These articles relate to the ways in which public health and medical interventions may limit individual liberties and/or other rights in the COVID19 pandemic. As the pandemic unfolds, so does the content on this website. Please share and visit often.
Kennedy Institute of Ethics Journal; June 23, 2020.
This paper by Daniel Goldberg presents a clear and compelling description of “legal epidemiology.” The discussion of stigma is good (he’s always good on that) and the pieces on the history of plagues are terrific (he’s an historian, so what would you expect?). But I loved his brief description of laws and policies as social determinants of health, which “can fairly be regarded as epidemiologic exposures akin to any other (e.g., toxicants, tobacco and hazardous working conditions)” and which can and should be categorized, bundled for implementation, and tracked for health impacts.
Recommended by Matthew Wynia.
New England Journal of Medicine; May 20, 2020.
In this personal perspective piece, Mark Earnest, MD, PhD reflects on the loss of “the intimacy of patient care” during the COVID pandemic. He invokes images from the Middle Ages when plague doctors wore costumes that included protective suits and beaked masks to protect themselves. To Dr. Earnest, “the image represented the triumph of fear and superstition over the more noble impulses I hoped would drive me in a time of crisis.” When in March 2020, he found himself covered in personal protective equipment preparing to meet a patient, he “stood for the first time outside the door of a patient who I suspected had Covid-19. I was wearing two layers of gloves, a gown, an N95 mask, and goggles. While taking her history and examining her, I felt a wave of guilt and a sense that I was betraying something important.” In this thought-provoking essay, Dr. Earnest explores how these new barriers effect his experience as a health care worker and also describes how being present to care for patient is paramount.
Annotation: John Reilly.
Human Rights Council of the UN General Assembly; March 20, 2020.
A study on the impact of ableism in medical and scientific practice…The report contains recommendations to assist States to develop and implement legal and policy reforms oriented to embracing disability as part of human diversity, in line with the standards set forth in the Convention on the Rights of Persons with Disabilities. They include adopting measures to raise awareness, implementing rights-based prevention policies, respecting and protecting personal autonomy, the right to life and the right to personal integrity of persons with disabilities, and promoting their participation in decision-making, especially during the COVID-19 pandemic.
Annotation: from the Report Summary.
New England Journal of Medicine; May 19, 2020.
This NEJM perspective article underscores the ethical obligation of the healthcare system to honor commitments to equally and fairly value the lives of people with disabilities when planning for crisis standards of care and allotment of scarce resources. It explores problems with existing discriminatory codes in certain states such as Utah, Alabama, and Pennsylvania and how they have been challenged, revised and revoked in response to a need for clear and equitable triage guidelines around the COVID-19 pandemic, with a special emphasis on the ethical justification for including near term prognosis in triage scoring systems. It concludes with six practical guideposts that States and hospitals should consider when creating, reviewing or revising triage and crisis standards of care protocols.
Annotation: Meleah Himber.
University of Kentucky Program for Bioethics & The UK Healthcare Ethics Committee; March 19, 2020.
The UK Program for Bioethics Educational Resource on Pandemic Ethics summarizes the history of pandemic ethics and ethical issues and principles in a pandemic. This comprehensive, evidence-based resource could be a useful tool for decision-making and planning in the COVID-19 pandemic. It includes links to pandemic ethics plans for resource allocation from Arizona, Maryland, Michigan, Tennessee, and Utah, as well as ethical framework for pandemic preparedness that public health practitioners, researchers, and students, ethics consultants, healthcare workers, and policy makers may find useful.
Annotation: Angela Lee-Winn.
Nuffield Council of Bioethics; March 26, 2020.
This document is an opinion piece by a British lawyer who is hoping to convince colleagues in the Nuffield Council on Bioethics that individual liberty (freedom from government interference) must yield to social or public health ethical and policy considerations in the face of this pandemic. The author articulates the view that we all are part of a society struggling for collective survival and, therefore, must concede unfettered individual liberty to the good of the whole in accepting some constraints, for example, lockdown. This is a useful resource to reinforce social ethics of collective action in contrast to each individual acting on personal behalf.
Annotation: Don Parsons
Nuffield Council on Bioethics; March 17, 2020.
This Rapid Policy Briefing is dated 3.17.2020, which means it is not fully current on the significant changes in UK policy that the government initiated in the ensuing weeks (including full stay-at-home orders). Nevertheless, it highlights values central to effective public health responses (trust and solidarity), and focuses much more on public health interventions than questions of clinical care and triage ethics. The discussion on solidarity is especially important and is developed more in this policy briefing than in many other ethics resources I have seen specifically focused on COVID19.
Annotation: Daniel Goldberg