Understanding the impact of the COVID-19 outbreak on vulnerable populations in Malaysia through an ethical lens: A study of non-state actors involved in aid distribution

Background: Globally, vulnerable populations have been disproportionately affected by the COVID-19 pandemic and subsequent responses, such as lockdown measures and mass vaccinations. Numerous ethical challenges have arisen at different levels, be it at the policy-making level or on the ground. For example, policymakers have to contain a highly contagious disease with high morbidity using scarce resources, while minimizing the medium- to long-term social and economic impacts induced by containment measures. This study explores the impact of COVID-19 on vulnerable populations in Malaysia by using an intersectional framework that accounts for overlapping forms of marginalization. Methods: This study utilizes in-depth qualitative data obtained from 34 individuals and organizations to understand the impact of the COVID-19 outbreak on vulnerable populations in Malaysia. We utilize four principles of ethics to guide our coding and interpretation of the data – namely beneficence, non-maleficence, justice and autonomy. We utilize a frequency analysis to roughly understand the types of ethical issues that emerged. Using hermeneutic content analysis (HCA), we then explore how the principles interact with each other. Results: Through the frequently analysis, we found that although beneficence was very prevalent in our dataset, so was a significant amount of harm – as perpetuated through injustice, the removal or lack of autonomy and maleficence. We also unearthed a worrying landscape of harm and deep systemic issues associated with a lack of support for vulnerable households – further exacerbated during the pandemic. Conclusions: Policy recommendations for aid organizations and society to mitigate these ethical problems are presented, such as long overdue institutional reforms and stronger ethical practices rooted in human rights principles, which government agencies and aid providers can then use in the provision of aid to vulnerable populations.

Looking into the kaleidoscope of activism: the engagement of care ethics and global bioethics for a refined health security

During public health crises, the United States utilizes a statist approach for securing its population’s health, which places state structures at the center of a (mainly economic) health security. The fairness of this approach relies on a distribution of resources to “trickle down” from institutions to individuals. Yet, “fairness,” in this regard, is determined a priori, that is, without reference to specific individuals who are receiving resources of health. This ignores contextual needs that arise from the disproportionate damage that epidemics and pandemics have on vulnerable populations. A statist approach can make a more equitable impact on global society if it integrates care ethics into its distributive justice. In this paper, I demonstrate how an ethic of care can substantiate health security. First, I show how an ethic of care can be engaged anywhere embodiment is recognizable—not just in the one-on-one setting of the clinical encounter—but in the (inter)national contexts through which public health crises have a full effect on. Second, I provide a methodology for state institutions to recognize the social embodiment necessary to engage an ethic of care in these contexts, specifically engaging the social embodiment that manifests through the social activism of vulnerable populations during public health crises. Third, I demonstrate how the social embodiment that activism lives through forces an encounter with state institutions, mimicking in this manner a clinical encounter on a macrocosmic scale. Finally, I assign an ethic of care to this encounter, meshing caring values to the criteria of distribution.

Clinical Characteristics of Vulnerable Populations Hospitalized and Diagnosed with COVID‑19 during Second Wave in Buenos Aires, Argentina.

There are a few in Argentina publications regarding the presentation of patients with COVID-19 requiring hospitalized and emergency care in vulnerable populations that compares the first and second wave, and it has few reports in developing countries. The objective is to determine whether in the care of vulnerable patients, to succeed against COVID-19, multiple public health tools and interventions necessary to minimize morbidity and mortality. The study is a prospective cohort investigation of 3028 patients during second wave with lab-confirmed COVID-19, who required any of the Health Centers response from April 1, 2021, to June 30, 2021. In a previous publication, our group analyzed the situation of hospitalized patients during the first wave in the same region, "Southeast Network" (SN), Buenos Aires Metropolitan Area (AMBA). SN with 1.8 million inhabitants residing in urban and rural areas. A total of 14 health centers with different levels of care complexity provide care to patients in the region. The information of each patient with COVID-19 evaluated by SN, was incorporated in an Epidemiological Dashboard. The investigation was designed and reported with consideration of observational studies in epidemiology. A total of 57.9% patients were men, and the mean age (SD) was 52.1 (13.5) years. Sixty four percent patients with pre-existing diseases, most frequent hypertension and diabetes, but diabetes, obesity, and cardiovascular disease presented higher risk. A total of 24.7% were hospitalized in Intensive Therapy Unit. The mortality of the cohort was 22.9%. Mortality was higher for patients aged 65 or more, and for those had some pre-existing disease. But, it was a slightly more than double that in the first wave, it is possible mainly due to the fact that more than doubled of patients in Second wave required hospitalization in ITU, compared to First wave. The patients presented greater severity of their medical condition at the time of their hospitalization. These findings were similar to those reported by other authors. Another possible cause of the high number of patients in the period studied is due to the fact that most of the hospitalized population had not been vaccinated. The health system was able to respond to the demand.

Mental Health and Attitude toward Substance use among Medical Students

Introduction: Medical students are important and vulnerable populations. High levels of stress, financial dependency, easy access to substances, and lack of adequate support increase their mental health problems and substance use. In this study, we aimed to investigate the relationship between their mental health status and attitude toward substances. Methods: In this cross-sectional study, a total of 157 medical students were enrolled using the convenient sampling method, to answer the Drug Attitude Scale test and General Health Questionnaire. Data were analyzed using the SPSS. Results: Mental health is significantly correlated with the attitude toward substance use. The participants in this study had mental health problems in general. Half of them also had a positive attitude and tendency to use substances. Conclusion: Mental health problems and tendency to use the substances were prevalent among medical students. More investigations and designation of therapeutic and preventive programs are necessary especially for vulnerable populations.

Dilemma of health rights of vulnerable citizens: a narrative review

Vulnerable populations have traditionally faced non availability of health services. Enforcement of constitutional protections to vulnerable citizens is essential to secure them their health rights. Hence current narrative review in perspective of rights laws was conducted with the objective to review and highlight provisions of the constitution of different countries and World Health Organization (WHO) and the on ground situation prevailing in Pakistan. This study has immense significance, since this can invoke debate, inspire research and recognition of the enabling articles/ provisions for health care guaranteed in the Constitution. For this purpose data was searched for publications related to constitution and health of countries including Pakistan, United States, United Kingdom, China, Saudi Arabia and India using search engines, data bases and different websites. 170 reports, publications & articles were downloaded out of which 30 English, full text articles, publications and reports were utilized for the current research. Keywords: Vulnerable population,

Negotiating Status: Pro Bono Partners and Counsels in Large Law Firms

Law firm pro bono work provides access to justice to low-income people and other vulnerable populations. The professionals that manage pro bono programs are at the forefront of that process. The limited available research on these professionals do not often distinguish lawyers from other managers or theorize about their status vis-à-vis other law firm lawyers. Yet the status of lawyers who are also managers of pro bono programs influences both their identities and the management and provision of legal services and advocacy. Drawing on original demographic and interview data, this article shows how law firm pro bono partners and counsels navigate their ambiguous roles and negotiate their status as lawyers and managers. I find that pro bono partners and counsels navigate their ambiguous roles by striving to be perceived as “real” lawyers, reframe their roles as business generators, conform to the billing culture, and establish a common identity. They also negotiate their titles and office spaces to raise their profiles. Gender inequality influences the negotiation of office spaces and the approval of pro bono matters. These findings have implications for lawyers who manage pro bono programs and the legitimacy of pro bono work.