Ethical Challenges Arising in the COVID-19 Pandemic: An Overview from the Association of Bioethics Program Directors (ABPD) Task Force

Abstract

The COVID-19 pandemic has raised a host of ethical challenges, but key among these has been the possibility that health care systems might need to ration scarce critical care resources. Rationing policies for pandemics differ by institution, health system, and applicable law. Most seem to agree that a patient’s ability to benefit from treatment and to survive are first-order considerations. However, there is debate about what clinical measures should be used to make that determination and about other factors that might be ethically appropriate to consider. In this paper, we discuss resource allocation and several related ethical challenges to the healthcare system and society, including how to define benefit, how to handle informed consent, the special needs of pediatric patients, how to engage communities in these difficult decisions, and how to mitigate concerns of discrimination and the effects of structural inequities.     

Identification,Response, and Referral of Suicidal Youth Following Applied Suicide Intervention Skills Training

Gatekeeper training is a public health approach to suicide prevention that encourages community members to identify those at risk for suicide, respond appropriately, and refer for clinical services. Despite widespread use, few studies have examined whether training results in behavior change in participants. This study employed a naturalistic pre–post design to follow 434 participants in Applied Suicide Intervention Skills Training, finding small but significant increases in self‐reported identification of at‐risk youth, some helpful responses to youth, and numbers of youth referred to treatment from pre‐test to 6‐ to 9‐month follow‐up. Changes in active listening and helping behaviors meant to support treatment referrals (such as convincing a youth to seek treatment) were not observed over time. Additional analyses explored predictors of self‐reported skill utilization including identification as a “natural helper” and attitudes about suicide prevention.     

The relationship between naturally occurring dysphoric moods,elaborative encoding,and recall performance

Abstract

An experiment was conducted to examine the effects of levels of naturally occurring dysphoria and elaborative encoding on recall. Previous research has indicated that the facilitative effects of elaborative encoding on recall are reduced by the induction of negative moods in laboratory settings. However, the effects of endogenous dysphoria on recall are less clear. In the present study, 82 subjects from a college population were categorised as dysphoria or nondysphoric on the basis of two self-report measures. They were then presented with sentences in both elaborated and nonelaborated form, and recall for target words embedded in the sentences was assessed. Results demonstrated that nondysphoric individuals benefited from elaborative encoding in recall performance, whereas dysphoric individuals did not. Results are discussed in terms of Ellis and Ashbrook's (1988) resource allocation model of depression.     

Willingness of Mentally Ill Individuals to Sign Up for a Novel Proposal to Prevent Firearm Suicide

The study goal was to determine whether a significant number of high suicide risk individuals would confidentially put their own names onto a list to prevent future gun purchases. An anonymous written survey was administered in an inpatient psychiatric unit and two outpatient psychiatric clinics at an academic medical center. Two hundred forty individuals were approached to fill out the survey, of whom 200 (83.3%) did so. Forty‐six percent of participants stated that they would put their own name onto the list. This novel suicide prevention proposal, a Do‐Not‐Sell List, would appeal to many people at high risk for suicide.     

Feminism and Health in the Decade of Behavior

National health data are presented to demonstrate that important issues of women's health are linked to inequality and to the generalized oppression of women. Health issues of violence, reproductive health, coronary health, and mental health are reviewed as they relate to women of color and diverse ethnicity as well as to women in general. Feminist principles are applied to these issues, pointing out inequalities in assessment, treatment and access to care, bias in research and lack of research on topics particularly relevant to women and minorities, and limitations in the education and training of health care providers. It is imperative that these problems, which are not solely biological, be addressed in light of systems-level analysis that includes a feminist lens. Guided by feminist principles and sensibilities, the relevance of behavioral and social science is outlined for research, training, assessment, intervention, evaluation, and overall social change.