BackgroundThe coronavirus 2019 pandemic placed unprecedented pressures on healthcare services and magnified ethical dilemmas related to how resources should be allocated. These resources include, among others, personal protective equipment, personnel, life-saving equipment, and vaccines. Decision-makers have therefore sought ethical decision-making tools so that resources are distributed both swiftly and equitably. To support the development of such a decision-making tool, a systematic review of the literature on relevant ethical values and principles was undertaken. The aim of this review was to identify (...) ethical values and principles in the literature which relate to the equitable allocation of resources in response to an acute public health threat, such as a pandemic.MethodsA rapid systematic review was conducted using MEDLINE, EMBASE, Google Scholar, LitCOVID and relevant reference lists. The time period of the search was January 2000 to 6th April 2020, and the search was restricted to human studies. January 2000 was selected as a start date as the aim was to capture ethical values and principles within acute public health threat situations. No restrictions were made with regard to language. Ethical values and principles were extracted and examined thematically.ResultsA total of 1,618 articles were identified. After screening and application of eligibility criteria, 169 papers were included in the thematic synthesis. The most commonly mentioned ethical values and principles were: Equity, reciprocity, transparency, justice, duty to care, liberty, utility, stewardship, trust and proportionality. In some cases, ethical principles were conflicting, for example, Protection of the Public from Harm and Liberty.ConclusionsAllocation of resources in response to acute public health threats is challenging and must be simultaneously guided by many ethical principles and values. Ethical decision-making strategies and the prioritisation of different principles and values needs to be discussed with the public in order to prepare for future public health threats. An evidence-based tool to guide decision-makers in making difficult decisions is required. The equitable allocation of resources in response to an acute public health threat is challenging, and many ethical principles may be applied simultaneously. An evidence-based tool to support difficult decisions would be helpful to guide decision-makers. (shrink)

A persistent problem in the dominant agricultural development model is the imposition of technologies without regard to local processes and cultures. Even with the recent shift towards sustainability and agroecology, initiatives continue to overlook local knowledge. In this article we provide analysis of agroecological soil management in the Maya-Achi territory of Guatemala. The Achí, subject to five decades of interventions and development, present an interesting case study for assessing the complementarities and tensions between traditional, generally preventative practices and external initiatives (...) which tend to be curative. Our findings reveal a complex farming system that continues to rely on ancestral knowledge and practices, many of which display a high potential for sustainability and are deeply embedded in local culture. While some new practices have been incorporated into the traditional system, abandonment rates are high, and some extension methods have been paternalistic. The Achí are thirsty for new ideas to help them confront their current, unprecedented challenges. However, future collaborations should be built on existing local knowledge, which has contributed to the development of preventative and restorative practices still in use. Introduced technologies must coincide with local needs and socioecological context in a manner that encourages beneficial synergies, as well as horizontal learning/teaching processes. (shrink)