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.     

COVID in NYC: What We Could Do Better

Abstract

New York City hospitals expanded resources to an unprecedented extent in response to the COVID pandemic. Thousands of beds, ICU beds, staff members, and ventilators were rapidly incorporated into hospital systems. Nonetheless, this historic public health disaster still created scarcities and the need for formal crisis standards of care. These were not available to NY clinicians because of the state’s failure to implement, with or without revision, long-standing guidance documents intended for just such a pandemic. The authors argue that public health plans for disasters should be well-funded and based on available research and expertise. Communities should insist that political representatives demonstrate responsible leadership by implementing and updating as needed, crisis standards of care. Finally, surge requirements should address the needs of both those expected to survive and those who will not, by expanding palliative care and other resources for the dying.     

Evaluation of The Practitioner Online Referral and Treatment Service (PORTS): the first 18 months of a state-wide digital service for adults with anxiety,depression, or substance use problems

ABSTRACT

The Practitioner Online Referral and Treatment Service (PORTS) is a new digital mental health service (DMHS) providing assessment, treatment, and consultation across Western Australia, for adults with anxiety, depression, or substance use problems, and experiencing financial hardship or geographical disadvantage. From July 2017 to December 2018, a total of 2,527 individuals were referred to PORTS. Of these, 150 (6%) did not give consent for their results to be analysed. Of the remaining 2,377 patients, 615 (26%) could not be contacted to confirm the referral, 596 (25%) received assessment or information from PORTS, 427 (18%) were referred to another service, and 739 (31%) commenced treatment at PORTS. Almost half (47%) of patients were from areas with significant socio-economic disadvantage. Those referred by another mental health service were more likely to engage in treatment than those referred by a General Practitioner (GP). Overall outcomes were excellent, with large effect sizes (Cohen’s d: 1.1–1.4), from assessment to post-treatment and 3-month follow-up, reliable deterioration was low, and GP and patient satisfaction was high. These results indicate that the PORTS DMHS model is a promising method for engaging primary care patients with anxiety and depression, including those experiencing financial and geographical disadvantage.     

The meaning of service questionnaire and its association with psychological growth among Veterans

ABSTRACT

Few studies have investigated what soldiers find meaningful after being exposed to highly stressful events and what positive effects they might have in the aftermath. This study reports the psychometric properties of a newly developed questionnaire, Meaning of Service (MoS), and its application to the study of how strongly meaning-making processes are associated with psychological growth. One hundred eighty-four Norwegian Air Force Veterans who have participated in various missions abroad in different branches of the military completed the MoS questionnaire along with other scales reflecting psychological growth, hardiness, resilience, stress, and exposure, as well as personal and mission characteristics. The principal component analysis mainly identified three major meaning themes as expected from previous qualitative research (Confirmation of ability, Cohesion of peers, and Significance of effort). The hierarchical regression analysis showed that all three meaning themes and two coping strategies were associated with psychological growth, and that Confirmation of ability (coping and recognition of coping) seems particularly important to enhance Veterans’ prospects of psychological growth. Future research directions are proposed including suggestions for minor modifications of the questionnaire.     

Driver fatigue among military truck drivers

The Israeli Defense Force (IDF) Transport Center is the largest and the most diverse transportation organization in Israel: three times as large as the largest commercial fleet in Israel, and military bases are spread all over the country. It also has the ability to regulate the drivers better: enforcing diet, hours of sleep, and working hours. The drivers are either permanently employed civilians, career service personnel, or mandatory service personnel. This employment status correlates with age, experience, carrier type, and several job characteristics (for example mandatory service drivers typically do not drive at night).The study consisted of a survey of 314 male drivers (30% of the entire base driver population). Despite the different environment, the military drivers display many characteristics and coping-behaviors characteristic of civilian drivers. Our results cast a doubt on the efficacy of enforcing night sleep and prohibiting night drives as an alternative to regulating hours of service. Our findings also reveal that it is insufficient to provide drivers with the time to sleep. One has to ensure that they also get a good quality of sleep. Implications for reducing fatigue in this environment are suggested. We identified the mandatory service drivers (young, less experienced drivers, lower military ranks) as a group of drivers that falls asleep more often and to a greater extent. They are particularly sensitive to sleep deficits and influenced by external events such as aggravation and boredom.It is important to provide drivers with more in-vehicle, accessible countermeasures to counter fatigue since they often do not stop, particularly in short-haul conditions. Since the radio has a high level of usage and acceptance among drivers, it could be exploited as an interactive communications system, as an educational medium, and as an image-enhancing device.