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Coronaviruses

Editor-in-Chief

ISSN (Print): 2666-7967
ISSN (Online): 2666-7975

Systematic Review Article

Ethical Challenges at the Time of the COVID-19 Pandemic – A Systematic Review

Author(s): Pugazhenthan Thangaraju* and Hemasri Velmurugan

Volume 4, Issue 2, 2023

Published on: 22 August, 2023

Article ID: e150823219730 Pages: 10

DOI: 10.2174/2666796704666230815142955

Price: $65

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Abstract

Background: The worldwide COVID-19 pandemic has resulted in an unprecedented influx of patients in hospitals, raising ethical concerns not just about triage and life-support decisions but also about family visits and the quality of end-of-life care. The value of ethics in the public healthcare system cannot be overstated; nonetheless, the ethics-related problems (or issues) identified during this epidemic have been linked to a lack of accountability, resource allocation challenges, and a loss of trust in healthcare providers. These elements have the ability to shake our ethical ideas, exacerbate ethical dilemmas, and put carers in dangerous situations.

Objectives: To determine the prevalence and distribution of ethical principles in COVID-19-related research publications.

Methods: The keywords were used to check the articles published on ethics-related problems at the time of the COVID-19 pandemic, published between January 1, 2021, and August 31, 2022. Secondly, we aimed to identify the prevalence and distribution of these ethical principles in research publications related to COVID-19.

Results: A total of 6152 articles were identified; 2816 were included for abstract and title screening. Of the 159 articles, 134 were excluded based on the inclusion and exclusion criteria. The remaining 25 articles were scrutinised extensively. There were 17 (68%) literature reviews, 5 (20%) systematic reviews, 1 (4%) integrative review, 1 (4%) cross-sectional study, and 1 (4%) observational study.

Conclusion: It is evident from the multitude of papers on the issue that medical ethical challenges, as well as ethical discussions and debates, continue to develop virtually every day. We attempted to portray the COVID-19 whirlpool, encompassing the scope, nature, and urgency of the issues that developed in a highly charged political atmosphere. There have been efforts to use ethical considerations to justify triage procedures. An imbalance between utilitarian and individual ethics, regardless of perspective, leads to insoluble discomforts that carers must overcome.

Graphical Abstract

[1]
Kooli C. COVID-19: Public health issues and ethical dilemmas. Ethics Med Public Health 2021; 17: 100635.
[http://dx.doi.org/10.1016/j.jemep.2021.100635] [PMID: 33553555]
[2]
Kasherman L, Madariaga A, Liu Q, et al. Ethical frameworks in clinical research processes during COVID-19: A scoping review. BMJ Open 2021; 11(7): e047076.
[http://dx.doi.org/10.1136/bmjopen-2020-047076]
[3]
Aliyu AA. Public health ethics and the COVID-19 pandemic. Ann Afr Med 2021; 20(3): 157-63.
[PMID: 34558443]
[4]
OSullivan L, Killeen RP, Doran P, et al. Adherence with reporting of ethical standards in COVID-19 human studies: A rapid review. BMC Med Ethics 2021; 22(1): 80.
[http://dx.doi.org/10.1186/s12910-021-00649-9]
[5]
Working Group Ethics: Public Health Ethics and COVID-19. Available from: https://public-health-covid-19.de/ (Last accessed on -2020 Jun 30)
[6]
Dawson A, Jennings B. The place of solidarity in public health ethics. Public Health Rev 2012; 34(1): 4.
[http://dx.doi.org/10.1007/BF03391656]
[7]
Bayer R, Fairchild AL. The genesis of public health ethics. Bioethics 2004; 18(6): 473-92.
[http://dx.doi.org/10.1111/j.1467-8519.2004.00412.x] [PMID: 15580720]
[8]
Kapiriri L, Ross A. The politics of disease epidemics: A comparative analysis of the SARS, Zika, and Ebola outbreaks. Glob Soc Welf 2020; 7(1): 33-45.
[http://dx.doi.org/10.1007/s40609-018-0123-y] [PMID: 32226719]
[9]
Varkey B. Principles of clinical ethics and their application to practice. Med Princ Pract 2021; 30(1): 17-28.
[http://dx.doi.org/10.1159/000509119] [PMID: 32498071]
[10]
Beauchamp TL, Childress JF. Principles of Biomedical Ethics. (8th ed.), New York: Oxford University Press 2019.
[11]
Childress JF, Beauchamp TL. Principles of Biomedical Ethics. (7th ed.), England: Oxford University Press 2003.
[12]
Mark A, Choffnes ER, Sparling PF, Hamburg MA, Leman SM. Ethical and legal considerations in mitigating pandemic disease: Workshop summary. Washington, DC: National Academic Press 2007.
[13]
Selgelid MJ. Pandethics. Public Health 2009; 123(3): 255-9.
[http://dx.doi.org/10.1016/j.puhe.2008.12.005] [PMID: 19223051]
[14]
Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. Syst Rev 2021; 10(1): 89.
[http://dx.doi.org/10.1186/s13643-021-01626-4]
[15]
Dal-Ré R, Becker SL, Bottieau E, Holm S. Availability of oral antivirals against SARS-CoV-2 infection and the requirement for an ethical prescribing approach. Lancet Infect Dis 2022; 22(8): e231-8.
[http://dx.doi.org/10.1016/S1473-3099(22)00119-0] [PMID: 35364019]
[16]
Macip S, Yuguero O. Individual freedom in the initial response to COVID-19. Front Public Health 2022; 10: 765016.
[http://dx.doi.org/10.3389/fpubh.2022.765016]
[17]
Seyferth AV, Wood SM, Kane RL, Chung KC. Representation of ethics in COVID-19 research: A systematic review. Plast Reconstr Surg 2022; 149(5): 1237-44.
[http://dx.doi.org/10.1097/PRS.0000000000009027] [PMID: 35311803]
[18]
Hall G, Ozemek C, Argüelles L, Shaw S, Davis D. It still takes a village: Advocating healthy living medicine for communities through social justice action. Prog Cardiovasc Dis 2022; 71: 58-63.
[http://dx.doi.org/10.1016/j.pcad.2022.04.014] [PMID: 35533794]
[19]
Salmond S, Dorsen C. Time to reflect and take action on health disparities and health inequities. Orthop Nurs 2022; 41(2): 64-85.
[http://dx.doi.org/10.1097/NOR.0000000000000828] [PMID: 35358124]
[20]
Cipriani G, Di Fiorino M, Cammisuli DM. Dementia in the era of COVID ‐19. Some considerations and ethical issues. Psychogeriatrics 2022; 22(1): 132-6.
[http://dx.doi.org/10.1111/psyg.12773] [PMID: 34775670]
[21]
Suwalowska H, Amara F, Roberts N, Kingori P. Ethical and sociocultural challenges in managing dead bodies during epidemics and natural disasters. BMJ Glob Health 2021; 6(11): e006345.
[http://dx.doi.org/10.1136/bmjgh-2021-006345] [PMID: 34740913]
[22]
Antoniou R, Romero-Kornblum H, Young JC, You M, Kramer JH, Chiong W. Reduced utilitarian willingness to violate personal rights during the COVID-19 pandemic. PLoS One 2021; 16(10): e0259110.
[http://dx.doi.org/10.1371/journal.pone.0259110]
[23]
Ibrahim B, Dawson R, Chandler JA, et al. The COVID-19 pandemic and organ donation and transplantation: Ethical issues. BMC Med Ethics 2021; 22(1): 142.
[http://dx.doi.org/10.1186/s12910-021-00711-6]
[24]
Valente CO, Silva FRD, Mussi FC, Lacerda MR, Freitas KS, Rosa DOS. Decision making by health professionals during COVID-19: An integrative review. Rev Bras Enferm 2021; 75(S1): e20210067.
[25]
Christofidou M, Lea N, Coorevits P. A literature review on the GDPR, COVID-19 and the ethical considerations of data protection during a time of crisis. Yearb Med Inform 2021; 30(1): 226-32.
[http://dx.doi.org/10.1055/s-0041-1726512] [PMID: 34479394]
[26]
Munir MA, Tandiabang PA, Setyawati T, Basry A, Cyio AD, Rahman N. Bioethical perspective of convalescent plasma therapy for COVID-19: A systematic review. Transfus Clin Biol 2021; 28(3): 271-5.
[http://dx.doi.org/10.1016/j.tracli.2021.03.005] [PMID: 33839300]
[27]
Cleveland Manchanda EC, Sanky C, Appel JM. Crisis standards of care in the USA: A systematic review and implications for equity amidst COVID-19. J Racial Ethn Health Disparities 2021; 8(4): 824-36.
[http://dx.doi.org/10.1007/s40615-020-00840-5] [PMID: 32789816]
[28]
Guaracha-Basanez GA, Contreras-Yáñez I, Hernández-Molina G, et al. Clinical and bioethical implications of health care interruption during the COVID-19 pandemic: A cross-sectional study in outpatients with rheumatic diseases. PLoS One 2021; 16(7): e0253718.
[http://dx.doi.org/10.1371/journal.pone.0253718]
[29]
Jacobsen AP, Robledo-Gil T, Nahas-Vigon JH, Epstein JA, Berger ZD, Sufrin CB. Care for Incarcerated Patients Hospitalized with COVID-19. J Gen Intern Med 2021; 36(7): 2094-9.
[http://dx.doi.org/10.1007/s11606-021-06861-y] [PMID: 33954889]
[30]
Hansson SO, Helgesson G, Juth N. Who should be tested in a pandemic? Ethical considerations. BMC Med Ethics 2021; 22(1): 76.
[http://dx.doi.org/10.1186/s12910-021-00640-4]
[31]
Hill L, Lambrinou E, Moser DK, Beattie JM. The COVID-19 pandemic: Challenges in providing supportive care to those with cardiovascular disease in a time of plague. Curr Opin Support Palliat Care 2021; 15(2): 147-53.
[http://dx.doi.org/10.1097/SPC.0000000000000552] [PMID: 33843761]
[32]
Sultan H, Mansour R, Shamieh O, Al-Tabba’ A, Al-Hussaini M. DNR and COVID-19: The ethical dilemma and suggested solutions. Front Public Health 2021; 9: 560405.
[http://dx.doi.org/10.3389/fpubh.2021.560405]
[33]
Gambino F, Petrini C, Riva L. Criteria for allocation of life-saving resources during the SARS-COV-2 pandemic: Ethical implications and aspects of legal liability. Ann Ist Super Sanita 2021; 57(2): 113-20.
[http://dx.doi.org/10.4415/ANN_21_02_01] [PMID: 34132207]
[34]
Tyrrell CSB, Mytton OT, Gentry SV, et al. Managing intensive care admissions when there are not enough beds during the COVID-19 pandemic: A systematic review. Thorax 2021; 76(3): 302-12.
[http://dx.doi.org/10.1136/thoraxjnl-2020-215518] [PMID: 33334908]
[35]
Chaimowitz GA, Upfold C, Géa LP, et al. Stigmatization of psychiatric and justice-involved populations during the COVID-19 pandemic. Prog Neuropsychopharmacol Biol Psychiatry 2021; 106: 110150.
[http://dx.doi.org/10.1016/j.pnpbp.2020.110150] [PMID: 33098908]
[36]
Tabary M, Abolhasani R, Araghi F, Aryannejad A, Safarpour Lima B. Ethical considerations in neurology during the COVID-19 pandemic. Neurol Sci 2021; 42(2): 437-44.
[http://dx.doi.org/10.1007/s10072-020-05032-x] [PMID: 33389228]
[37]
Murugappan KR, Walsh DP, Mittel A, Sontag D, Shaefi S. Veno-venous extracorporeal membrane oxygenation allocation in the COVID-19 pandemic. J Crit Care 2021; 61: 221-6.
[http://dx.doi.org/10.1016/j.jcrc.2020.11.004] [PMID: 33220575]
[38]
Kute V, Ramesh V, Shroff S, et al. Benefit to few versus risk to many: An ethical dilemma during coronavirus disease 2019 pandemic for deceased-donor organ transplant in a resource-limited developing country. Exp Clin Transplant 2021; 19(1): 1-7.
[http://dx.doi.org/10.6002/ect.2020.0134] [PMID: 32778012]
[39]
Netters S, Dekker N, van de Wetering K, et al. Pandemic ICU triage challenge and medical ethics. BMJ Support Palliat Care 2021; 11(2): 133-7.
[http://dx.doi.org/10.1136/bmjspcare-2020-002793] [PMID: 33541855]
[40]
Luce JM, White DB. A history of ethics and law in the intensive care unit. Crit Care Clin 2009; 25(1): 221-37. x.
[http://dx.doi.org/10.1016/j.ccc.2008.10.002] [PMID: 19268804]
[41]
Fiscella K, Franks P, Doescher MP, Saver BG. Disparities in health care by race, ethnicity, and language among the insured: Findings from a national sample. Med Care 2002; 40(1): 52-9.
[http://dx.doi.org/10.1097/00005650-200201000-00007] [PMID: 11748426]
[42]
Savulescu J, Vergano M, Craxì L, Wilkinson D. An ethical algorithm for rationing life-sustaining treatment during the COVID-19 pandemic. Br J Anaesth 2020; 125(3): 253-8.
[http://dx.doi.org/10.1016/j.bja.2020.05.028] [PMID: 32560912]
[43]
Doldi M, Moscatelli A, Ravelli A, Spiazzi R, Petralia P. Medicine and humanism in the time of COVID-19. Ethical choices. Acta Biomed 2020; 91(4): e2020167.
[PMID: 33525224]
[44]
Ruiz-Hornillos J, Hernández Suárez P, Marín Martínez JM, et al. Bioethical concerns during the COVID-19 pandemic: What did healthcare ethics committees and institutions state in spain? Front Public Health 2021; 9: 737755.
[http://dx.doi.org/10.3389/fpubh.2021.737755] [PMID: 34722445]
[45]
dos Santos JLG, Stein Messetti PA, Adami F, et al. Collision of fundamental human rights and the right to health access during the novel coronavirus pandemic. Front Public Health 2021; 8: 570243.
[http://dx.doi.org/10.3389/fpubh.2020.570243] [PMID: 33490011]

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