Ethical challenges arising in the COVID-19 pandemic: An overview from the Association of Bioethics Program Directors (ABPD) task force
Public Health; decision-making; health care delivery; health policy; end-of-life issues; rationing/resource allocation
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.
McGuire AL;Aulisio M P;Davis FD;Erwin C;Harter TD;Jagsi R;Klitzman R;Macauley R;Racine E;Wolf SM;Wynia M;Wolpe PR;The COVID-19 Task Force of the Association of Bioethics Program Directors (ABPD)
The American Journal of Bioethics
2020
2020-07-02
journalArticle
<a href="http://doi.org/10.1080/15265161.2020.1764138" target="_blank" rel="noreferrer noopener">10.1080/15265161.2020.1764138</a>
Geriatric emergency medicine and the 2006 Institute of Medicine reports from the Committee on the Future of Emergency Care in the U.S. Health System.
Aged; United States; Outpatients; Emergency Medicine; Health Services Needs and Demand; Health Policy; Nursing Homes; Disaster Planning; Inpatients; Drugs; Health Care Delivery; Institute of Medicine (U.S.); Subacute Care; Prehospital Care; 80 and Over; Emergency Care – Trends – In Old Age; Emergency Service – Trends; Health Services for the Aged – Trends
Three recently published Institute of Medicine reports, Hospital-Based Emergency Care: At the Breaking Point, Emergency Medical Services: At the Crossroads, and Emergency Care for Children: Growing Pains, examined the current state of emergency care in the United States. They concluded that the emergency medicine system as a whole is overburdened, underfunded, and highly fragmented. These reports did not specifically discuss the effect the aging population has on emergency care now and in the future and did not discuss special needs of older patients. This report focuses on the emergency care of older patients, with the intent to provide information that will help shape discussions on this issue.
Wilber S T; Gerson L W; Terrell KM; Carpenter CR; Shah MN; Heard K; Hwang U
Academic Emergency Medicine
2006
2006-12
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1197/j.aem.2006.09.050" target="_blank" rel="noreferrer noopener">10.1197/j.aem.2006.09.050</a>
The After Discharge Care Management of Low Income Frail Elderly (AD-LIFE) Randomized Trial: Theoretical Framework and Study Design.
Aged; Frail Elderly; Study Design; Conceptual Framework; Health Care Delivery; Transitional Programs; Models; Theoretical; Treatment Outcomes; Multidisciplinary Care Team; Medical Practice; Poverty; 80 and Over; Evidence-Based; Chronic Disease – Therapy; After Care – Methods; Disease Management – Methods; Integrated – Methods; Randomized Controlled Trials – Evaluation
Interdisciplinary care management is advocated for optimal care of patients with many types of chronic illnesses; however, few models exist that have been tested using randomized trials. The purpose of this report is to describe the theoretical basis for the After Discharge Management of Low Income Frail Elderly (AD-LIFE) trial, which is an ongoing 2-group randomized trial (total n = 530) to test a chronic illness management and transitional care intervention. The intervention is based on Wagner's chronic illness care model and involves comprehensive posthospitalization nurse-led interdisciplinary care management for low income frail elders with chronic illnesses, employs evidence-based protocols that were developed using the Assessing Care of Vulnerable Elders (ACOVE) guidelines, emphasizes patient activation, and integrates with community-based long-term care and other community agencies. The primary aim of the AD-LIFE trial is to test a chronic illness management intervention in vulnerable patients who are eligible for Medicare and Medicaid. This model, with its standardized, evidence-based medical and psychosocial intervention protocols, will be easily transportable to other sites interested in optimizing outcomes for chronically ill older adults. If the results of the AD-LIFE trial demonstrate the superiority of the intervention, then this data will be important for health care policy makers. ( Population Health Management 2011;14:137-142)
Allen Kyle R; Hazelett Susan E; Jarjoura David; Wright Kathy; Fosnight Susan M; Kropp Denise J; Hua Keding; Pfister Eugene W
Population Health Management
2011
2011-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1089/pop.2010.0016" target="_blank" rel="noreferrer noopener">10.1089/pop.2010.0016</a>
Behavioral Health and Primary Care Integration in Ohio's Psychiatry Residency Training.
*Internship and Residency; Delivery of Health Care; Education; Graduate; Health Care Delivery; Humans; Integrated; Internship and Residency; Medical; Mental Health Services – Administration; Mental Health Services/*organization & administration; Ohio; Physician's Role; Primary Health Care – Administration; Primary Health Care/*organization & administration; Psychiatry; Psychiatry – Education; Psychiatry/*education/organization & administration; Qualitative Research; Qualitative Studies; Referral and Consultation
Reed Eric; Crane Dushka; Svendsen Dale; Herman Lon; Evans Brian; Niedermier Julie; Resch William; Ronis Robert; Varley Joseph; Welton Randy
Academic psychiatry : the journal of the American Association of Directors of Psychiatric Residency Training and the Association for Academic Psychiatry
2016
2016-12
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1007/s40596-016-0623-y" target="_blank" rel="noreferrer noopener">10.1007/s40596-016-0623-y</a>
Translating Interventions that Target Criminogenic Risk Factors for use in Community Based Mental Health Settings.
*Community mental health services; *Criminal justice involvement; *Criminal Law; *Intervention research; Community Mental Health Services – Administration; Community Mental Health Services/*organization & administration; Crime – Prevention and Control; Criminology; Female; Focus Groups; Health Care Delivery; Human; Humans; Male; Mental Disorders; Mental Disorders/*psychology; Mentally Ill Persons/*psychology; Qualitative Research; Risk Factors; Staff Development
This study explored facilitators and barriers associated with engaging criminogenic interventions in community mental health service settings. Focus groups and guided large group discussions were conducted with 46 consumers, providers and administrators. Results suggest that participants were generally supportive of offering criminogenic interventions to justice involved persons with serious mental illness in community based mental health service settings. Key issues to consider when engaging criminogenic interventions in community mental health service settings include identifying sustainable funding sources, providing adequate training for staff, and tailoring the delivery and pace of the content to the particular treatment needs of SMI participants.
Wilson Amy Blank; Bonfine Natalie; Farkas Kathleen J; Duda-Banwar Janelle
Community mental health journal
2017
2017-11
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1007/s10597-017-0119-6" target="_blank" rel="noreferrer noopener">10.1007/s10597-017-0119-6</a>