Public Health

Pandemic Ethics: Key Workers Have a Stronger Claim to Compensation and Hazard Pay for Working During The COVID-19 Pandemic Than The Armed Forces Do When on Deployment

By Doug McConnell and Dominic Wilkinson

Post originally appeared on the Journal of Medical Ethics Blog

 

While the general public enjoy the relative safety of social distancing, key workers are at a higher risk of both contracting COVID-19 and transmitting it to their families. This is especially the case for ‘frontline’ workers who are frequently exposed to the virus and may not have access to adequate personal protective equipment (PPE). Tragically, many key workers have died of COVID-19 around the world already, including over 100 in the UK.

Although it is relatively rare for key workers to die from COVID-19, the risk of death is obviously much greater than one would usually expect in these roles and key workers clearly have good reason to be anxious. For ‘frontline’ workers, the distress is compounded by working in harrowing conditions where so many are dying alone. Furthermore, frontline workers have to take on the burdens of ensuring they do not transmit infections to their families, by moving in with patients, living in hotels, or maintaining rigorous social distancing in their own homes.

These atypical costs, risks, and burdens suggest that key workers are owed compensation in addition to their usual pay and a few instances of nationally coordinated applause. Continue reading

Maximising Ventilators: Some Ethical Complications

Written by Joshua Parker and Ben Davies

One of the impending tragedies of the COVID-19 pandemic is a grave mismatch between the supply of ventilators and the numbers needing them. This situation, as seen in Italy, is predicted to be mirrored here in the UK. Coronavirus can cause acute respiratory distress syndrome for which the management is mechanical ventilation on the ICU. This represents these patients’ only chance at survival. Part of the response to the incoming tsunami of patients requiring ventilation is to produce more ventilators. This is a reasonable way to try to lessen the mismatch between supply and demand. However, producing more ventilators cannot be the solution in isolation. As a complex piece of medical equipment, ventilators need trained staff to operate them and provide the additional care ventilated patients require. There has been a significant push to attempt to ensure enough ventilator trained staff as possible. Both staff and ventilator shortages present significant issues; yet it is shortages of ventilators that account for the bulk of ethical discussion so far. It is therefore worth exploring some of the ethical problems that might arise should there be plenty of ventilators, but not enough staff.

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The Perfect Protocol? Ethics Guidelines in a Pandemic

Written by Joshua Parker and Ben Davies

One question occupying politicians and healthcare workers in the middle of this global pandemic is whether there will be enough ventilators when COVID-19 reaches its peak. As cases in the UK continue to increase, so too will demand for ventilators; Italy has reported overwhelming demand for the equipment and the need to ration access, and the UK will likely face similar dilemmas. Indeed, one UK consultant has predicted a scenario of having 8 patients for every one ventilator. Aside from anything else, this would be truly awful for the healthcare professionals having to make such decisions and live with the consequences.

Ethics is an inescapable part of medical practice, and healthcare professionals face numerous ethical decisions throughout their careers. But ethics is challenging, often involving great uncertainty and ambiguity. Medics often lack the time to sort through the morass that is ethics.  Many therefore prefer heuristics, toolboxes and a handful of principles to simplify, speed up and streamline their ethics.

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Irresponsible Parents, Religious Beliefs, and Coercion. What the Rockland County Measles Outbreak Response Teaches Us About Vaccination Policies

Written by Alberto Giubilini

Oxford Martin School, Wellcome Centre for Ethics and Humanities, University of Oxford

 

Following a measles outbreak, Rockland County in New York has enforced a 30 day emergency measure that involves barring unvaccinated children and teenagers from any public place (not just schools, but also restaurants, shopping centres, places of worship, and so on). Parents face up to 6 months in jail and/or a $500 fine if they are found to have allowed their unvaccinated children in public spaces. In fact, this measure resembles quite closely a form of quarantine. Some might think this kind of policy is too extreme. However, I think the problem is that the measure is not extreme enough. It is necessary and justified given the state of emergency, but it is not sufficient as a vaccination policy. Parents can still decide not to vaccinate their children and keep them at home for the 30 days the order will last. Thus, the policy still gives some freedom to parents, who are responsible for the situation, and this freedom comes at the cost of penalizing the children, who are not responsible. We need to contain and to prevent measles cases and measles outbreaks by forcing parents to vaccinate their children, not simply by preventing children from leaving their homes when emergencies arise. Continue reading

Video Interview: Alberto Giubilini on the Ethics of Vaccination

Why do some people refuse to have their child vaccinated? Are there any good reasons not to vaccinate one’s child? Why should one have one’s child vaccinated if this doesn’t make a difference to whether the community is protected? Why is vaccinating one’s child an ethical issue? In this interview with Dr Katrien Devolder, Dr Alberto Giubilini (Philosophy, Oxford) discusses these and other questions, which he addresses in his new book ‘The Ethics of Vaccination’ (downloadable for free).

In Defence of Impulsivity

Written by Dr Rebecca Brown

It has become commonplace to identify a lack of impulse control as a major cause of poor health. A popular theory within behavioural science tells us that our behaviour is regulated via two systems: the fast, impulsive system 1 (the ‘impulsive’ or ‘automatic’ system) and the slower, deliberative system 2 (the ‘reflective’ system). Much of our behaviour is routine and repeated in similar ways in similar contexts: making coffee in the morning, travelling to work, checking our email. Such behaviours develop into habits, and we are able to successfully perform them with minimal conscious input and cognitive effort. This is because they come under the control of our impulsive system.

Habits have become a focus of health promoters. It seems that many of these routine, repeated behaviours actually have a significant impact on our health over a lifetime: what we eat and drink and how active we are can affect our risk of developing chronic diseases like type II diabetes, heart disease, lung disease and cancer. Despite considerable efforts to educate people as to the risks of eating too much, exercising to little, smoking and drinking, many people continue to engage in such unhealthy habits. One reason for this, it is proposed, is people’s limited ability to exert conscious (reflective) control over their habitual (impulsive) behaviour.

Given this, one might think that it would be preferable if people were generally able to exhibit more reflective control; that behaviour was less frequently determined by impulsive processes and more frequently determined by reflective deliberation. Perhaps this could form part of the basis for advising people to be more ‘mindful’ in their everyday activities, such as eating, and regimes for training one’s willpower ‘muscle’ to ensure confident conscious control over one’s behaviour. Continue reading

Video Series: Should We Pay People to Quit Smoking or Lose Weight?

Should we pay people to quit smoking or lose weight? Would paying them amount to coercion?  Is there a risk that if we start paying for healthy behaviour, its value will be corrupted? Is paying unhealthy people unfair to those who already lead healthy life styles? In this video interview (with Katrien Devolder),  Dr Rebecca Brown from the Oxford Uehiro Centre for Practical Ethics responds to these and other concerns and defends the use of financial incentives as a tool for health promotion.

Video Series: Tom Douglas on Asbestos, a Serious Public Health Threat

Asbestos kills more people per year than excessive sun exposure, yet it receives much less attention. Tom Douglas (Oxford Uehiro Centre for Practical Ethics) explains why asbestos is still a serious public health threat and what steps should be undertaken to reduce this threat. And yes, the snow in The Wizard of Oz was asbestos!

Asbestos neglect

Written by Tom Douglas

This is an unedited version of an article originally published by The Conversation

 

‘Calais Jungle Camp littered with asbestos’, ‘Buckingham Palace could be vacated to remove asbestos’, ‘Safety concerns for refugees and workers as Nauru asbestos removal program kicks off’.

Headlines such as these occur with monotonous regularity. Widespread asbestos use throughout much of the 20th century has ensured that the next contamination scandal is never far off, and asbestos-related legal decisions and personal tragedies often make the news as well. But despite the ongoing media attention, asbestos has not captured the public imagination as a public health threat, at least, not in comparison to other comparable threats like excessive sun exposure and drink driving.

Asbestos is a versatile fibrous mineral that can be cheaply mined and has unusual fire resistance and durability. Its use exploded in the twentieth century, when it was included in such diverse products as automobile brake linings, pipe insulation, ceiling and floor tiles, textured paints, concrete, mattresses, electric blankets, heaters, ironing boards and even piano felts. There is no safe threshold for exposure to asbestos dust, with even single exposures having been linked to cancer. Rates of asbestos-related cancer have recently been on the rise in Europe and Japan and look set to climb in many developing countries where asbestos is still being widely used, often without safety precautions. According to WHO estimates, asbestos now causes more deaths globally than excessive sun exposure. In the UK it is estimated to cause almost three times as many deaths as road traffic accidents.

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Cross Post – Most powerful lesson from Ebola: We do not learn our lessons

BY MAXWELL J. SMITH & ROSS E.G. UPSHUR

This article is cross posted from the OUPblog.  To see the original article please follow this link: http://bit.ly/1mjAg0Z

 ebola

‘Ebola is a wake-up call.’

 

This is a common sentiment expressed by those who have reflected on the ongoing Ebola outbreak in West Africa. It is a reaction to the nearly 30,000 cases and over 11,000 deaths that have occurred since the first cases of the outbreak were reported in March 2014. Though, it is not simply a reaction to the sheer number of cases and deaths; it is an acknowledgement that an outbreak of this magnitude should have never occurred and that we as a global community remain ill-prepared to prevent and respond to deadly global infectious disease outbreaks. Continue reading

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