Thomas J Papadimos1,2, Evadne G Marcolini3, Mehrnaz Hadian4, George E Hardart5, Nicholas Ward6, Mitchell M Levy6, Stanislaw P Stawicki7, Judy E Davidson8. 1. Division of Critical Care, Department of Anesthesiology, University of Toledo College of Medicine and Life Sciences, Toledo, OH. 2. 2nd Department of Anesthesiology, University of Athens, Athens, Greece. 3. Department of Emergency Medicine, Critical Care Education for Emergency Medicine, Neurological Critical Care Fellowship, University of Vermont Larner College of Medicine, Burlington, VT. 4. Department of Medicine, Institute for Public Information in Research and Education in Critical Care Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA. 5. Division of Pediatric Critical Care, Department of Pediatrics, Center for Bioethics, Program in Women and Children's Bioethics, Columbia University College of Physicians and Surgeons, New York, NY. 6. Division of Critical Care, Pulmonary, and Sleep Medicine, Department of Medicine, Warren Alpert Medical School, Brown University, Providence, RI. 7. Departments of Research and Innovation and Surgery, St. Luke's University Heath Network, Bethlehem, PA. 8. Nurse Scientist, Education, Development and Research, University of California San Diego Health System, San Diego, CA.
Abstract
OBJECTIVES: Outbreaks of disease, especially those that are declared a Public Health Emergency of International Concern, present substantial ethical challenges. Here we start a discourse (with a continuation of the dialogue in Ethics of Outbreaks Position Statement. Part 2: Family-Centered Care) concerning the ethics of the provision of medical care, research challenges and behaviors during a Public Health Emergency of International Concern with a focus on the proper conduct of clinical or epidemiologic research, clinical trial designs, unregistered medical interventions (including vaccine introduction, devices, pharmaceuticals, who gets treated, vulnerable populations, and methods of data collection), economic losses, and whether there is a duty of health care providers to provide care in such emergencies, and highlighting the need to understand cultural diversity and local communities in these efforts. DESIGN: Development of a Society of Critical Care Medicine position statement using literature review and expert consensus from the Society of Critical Care Medicine Ethics committee. The committee had representation from ethics, medical philosophy, critical care, nursing, internal medicine, emergency medicine, pediatrics, anesthesiology, surgery, and members with international health and military experience. SETTING: Provision of therapies for patients who are critically ill or who have the potential of becoming critically ill, and their families, regarding medical therapies and the extent of treatments. POPULATION: Critically ill patients and their families affected by a Public Health Emergency of International Concern that need provision of medical therapies. INTERVENTIONS: Not applicable. MAIN RESULTS: Interventions by high income countries in a Public Health Emergency of International Concern must always be cognizant of avoiding a paternalistic stance and must understand how families and communities are structured and the regional/local traditions that affect public discourse. Additionally, the obligations, or the lack of obligations, of healthcare providers regarding the treatment of affected individuals and communities must also be acknowledged. Herein, we review such matters and suggest recommendations regarding the ethics of engagement in an outbreak that is a Public Health Emergency of International Concern.
OBJECTIVES: Outbreaks of disease, especially those that are declared a Public Health Emergency of International Concern, present substantial ethical challenges. Here we start a discourse (with a continuation of the dialogue in Ethics of Outbreaks Position Statement. Part 2: Family-Centered Care) concerning the ethics of the provision of medical care, research challenges and behaviors during a Public Health Emergency of International Concern with a focus on the proper conduct of clinical or epidemiologic research, clinical trial designs, unregistered medical interventions (including vaccine introduction, devices, pharmaceuticals, who gets treated, vulnerable populations, and methods of data collection), economic losses, and whether there is a duty of health care providers to provide care in such emergencies, and highlighting the need to understand cultural diversity and local communities in these efforts. DESIGN: Development of a Society of Critical Care Medicine position statement using literature review and expert consensus from the Society of Critical Care Medicine Ethics committee. The committee had representation from ethics, medical philosophy, critical care, nursing, internal medicine, emergency medicine, pediatrics, anesthesiology, surgery, and members with international health and military experience. SETTING: Provision of therapies for patients who are critically ill or who have the potential of becoming critically ill, and their families, regarding medical therapies and the extent of treatments. POPULATION: Critically illpatients and their families affected by a Public Health Emergency of International Concern that need provision of medical therapies. INTERVENTIONS: Not applicable. MAIN RESULTS: Interventions by high income countries in a Public Health Emergency of International Concern must always be cognizant of avoiding a paternalistic stance and must understand how families and communities are structured and the regional/local traditions that affect public discourse. Additionally, the obligations, or the lack of obligations, of healthcare providers regarding the treatment of affected individuals and communities must also be acknowledged. Herein, we review such matters and suggest recommendations regarding the ethics of engagement in an outbreak that is a Public Health Emergency of International Concern.
Authors: Stanislaw P Stawicki; Rebecca Jeanmonod; Andrew C Miller; Lorenzo Paladino; David F Gaieski; Anna Q Yaffee; Annelies De Wulf; Joydeep Grover; Thomas J Papadimos; Christina Bloem; Sagar C Galwankar; Vivek Chauhan; Michael S Firstenberg; Salvatore Di Somma; Donald Jeanmonod; Sona M Garg; Veronica Tucci; Harry L Anderson; Lateef Fatimah; Tamara J Worlton; Siddharth P Dubhashi; Krystal S Glaze; Sagar Sinha; Ijeoma Nnodim Opara; Vikas Yellapu; Dhanashree Kelkar; Ayman El-Menyar; Vimal Krishnan; S Venkataramanaiah; Yan Leyfman; Hassan Ali Saoud Al Thani; Prabath Wb Nanayakkara; Sudip Nanda; Eric Cioè-Peña; Indrani Sardesai; Shruti Chandra; Aruna Munasinghe; Vibha Dutta; Silvana Teixeira Dal Ponte; Ricardo Izurieta; Juan A Asensio; Manish Garg Journal: J Glob Infect Dis Date: 2020-05-22
Authors: Ajay K Gupta; Hani Jneid; Daniel Addison; Hossein Ardehali; Amelia K Boehme; Sanket Borgaonkar; Romain Boulestreau; Kevin Clerkin; Nicolas Delarche; Holli A DeVon; Isabella M Grumbach; Jose Gutierrez; Daniel A Jones; Vikas Kapil; Carmela Maniero; Amgad Mentias; Pamela S Miller; Sher May Ng; Jai D Parekh; Reynaldo H Sanchez; Konrad Teodor Sawicki; Anneline S J M Te Riele; Carol Ann Remme; Barry London Journal: J Am Heart Assoc Date: 2020-04-29 Impact factor: 5.501
Authors: Michael R Ehmann; Elizabeth K Zink; Amanda B Levin; Jose I Suarez; Harolyn M E Belcher; Elizabeth L Daugherty Biddison; Danielle J Doberman; Karen D'Souza; Derek M Fine; Brian T Garibaldi; Eric A Gehrie; Sherita H Golden; Ayse P Gurses; Peter M Hill; Mark T Hughes; Jeffrey Kahn; Colleen G Koch; Jason J Marx; Barry R Meisenberg; Jeffrey Natterman; Cynda H Rushton; Adam Sapirstein; Stephen R Selinger; R Scott Stephens; Eric S Toner; Yoram Unguru; Maureen van Stone; Allen Kachalia Journal: Chest Date: 2020-09-28 Impact factor: 9.410