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2021-10-28

Canadian Blood Services, Ottawa, ON, Canada.; Canadian Blood Services, Ottawa, ON, Canada.; Faculty of Law, University of Ottawa, Ottawa, ON, Canada.; Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada.; Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada.; Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.; Canadian Blood Services, Ottawa, ON, Canada.; Canadian Blood Services, Ottawa, ON, Canada.; Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada.; Canadian Blood Services, Ottawa, ON, Canada.; Faculty of Medicine, Department of Bioethics, Dalhousie University, Halifax, NS, Canada.; Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada.; CHU de Québec-Université Laval Research Centre, Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, Université Laval, Quebec, QC, Canada.; Transplant Québec, Montreal, QC, Canada.; Canadian Blood Services, Ottawa, ON, Canada.; Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada.; Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada. Marie-chantal.fortin.med@ssss.gouv.qc.ca.; Centre de Recherche du CHUM, Room R12-418, 900 rue St-Denis, Montreal, QC, H2X 0A9, Canada. Marie-chantal.fortin.med@ssss.gouv.qc.ca.; Faculté de Médecine, Université de Montreal, Montreal, QC, Canada. Marie-chantal.fortin.med@ssss.gouv.qc.ca.

BACKGROUND: The COVID-19 pandemic has had a significant impact on the health system worldwide. The organ and tissue donation and transplantation (OTDT) system is no exception and has had to face ethical challenges related to the pandemic, such as risks of infection and resource allocation. In this setting, many Canadian transplant programs halted their activities during the first wave of the pandemic. METHOD: To inform future ethical guidelines related to the COVID-19 pandemic or other public health emergencies of international concern, we conducted a literature review to summarize the ethical issues. RESULTS: This literature review identified three categories of ethical challenges. The first one describes the general ethical issues and challenges reported by OTDT organizations and transplantation programs, such as risks of COVID-19 transmission and infection to transplant recipients and healthcare professionals during the transplant process, risk of patient waitlist mortality or

2021-04-11

Bioethics Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy. marta.perin@ausl.re.it.; PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy. marta.perin@ausl.re.it.; Bioethics Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.

BACKGROUND: Under COVID-19 pandemic, many organizations developed guidelines to deal with the ethical aspects of resources allocation. This study describes the results of an argument-based review of ethical guidelines developed at the European level. It aims to increase knowledge and awareness about the moral relevance of the outbreak, especially as regards the balance of equity and dignity in clinical practice and patient's care. METHOD: According to the argument-based review framework, we started our research from the following two questions: what are the ethical principles adopted by the ethical guidelines produced at the beginning of the COVID-19 outbreak related to resource allocation? And what are the practical consequences in terms of 'priority' of access, access criteria, management of the decision-making process and patient care? RESULTS: Twenty-two ethical guidelines met our inclusion criteria and the results of our analysis are organized into 4 ethical concepts and related

2021-01-03

Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, United States of America. Electronic address: kmurugap@bidmc.harvard.edu.; Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, United States of America.; Department of Anesthesiology, Columbia University Medical Center, 622 West 168th Street, New York, NY 10032, United States of America.; Managing General Counsel, Beth Israel Lahey Health, 109 Brookline Ave, Suite 300, Boston, MA 02215, United States of America; Ethics Advisory Committee, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215, United States of America.; Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, United States of America.

Rapid global spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the resultant clinical illness, coronavirus disease 2019 (COVID-19), drove the World Health Organization to declare COVID-19 a pandemic. Veno-venous Extra-Corporeal Membrane Oxygenation (VV-ECMO) is an established therapy for management of patients demonstrating the most severe forms of hypoxemic respiratory failure from COVID-19. However, features of COVID-19 pathophysiology and necessary length of treatment present distinct challenges for utilization of VV-ECMO within the current healthcare emergency. In addition, growing allocation concerns due to capacity and cost present significant challenges. Ethical and legal aspects pertinent to triage of this resource-intensive, but potentially life-saving, therapy in the setting of the COVID-19 pandemic are reviewed here. Given considerations relevant to VV-ECMO use, additional emphasis has been placed on emerging hospital resource scarcity and

2021-11-10

Directorate of Research for Health, Ministry of Health, 1925 9 de Julio Av, 1091, Buenos Aires, Argentina. apalmero@msal.gov.ar.; Pontifical Catholic University of Peru, Lima, Peru.; Center for the Study of State and Society, Buenos Aires, Argentina.; School of Law, University of Buenos Aires, Buenos Aires, Argentina.

BACKGROUND: Research has been an essential part of the COVID-19 pandemic response, including in Latin American (LA) countries. However, implementing research in emergency settings poses the challenge of producing valuable knowledge rapidly while upholding research ethical standards. Research ethics committees (RECs) therefore must conduct timely and rigorous ethics reviews and oversight of COVID-19 research. In the LA region, there is limited knowledge on how countries have responded to this need. To address this gap, the objective of our project is to explore if LA countries developed policies to streamline ethics review and oversight of research in response to the pandemic while ensuring its adherence to ethical standards, and to analyze to what extent these governance frameworks are in accordance with international guidance. METHODS: We conducted a descriptive and exploratory study assessing the COVID-19 research ethics governance frameworks of 19 LA countries, considering 4

2021-10-10

Queensland Bioethics Centre, Australian Catholic University, 1100 Nudgee Rd., Brisbane, Australia. bridget.pratt@acu.edu.au.; Centre for Health Equity, School of Population and Global Health, University of Melbourne, Melbourne, Australia. bridget.pratt@acu.edu.au.; The Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK.

BACKGROUND: Rapid data sharing can maximize the utility of data. In epidemics and pandemics like Zika, Ebola, and COVID-19, the case for such practices seems especially urgent and warranted. Yet rapidly sharing data widely has previously generated significant concerns related to equity. The continued lack of understanding and guidance on equitable data sharing raises the following questions: Should data sharing in epidemics and pandemics primarily advance utility, or should it advance equity as well? If so, what norms comprise equitable data sharing in epidemics and pandemics? Do these norms address the equity-related concerns raised by researchers, data providers, and other stakeholders? What tensions must be balanced between equity and other values? METHODS: To explore these questions, we undertook a systematic scoping review of the literature on data sharing in epidemics and pandemics and thematically analyzed identified literature for its discussion of ethical values, norms

2021-09-29

School of Engineering, University of Warwick, Coventry, CV47AL, UK.; Institute of Advanced Study, University of Warwick, Coventry, CV47AL, UK.; School of Engineering, University of Warwick, Coventry, CV47AL, UK. d.piaggio@warwick.ac.uk.; Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy.; School of Engineering, University of Warwick, Coventry, CV47AL, UK.; European Alliance of Medical and Biological Engineering and Science (EAMBES), Leuven, Belgium.; IUPESM, York, UK.

In March 2019, the World Health Organization (WHO) declared that humanity was entering a global pandemic phase. This unforeseen situation caught everyone unprepared and had a major impact on several professional categories that found themselves facing important ethical dilemmas. The article revolves around the category of biomedical and clinical engineers, which were among those most involved in dealing with and finding solutions to the pandemic. In hindsight, the major issues brought to the attention of biomedical engineers have raised important ethical implications, such as the allocation of resources, the responsibilities of science and the inadequacy and non-universality of the norms and regulations on biomedical devices and personal protective equipment. These issues, analyzed one year after the first wave of the pandemic, come together in the appeal for responsibility for thought, action and, sometimes, even silence. This highlights the importance of interdisciplinarity and the

2021-07-27

Department of Biomedical Ethics, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan. nakazawa@m.u-tokyo.ac.jp.; Office of Bioethics, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan.; Department of Philosophy, Carnegie Mellon University, Pittsburgh, USA.; Department of Biomedical Ethics, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.; Division of Medical Ethics, New York University School of Medicine, New York, USA.

BACKGROUND: Solitary death (kodokushi) has recently become recognized as a social issue in Japan. The social isolation of older people leads to death without dignity. With the outbreak of COVID-19, efforts to eliminate solitary death need to be adjusted in line with changes in lifestyle and accompanying changes in social structure. Health monitoring services that utilize wearable devices may contribute to this end. Our goals are to outline how wearable devices might be used to (1) detect emergency situations involving solitary older people and swiftly connect them with medical treatment, to (2) reduce the frequency of deaths that remain undiscovered and (3) to reduce social isolation by promoting social interaction. METHODS: Theoretical and philosophical approaches were adopted to examine ethical issues surrounding the application of wearable devices and cloud-based information processing systems to prevent solitary death in the world with/after COVID-19. MAIN BODY: (1) Technology

2021-06-23

University of Chicago Pritzker, School of Medicine, 924 E 57th St. Ste. 104, Chicago, IL 60637, United States. Electronic address: alyssa.lombardo@uchospitals.edu.; Pediatric Urology, Section of Urology, Department of Surgery, Division of the Biological Sciences and Pritzker School of Medicine, The University of Chicago, 5841 S. Maryland Ave. MC 7122, Chicago, IL 60637, United States; The MacLean Center for Clinical Medical Ethics, The University of Chicago, 5841 S Maryland Ave. MC 6098, Chicago, IL 60637, United States.; University of Illinois, College of Medicine, 1853W Polk St. MC 785, Chicago, IL 60612, United States.; Pediatric Urology, Section of Urology, Department of Surgery, Division of the Biological Sciences and Pritzker School of Medicine, The University of Chicago, 5841 S. Maryland Ave. MC 7122, Chicago, IL 60637, United States.; Section of Pediatric Urology, Department of Urology, University of Alabama at Birmingham, Children's of Alabama, 1530 3rd Ave. S, Birmingham, AL 35233, United States.; Pediatric Urology, Section of Urology, Department of Surgery, Division of the Biological Sciences and Pritzker School of Medicine, The University of Chicago, 5841 S. Maryland Ave. MC 7122, Chicago, IL 60637, United States.

INTRODUCTION: The COVID-19 pandemic has ripped around the globe, stolen family members and forced healthcare systems to operate under an unprecedented strain. As of December 2020, 74.7 million people have contracted COVID-19 worldwide and although vaccine distribution has commenced, a recent rise in cases suggest that the pandemic is far from over. METHODS: This piece explores how COVID-19 has explicitly impacted the field of pediatric urology and its patients with a focus on vulnerable subpopulations. RESULTS: Various medical and surgical associations have published guidelines in reaction to the initial onset of the pandemic in early 2020. DISCUSSION AND CONCLUSION: As the number of patients with COVID-19 increases, long-term recovery and future preparedness are imperative and should be cognizant of patient subpopulations that have been subject to disproportionate morbidity and mortality burden. Development of a dedicated response team would aid in achieving preparedness by drafting

2021-05-03

British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada. oraliagr@alumni.ubc.ca.; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada. oraliagr@alumni.ubc.ca.; CIHR Canadian HIV Trials Network, Vancouver, BC, Canada. oraliagr@alumni.ubc.ca.; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.; British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada.; British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada.; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.; British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada.; British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada.; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.

The COVID-19 pandemic has demonstrated both the positive and negative use, usefulness, and impact of digital technologies in public health. Digitalization can help advance and sustain the core functions of public health, including health promotion and prevention, epidemiological surveillance, and response to emergent health issues. Digital technologies are thus-in some areas of public discourse-presented as being both necessary and inevitable requirements to address routine and emergency public health issues. However, the circumstances, ways, and extent to which they apply remain a subject of critical reflection and empirical investigation. In this commentary, we argue that we must think through the use of digital technologies in public health and that their usefulness must be assessed in relation to their short- and long-term ethical, health equity, and social justice implications. Neither a sense of digital technological optimism and determinism nor the demands of addressing

2021-03-10

Sydney Dental School, Faculty of Medicine and Health, University of Sydney, Westmead Campus, NSW, 2145, Australia. tony.skapetis@sydney.edu.au.; Division of Oral Health, Western Sydney Local Health District, Westmead, NSW, Australia. tony.skapetis@sydney.edu.au.; Sydney Dental School, Faculty of Medicine and Health, University of Sydney, Westmead Campus, NSW, 2145, Australia.; Division of Oral Health, Western Sydney Local Health District, Westmead, NSW, Australia.; Sydney Dental School, Faculty of Medicine and Health, University of Sydney, Westmead Campus, NSW, 2145, Australia.; Division of Oral Health, Western Sydney Local Health District, Westmead, NSW, Australia.

BACKGROUND: The COVID-19 pandemic has presented extraordinary challenges to worldwide healthcare systems, however, prevalence remains low in some countries. While the challenges of conducting research in high-prevalence countries are well published, there is a paucity from low COVID-19 countries. METHODS: A PRISMA guided systematic review was conducted using the databases Ovid-Medline, Embase, Scopus and Web of Science to identify relevant articles discussing ethical issues relating to research in low prevalence COVID-19 countries. RESULTS: The search yielded 133 original articles of which only 2 fit the inclusion criteria and aim, with neither specific to low prevalence. Most of the available literature focused on clinical management and resource allocation related to high prevalence countries. These results will be discussed under the ethical dimensions of equity, individual liberty, privacy and confidentiality, proportionality, public protection, provision of care, reciprocity