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  1. Utilitarian Principlism as a Framework for Crisis Healthcare Ethics.Laura Vearrier & Carrie M. Henderson - 2021 - HEC Forum 33 (1):45-60.
    This paper introduces the model of Utilitarian Principlism as a framework for crisis healthcare ethics. In modern Western medicine, during non-crisis times, principlism provides the four guiding principles in biomedical ethics—autonomy, nonmaleficence, beneficence, and justice; autonomy typically emerges as the decisive principle. The physician–patient relationship is a deontological construct in which the physician’s primary duty is to the individual patient and the individual patient is paramount. For this reason, we term the non-crisis ethical framework that guides modern medicine Deontological Principlism. (...)
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  • Covid-19 in Historical Context: Creating a Practical Past.Amy W. Forbes - 2021 - HEC Forum 33 (1-2):7-18.
    Decades ago, in his foundational essay on the early days of the AIDS crisis, medical historian Charles Rosenberg wrote, “epidemics start at a moment in time, proceed on a stage limited in space and duration, following a plot line of increasing revelatory tension, move to a crisis of individual and collective character, then drift toward closure.” In the course of epidemics, societies grappled with sudden and unexpected mortality and also returned to fundamental questions about core social values. “Epidemics,” Rosenberg wrote, (...)
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  • When Do Caregivers Ignore the Veil of Ignorance? An Empirical Study on Medical Triage Decision–Making.Azgad Gold, Binyamin Greenberg, Rael Strous & Oren Asman - 2021 - Medicine, Health Care and Philosophy 24 (2):213-225.
    In principle, all patients deserve to receive optimal medical treatment equally. However, in situations in which there is scarcity of time or resources, medical treatment must be prioritized based on a triage. The conventional guidelines of medical triage mandate that treatment should be provided based solely on medical necessity regardless of any non-medical value-oriented considerations. This study empirically examined the influence of value-oriented considerations on medical triage decision–making. Participants were asked to prioritize medical treatment relating to four case scenarios of (...)
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  • Withdrawing Critical Care From Patients in a Triage Situation.Joseph Tham, Louis Melahn & Michael Baggot - 2021 - Medicine, Health Care and Philosophy 24 (2):205-211.
    The advent of COVID-19 has been the occasion for a renewed interest in the principles governing triage when the number of critically ill patients exceeds the healthcare infrastructure’s capacity in a given location. Some scholars advocate that it would be morally acceptable in a crisis to withdraw resources like life support and ICU beds from one patient in favor of another, if, in the judgment of medical personnel, the other patient has a significantly better prognosis. The paper examines the arguments (...)
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  • The Divided Principle of Justice: Ethical Decision-Making at Surge Capacity.Sunit Das & Connor T. A. Brenna - 2021 - American Journal of Bioethics 21 (8):37-39.
    As Alfandre and colleagues describe in “Between Usual and Crisis Phases of a Public Health Emergency: The Mediating Role of Contingency Measures”, efforts to maintain standards of care durin...
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  • Supporting Real-Time Ethical Deliberation in Contingency Capacity During the COVID-19 Pandemic.Mark R. Tonelli & Catherine R. Butler - 2021 - American Journal of Bioethics 21 (8):25-27.
    The reality of resource limitation during the Coronavirus Disease 2019 pandemic has deeply challenged established approaches to healthcare system emergency response. Early preparation du...
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  • Between Usual and Crisis Phases of a Public Health Emergency: The Mediating Role of Contingency Measures.David Alfandre, Virginia Ashby Sharpe, Cynthia Geppert, Mary Beth Foglia, Kenneth Berkowitz, Barbara Chanko & Toby Schonfeld - 2021 - American Journal of Bioethics 21 (8):4-16.
    Much of the sustained attention on pandemic preparedness has focused on the ethical justification for plans for the “crisis” phase of a surge when, despite augmentation efforts, the demand for life...
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  • Dignity, Autonomy, and Allocation of Scarce Medical Resources During COVID-19.David G. Kirchhoffer - 2020 - Journal of Bioethical Inquiry 17 (4):691-696.
    Ruth Macklin argued that dignity is nothing more than respect for persons or their autonomy. During the COVID-19 pandemic, difficult decisions are being made about the allocation of scarce resources. Respect for autonomy cannot justify rationing decisions. Justice can be invoked to justify rationing. However, this leaves an uncomfortable tension between the principles. Dignity is not a useless concept because it is able to account for why we respect autonomy and for why it can be legitimate to override autonomy in (...)
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  • Why Should HCWs Receive Priority Access to Vaccines in a Pandemic?Xavier Symons, Steve Matthews & Bernadette Tobin - 2021 - BMC Medical Ethics 22 (1):1-9.
    BackgroundViral pandemics present a range of ethical challenges for policy makers, not the least among which are difficult decisions about how to allocate scarce healthcare resources. One important question is whether healthcare workers should receive priority access to a vaccine in the event that an effective vaccine becomes available. This question is especially relevant in the coronavirus pandemic with governments and health authorities currently facing questions of distribution of COVID-19 vaccines.Main textIn this article, we critically evaluate the most common ethical (...)
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  • Among Equity and Dignity: An Argument-Based Review of European Ethical Guidelines Under COVID-19.Ludovica De Panfilis & Marta Perin - 2021 - BMC Medical Ethics 22 (1):1-29.
    BackgroundUnder COVID-19 pandemic, many organizations developed guidelines to deal with the ethical aspects of resources allocation. This study describes the results of an argument-based review of ethical guidelines developed at the European level. It aims to increase knowledge and awareness about the moral relevance of the outbreak, especially as regards the balance of equity and dignity in clinical practice and patient’s care. MethodAccording to the argument-based review framework, we started our research from the following two questions: what are the ethical (...)
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  • ¿No es país para viejos? La edad como criterio de triaje durante la pandemia COVID-19.Jon Rueda - 2020 - Enrahonar 65:85-98.
    La pandemia de la COVID-19 ha levantado sospechas de edadismo y gerontofobia en diversas prácticas de racionamiento sanitario. La edad es un criterio de triaje controvertido. En este artículo se esclarece la relevancia ética de la edad dentro de los sistemas de triaje, analizando particularmente su rol dentro de los principios de equidad y de eficiencia. La equidad requiere dar más oportunidades a aquellos que han cumplido menos ciclos vitales. La eficiencia tiene en cuenta la edad de manera subrepticia al (...)
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  • Resource Allocation During COVID-19: A Focus on Vulnerable Populations.C. De V. Castelyn, I. M. Viljoen, A. Dhai & M. S. Pepper - 2020 - South African Journal of Bioethics and Law 13 (2):83.
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  • Should Age Matter in COVID-19 Triage? A Deliberative Study.Margot N. I. Kuylen, Scott Y. Kim, Alexander Ruck Keene & Gareth S. Owen - 2021 - Journal of Medical Ethics 47 (5):291-295.
    The COVID-19 pandemic put a large burden on many healthcare systems, causing fears about resource scarcity and triage. Several COVID-19 guidelines included age as an explicit factor and practices of both triage and ‘anticipatory triage’ likely limited access to hospital care for elderly patients, especially those in care homes. To ensure the legitimacy of triage guidelines, which affect the public, it is important to engage the public’s moral intuitions. Our study aimed to explore general public views in the UK on (...)
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  • Ethical Advice for an Intensive Care Triage Protocol in the COVID-19 Pandemic: Lessons Learned From The Netherlands.Marcel Verweij, Suzanne van de Vathorst, Maartje Schermer, Dick Willems & Martine de Vries - 2020 - Public Health Ethics 13 (2):157-165.
    At the height of the COVID-19 crisis in the Netherlands a shortness of intensive care beds was looming. Dutch professional medical organizations asked a group of ethicists for assistance in drafting guidelines and criteria for selection of patients for intensive care treatment in case of absolute scarcity, when medical selection criteria would no longer suffice. This article describes the Dutch context, the process of drafting the advice and reflects on the role of ethicists and lessons learned. We argue that timely (...)
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  • The Perfect Moral Storm: Diverse Ethical Considerations in the COVID-19 Pandemic.Vicki Xafis, G. Owen Schaefer, Markus K. Labude, Yujia Zhu & Li Yan Hsu - 2020 - Asian Bioethics Review 12 (2):65-83.
    The COVID-19 pandemic has both exposed and created deep rifts in society. It has thrust us into deep ethical thinking to help justify the difficult decisions many will be called upon to make and to protect from decisions that lack ethical underpinnings. This paper aims to highlight ethical issues in six different areas of life highlighting the enormity of the task we are faced with globally. In the context of COVID-19, we consider health inequity, dilemmas in triage and allocation of (...)
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  • Counteracting COVID-19 Healthcare Inequity: Supporting Antiracist Practices at Bedside.Crystal E. Brown & Georgina D. Campelia - 2021 - American Journal of Bioethics 21 (2):79-82.
    In “Racism and Bioethics: the myth of color blindness” Braddock convincingly argues that a “color blind” approach to triage and resource allocation in the setting of the COVID-19 pandemic pe...
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  • Defending the Inclusion of Categorical Exclusion Criteria in Crisis Standard of Care Frameworks.Janet Malek - 2020 - American Journal of Bioethics 20 (7):156-158.
    Volume 20, Issue 7, July 2020, Page 156-158.
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  • Beyond Ventilators and Prematurity: Most Rationing Dilemmas Are Morally Fraught.Anne Sullivan, Sadath Sayeed & Christy L. Cummings - 2020 - American Journal of Bioethics 20 (7):174-177.
    Volume 20, Issue 7, July 2020, Page 174-177.
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  • When Exclusion Criteria Are Appropriate.Andrew M. Courtwright - 2020 - American Journal of Bioethics 20 (7):158-160.
    Volume 20, Issue 7, July 2020, Page 158-160.
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  • A Call for Dialysis-Specific Resource Allocation Guidelines During COVID-19.Jordan A. Parsons & Dominique E. Martin - 2020 - American Journal of Bioethics 20 (7):199-201.
    Volume 20, Issue 7, July 2020, Page 199-201.
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  • COVID-19, Pandemic Triage, and the Polymorphism of Justice.Jonathan H. Marks - 2020 - American Journal of Bioethics 20 (7):103-106.
    Volume 20, Issue 7, July 2020, Page 103-106.
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  • Examining Public Trust in Categorical Versus Comprehensive Triage Criteria.Jon Rueda, Ivar R. Hannikainen, Joaquín Hortal-Carmona & David Rodriguez-Arias - 2020 - American Journal of Bioethics 20 (7):106-109.
    Volume 20, Issue 7, July 2020, Page 106-109.
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  • Ethics Lessons From Seattle’s Early Experience With COVID-19.Denise M. Dudzinski, Benjamin Y. Hoisington & Crystal E. Brown - 2020 - American Journal of Bioethics 20 (7):67-74.
    Ethics consultants and critical care clinicians reflect on Seattle’s early experience as the United States’ first epicenter of COVID-19. We discuss ethically salient issues confronted at UW Medicin...
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  • Ethical Challenges Arising in the COVID-19 Pandemic: An Overview From the Association of Bioethics Program Directors (ABPD) Task Force.Amy L. McGuire, Mark P. Aulisio, F. Daniel Davis, Cheryl Erwin, Thomas D. Harter, Reshma Jagsi, Robert Klitzman, Robert Macauley, Eric Racine, Susan M. Wolf, Matthew Wynia & Paul Root Wolpe - 2020 - American Journal of Bioethics 20 (7):15-27.
    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 p...
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  • Wir müssen abwägen – aber wie sollen wir abwägen?: Fragen der Moral in einer pandemischen Corona-Krise.Lutz Wingert - 2021 - Deutsche Zeitschrift für Philosophie 69 (1):29-66.
    The global Covid-19 crisis raises at least three moral questions, which my contribution answers as follows: Which patient should get treatment according to triage criteria? The patient whose treatment has the best prospect of success. How should we resolve the conflict between public health measures and economic needs? Public health should have priority, but reaches its limits where the individual right to stay afloat through one’s own work is violated. How should we resolve the conflict between public health measures and (...)
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  • Prioritising ‘Already-Scarce’ Intensive Care Unit Resources in the Midst of COVID-19: A Call for Regional Triage Committees in South Africa.Kantharuben Naidoo & Reshania Naidoo - 2021 - BMC Medical Ethics 22 (1):1-9.
    BackgroundThe worsening COVID-19 pandemic in South Africa poses multiple challenges for clinical decision making in the context of already-scarce ICU resources. Data from national government and the last published national audit of ICU resources indicate gross shortages. While the Critical Care Society of Southern Africa guidelines provide a comprehensive guideline for triage in the face of overwhelmed ICU resources, such decisions present massive ethical and moral dilemmas for triage teams. It is therefore important for the health system to provide clinicians (...)
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  • Vaccine Rationing and the Urgency of Social Justice in the Covid‐19 Response.Harald Schmidt - 2020 - Hastings Center Report 50 (3):46-49.
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  • Incorporating Stakeholder Perspectives on Scarce Resource Allocation: Lessons Learned From Policymaking in a Time of Crisis.Bethany Bruno, Heather Mckee Hurwitz, Marybeth Mercer, Hilary Mabel, Lauren Sankary, Georgina Morley, Paul J. Ford, Cristie Cole Horsburgh & Susannah L. Rose - 2021 - Cambridge Quarterly of Healthcare Ethics 30 (2):390-402.
    The coronavirus disease crisis provoked an organizational ethics dilemma: how to develop ethical pandemic policy while upholding our organizational mission to deliver relationship- and patient-centered care. Tasked with producing a recommendation about whether healthcare workers and essential personnel should receive priority access to limited medical resources during the pandemic, the bioethics department and survey and interview methodologists at our institution implemented a deliberative approach that included the perspectives of healthcare professionals and patient stakeholders in the policy development process. Involving the (...)
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  • Between Crisis and Convention: How Should We Address Contingency?Trevor Bibler - 2020 - Hastings Center Report 50 (5):17-19.
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  • Patients Left Behind: Ethical Challenges in Caring for Indirect Victims of the Covid‐19 Pandemic.Bethany Bruno & Susannah Rose - 2020 - Hastings Center Report 50 (4):19-23.
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  • When Is Age Choosing Ageist Discrimination?Teneille R. Brown, Leslie P. Francis & James Tabery - 2021 - Hastings Center Report 51 (1):13-15.
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  • Getting to the Truth: Ethics, Trust, and Triage in the United States Versus Europe During the Covid‐19 Pandemic.Kristina Orfali - 2021 - Hastings Center Report 51 (1):16-22.
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  • Imagining and Preparing for the Aftermath of the COVID-19 Pandemic: A Justification for Taking Caring Responsibilities into Consideration when Allocating Scarce Resources.Christopher F. C. Jordens - 2020 - Journal of Bioethical Inquiry 17 (4):773-776.
    Various models have been used to “emplot” our collective experience of the COVID-19 pandemic, including the epidemiological curve, threshold models, and narrative. Drawing on a threshold model that was designed to frame resource-allocation decisions in clinical care, I offer an ethical justification for taking caring responsibilities into consideration in such decisions during pandemics. My basic argument is that we should prioritize the survival of patients with caring responsibilities for similar reasons we should prioritize the survival of healthcare professionals. More generally, (...)
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  • Disability Discrimination, Medical Rationing and COVID-19.Bo Chen & Donna Marie McNamara - 2020 - Asian Bioethics Review 12 (4):511-518.
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  • Empowering the Poor and the Front-Liners; Equality of Capability in the Time of COVID-19 Pandemic.Gerry Arambala - 2020 - Eubios Journal of Asian and International Bioethics 30 (5):248-253.
    The advent of the equality of capability theory, as developed by Amartya Sen, has brought about the radicalization of the conventional theories of social justice and development. Sen’s remarkable contribution in the field of developmental theories has paved the way for the reconfiguration and development of normative economics and political philosophy. With his insistence on humanizing development and focusing on the actual freedom of the person as the main criteria for development, Sen’s capability approach will be utilized as the moral (...)
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  • Challenges and Opportunities for Human Behavior Research in the Coronavirus Disease (COVID-19) Pandemic.Claudio Gentili & Ioana A. Cristea - 2020 - Frontiers in Psychology 11.
  • Ethically Allocating COVID-19 Drugs Via Pre-Approval Access and Emergency Use Authorization.Jamie Webb, Lesha D. Shah & Holly Fernandez Lynch - 2020 - American Journal of Bioethics 20 (9):4-17.
    Allocating access to unapproved COVID-19 drugs available via Pre-Approval Access pathways or Emergency Use Authorization raises unique challenges at the intersection of clinical care and research....
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  • Rationing in a Pandemic: Lessons From Italy.Lucia Craxì, Marco Vergano, Julian Savulescu & Dominic Wilkinson - 2020 - Asian Bioethics Review 12 (3):325-330.
    In late February and early March 2020, Italy became the European epicenter of the COVID-19 pandemic. Despite increasingly stringent containment measures enforced by the government, the health system faced an enormous pressure, and extraordinary efforts were made in order to increase overall hospital beds’ availability and especially ICU capacity. Nevertheless, the hardest-hit hospitals in Northern Italy experienced a shortage of ICU beds and resources that led to hard allocating choices. At the beginning of March 2020, the Italian Society of Anesthesia, (...)
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