  
Consensus Method ◽  
Structured Interviews

Background: Information sharing is one of the most important means of public health nurses collaborating with other healthcare professionals and community members. There are complicated ethical issues in the process. Research objectives: To describe the ethical dilemmas associated with client information sharing that Japanese public health nurses experience in daily practice and to clarify their decision-making process to resolve these dilemmas. Research design: Data were collected using a three-phase consensus method consisting of semi-structured interviews, self-administered questionnaires and a group interview. Participants and research context: We surveyed administrative public health nurses in Shizuoka Prefecture, Japan. The semi-structured interviews were carried out with 12 administrative public health nurses, and the self-administered questionnaires were sent to all 899 administrative public health nurses. The group interview was carried out with eight administrative public health nurses. Ethical considerations: Ethical approval was granted by the ethics committee of the School of Health Sciences, Nagoya University, Japan (8-158, 9-130). Findings: Information-sharing ethical dilemmas occurred most often when clients’ decisions did not coincide with the nurses’ own professional assessments, particularly when they faced clinical issues that were inherently ambiguous. In their decision-making processes, nurses prioritised ‘protection of health and life’. Discussion: These findings suggest that, above all, they sought to address urgent risks to clients’ lives while upholding the principle of client autonomy as much as possible. In such cases, the nurses made decisions regarding whether to share information about the client depending on the individual situation. Conclusion: Public health nurses should protect the client’s health while taking into consideration their relationship with the client.

scholarly journals (P1-106) Scarce Resources Planning Summit for Pediatric Critical Care and Transport Stakeholders

2011 ◽  
Vol 26 (S1) ◽  
pp. s133-s133
Author(s):  
S. Reynolds ◽  
E.K. Weber ◽  
P.J. Severin
Keyword(s):  
Critical Care ◽  
Emergency Preparedness ◽  
Ethical Issues ◽  
Community Integration ◽  
Pediatric Emergency ◽  
Standards Of Care ◽  
Pediatric Critical Care ◽  
Scarce Resources ◽  
Incident Command ◽  
Key Issues

There are six children's hospitals in Chicago, Illinois and the surrounding region. These hospitals often have bed limitations due to high censuses in daily operations. The Pediatric Committee of the Chicago Healthcare System Coalition for Preparedness and Response had provided two conferences in pediatric emergency preparedness in Spring 2010 that identified a need to examine scarce critical care resources in the region. A “Pediatric Critical Care and Transport Stakeholder's Summit” was convened in April 2010. This meeting brought together the Pediatric Critical Care Medical and Nursing Directors along with Transport Team representatives from major hospitals to identify the key issues related to pediatric emergency preparedness and scarce resources. The four-hour Summit, was held in a Conference Center, away from any hospital or clinical setting, was organized into seven sections: (1) Welcome & Introductions; (2) Issues Identification; (3) Scenario Introduction; (4) Specific Issues Indentification; (5) Prioritization of Specific Issues; (6) Development of Action Steps; and (7) Moving Forward. A Facilitator with specific knowledge of hospital-based preparedness led the Summit process. He utilized a pediatric scenario to engage the participants in discussion, interaction, and planning. Action steps, with statements of need and specific action items were developed, based on the following prioritized issues: (1) lack of pediatric training and experience for front line personnel; (2) alternate care sites/bed capacity/surge planning; (3) ethical issues; (4) transport; (5) credentialing/pediatric specialist availability; (6) incident command/community integration; (7) pediatric supplies and equipment; (8) patient indentification; (9) financial tracking/reimbursement; and (10) Crisis Standards of Care/Crisis Operation Standards Moving forward, the participants of the Summit will reconvene into small workgroups to develop plans and training for the areas specified above. In May, 2011 a statewide exercise utilizing the special population of children will occur to test these plans.

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