Guiding Cardiac Care During the COVID-19 Pandemic: How Ethics Shapes Our Health System Response

Abstract

The COVID-19 pandemic has raised ethical questions for the cardiovascular leader and practitioner. Attention has been redirected from a system that focuses on individual patient benefit toward one that focuses on protecting society as a whole. Challenging resource allocation questions highlight the need for a clearly articulated ethics framework that integrates principled decision making into how different cardiovascular care services are prioritized. A practical application of the principles of harm minimisation, fairness, proportionality, respect, reciprocity, flexibility, and procedural justice is provided, and a model for prioritisation of the restoration of cardiovascular services is outlined. The prioritisation model may be used to determine how and when cardiovascular services should be continued or restored. There

Decision making by health professionals during COVID-19: an integrative review

“…Reflection articles were the most common design (94.44%) (2,(4)(5)(6)(8)(9)(10)(11)(13)(14)(15)(16)(21)(22)(23)(24)(25) , followed by descriptive qualitative studies (5.56%) (26) . Most articles were published in English (94.74%) (2,(4)(5)(6)(9)(10)(11)(13)(14)(15)(24)(25)(26) , in journals from the medical (55.60%) (2,4,8,11,(13)(14)(15)(16)22,25) , ethical (33.30%) (5)(6)10,21,24,26) , and public health fields (11.10%) (9,23) . The BVS was the portal with the highest number of articles (73.68%) (2,…”

“…Most articles were published in English (94.74%) (2,(4)(5)(6)(9)(10)(11)(13)(14)(15)(24)(25)(26) , in journals from the medical (55.60%) (2,4,8,11,(13)(14)(15)(16)22,25) , ethical (33.30%) (5)(6)10,21,24,26) , and public health fields (11.10%) (9,23) . The BVS was the portal with the highest number of articles (73.68%) (2,(4)(5)8,10,(13)(14)16,21,26) , followed by ScienceDirect (15.79%) (9,15,25) , and MEDLINE (10.53%) (6,11) .…”

“…Eight studies were carried out in North America (seven in the United States of America and one in Canada) (2,(8)(9)13,(15)(16)23,25) , seven in Europe (two in Spain, two in Italy, two in the United Kingdom, and one in Belgium) (5,(10)(11)14,22,24,26) , two in Asia (one in Israel and one in Nepal) (4,6) , and one involved researchers from both Europe and Asia (21) . There were no studies in South America.…”

“…Since the morbimortality is higher among elders, should I prioritize younger patients to the detriment of older ones (12) ? When attending two patients who need mechanical ventilation, if there is only one ventilator, which patient to choose (11,13) ? In the absence of adequate personal protective equipment (PPE), do I have the moral obligation and the professional duty to provide assistance (9,13) ?…”

“…When attending two patients who need mechanical ventilation, if there is only one ventilator, which patient to choose (11,13) ? In the absence of adequate personal protective equipment (PPE), do I have the moral obligation and the professional duty to provide assistance (9,13) ? How should patients be admitted to Intensive Care Units (ICUs) during a pandemic (11,14) ?…”