ETHICAL CHALLENGES IN HEALTHCARE ARISING FROM THE COVID-19 PANDEMIC
Keywords:
COVID-19, COVID-19 Vaccine, Equity, Human Challenge Studies, Human Dignity, Human Rights, Informed Consent, Privacy of Citizens, Triage, World Health OrganizationAbstract
The COVID-19 pandemic has, till the end of September 2020, infected more than 34 million people the world over, and more than one million have died. The ethical challenges it has raised are many. This article highlights some of the main ethical challenges in healthcare. It argues that the pandemic could have been avoided, or, at best, very much reduced, if the problem had been nipped in the bud, and due warnings were sounded to other countries; the role of China and the WHO are particularly highlighted. Denial of the problem, and inaction by some prominent world leaders who placed politics and economics before health, has resulted in their countries being most affected by the pandemic. The article also discusses some of the other ethical concerns in healthcare that have arisen: the problems of triage; the effect on non-COVID related medical care; problems of honouring the requirements of informed consent, CPR, DNR Orders, etc.; the sad plight of healthcare and other frontline workers; the issue of citizens’ privacy and rights; the ethics of human challenge studies, and problems in developing and distributing a safe and effective vaccine. The important values of human dignity, human rights, privacy, equity, and justice are to be upheld at all times as we make our way out of this crisis. A close collaboration between all the principal actors as well as the citizens of the world is necessary to help end the pandemic and to return to normalcy.
References
“In Bhagalpur, Tale of 4 Health Centres: Crowded Rooms, Staff without Masks,” Indian Express, 29.06.20.
“Jair Bolsanaro and his ‘Non-normal Antics amid Pandemic,” Wion News, https://www. wionews.com/photos/jair-bolsonaro-and-his-non-normal-antics-amid-pandemic-314020.
“Layoffs and Losses: COVID-19 Leaves US Hospitals in Financial Crisis,” www.usnews.com, May 6, 2020.
“Private Hospitals Stare at Losses amid COVID Outbreak,” www.livemint.com, 15.04.2020.
“Timeline of WHO’s Response to COVID-19,” World Health Organization, July 30, 2020 (updated). https://www.who.int/news-room/detail/29-06-2020-COVIDtimeline.
“US Hospitals are Losing Millions of Dollars per Day in the midst of the COVID-19 Pandemic,” www.cnbc.com, May 5, 2020.
“WHO Director-General’s statement on the advice of the IHR Emergency Committee on Novel Coronavirus,” World Health Organization, 23 January, 2020. https://www.who.int/dg/speeches/detail/who-director-general-s-statement-on-the-advice-of-the-ihr-emergency-committee-on-novel-coronavirus.
Abraham Thomas, “Regulate COVID Treatment Costs at Private Hospitals, Orders Supreme Court,” Hindustan Times, July 14, 2020.
Alex Ward, “World Leaders who Denied the Coronavirus’s Danger Made us all Less Safe,” Vox, March 30, 2020.
Amit Bhattacharya, “India Sets Grim World Record with 79,000 fresh cases in a day,” The Times of India, 30.08.2020.
Amy L. McGuire et al, “Ethical Challenges Arising in the COVID-19 Pandemic: An Overview from the Association of Bioethics Program Directors (ABPD) Task Force,” The American Journal of Bioethics (08 June, 2020) 1-13.
British Medical Association, “COVID-19: Ethical Issues: A Guidance Note,” April 2020. https://www.bma.org.uk/media/2360/bma-COVID-19-ethics-guidance-april-2020.pdf.
C. Marpakwar, “Audit Reveals how Hospital Inflated COVID Patient’s Bill,” Mumbai Mirror, 07.07.2020.
Christine C. Toevs, “CPR in the Times of COVID-19,” Christian Medical and Dental Associations, 07 April, 2020.
Christopher Cheney, “4 Ethical Dilemmas for Healthcare Organizations during the COVID-19 Pandemic,” Health Leaders, 18 March, 2020.
Craig Timberg et al, “Cellphone Apps to Track COVID-19 Spread Struggle Worldwide amid Privacy Concerns,” The Washington Post, August 18, 2020.
Dali L. Yang, “Wuhan Officials Tried to Cover up COVID-19 and set it Careening outward,” The Washington Post, March 10, 2020.
Daniel Horn, “The Coronavirus is Bankrupting Primary Care Doctors,” The Washington Post, 24 April, 2020.
David A. Graham, “Trump Can’t Bluff His Way Out of This,” The Atlantic, June 26, 2020.
David Reid, “India Confirms its First Coronavirus Case,” CNBC, 30.01.2020.
Devesh Kumar, “Half a Million COVID-19 Cases in India: How we Got to where we are,” The Wire, June 28, 2020.
Director-General, Indian Council of Medical Research (ICMR), circular No. DO.no.ECD/COVID19/Misc.2020, July 2, 2020.
Dr Tedros A. Ghebreyesus, Director-General, World Health Organization (media briefing), August 18, 2020.
Dr. Shengjie Lai, “Early and Combined Interventions Crucial in Tackling COVID-19 Spread in China,” University of Southampton, March 11, 2020. https://www.southampton.ac.uk/news/2020/03/COVID-19-china.page.
Editorial Team, “China didn’t Warn Public of Likely Pandemic for 6 Key Days,” The Associated Press, April 15, 2020.
Euzebiuz Jamrozik, “COVID-19 Human Challenge Studies: Ethical Issues,” The Lancet (May 29, 2020), DOI: 10.1016/S1473-3099(20)30438-2, 1-6, 1.
Ewen Callaway, “Russia’s Fast-track Coronavirus Vaccine Draws Outrage over Safety,” Nature, August 11, 2020.
Ezekiel J. Emanuel et al, “Fair Allocation of Scarce Medical Resources in the Time of COVID-19,” The New England Journal of Medicine, (May 21, 2020) 2049-1055.
HT Correspondent, “Coronavirus: Concerns in UP’s Basti as 50 Migrants, Who Returned from Maharashtra, Found Positive,” India.com, May 19, 2020 and “As Bihar Finds 26% of Returning Delhi Migrants Infected, Doubts Cast on NCR’s COVID Count,” The Wire, May 19, 2020.
HT Correspondent, “One-third of Migrant Workers could be Infected with COVID-19: Centre Tells SC,” Hindustan Times, April 1, 2020.
Ivan Castano, “Brazilian Doctors Fume as President Bolsonaro Hid COVID-19 Data and now has Tested Positive Himself,” MarketWatch, July 7, 2020.
James Kraska, “China is Legally Responsible for COVID-19 Damage and Claims could be in the Trillions,” War on the Rocks, March 23, 2020.
Jay Pandya, “‘Namaste Trump’ Event Responsible for COVID-19 Spread in Gujarat, India Paying Price: Cong,” Republicworld.com, 8 May, 2020.
Jaya Harrar, “Is Coronavirus Global Governance’s Failure?” Lawyer Monthly, May 29, 2020, https://www.lawyer-monthly.com/2020/05/is-coronavirus-global-governances-failure/
Jeffrey P Kahn, ed., Digital Contact Tracing for Pandemic Response: Ethics and Governance Guidance, Baltimore: Johns Hopkins University Press, 2020.
Jonathan Corum et al, “Cornavirus Vaccine Tracker,” The New York Times, August 21, 2020.
Julian E. Barnes, “Russia is Trying to Steal Virus Vaccine Data, Western Nations Say,” The New York Times, August 11, 2020.
Katie Pearce, “Distributing A COVID-19 Vaccine Raises Complex Ethical Issues,” Johns Hopkins University (HUB), July 1, 2020.
Kraska, “China is Legally Responsible for COVID-19 Damage.”; See “Chinese New Year Calendar, 2020.” https://chinesenewyear.net/calendar/.
Lawrence Freedman, “How the World Health Organization’s Failure to Challenge China over Coronavirus Cost us Dearly,” New Statesman, 5 April, 2020.
Margot Sanger-Katz, “Why 1.4 Million Health Jobs Have been Lost during a Huge Health Crisis,” New York Times, 10 May, 2020.
Mayilvaganan, “Contact Tracing: Has Tamil Nadu Lost Track?” Times News Service, June 8, 2020.
McGuire, “Ethical Challenges,” 1-3; Editors, “Bioethics Amidst the COVID-19 Pandemic,” Frontiers, www.frontiersin.org; Emanuel, “Fair Allocation,” 2049-51.
Melissa Butz, “Coronavirus Vaccine Poses a Potential Ethical Problem for Catholics,” Rome Reports, May 31, 2020.
Mohammad Ayoob, “Is China Culpable for the Spread of Coronavirus?” The Strategist, 31 March, 2020.
Muhammed Sabith, “Kerala: Opposition Raises Pitch against Police Move to Collect Call Records of COVID-19 Patients, The Wire, August 18, 2020.
Philip Bump, “Trump Continues to Refuse to Accept the Deadliness of the Coronavirus Pandemic,” The Washington Post, April 28, 2020.
Pranab Bardhan, “The two Largest Democracies in the World are the Sickest now,” Scroll.in, August 24, 2020.
Prasad Ravindranath, “ICMR Threatens Principal Investigators to Complete COVID-19 Vaccine Trial by August 15,” Science Chronicle, July 3, 2020.
Prashasti Singh, “New COVID-19 Hotspots are Emerging in Rural Villages across India,” Hindustan Times, June 22, 2020.
Qun Li et al, “Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus–Infected Pneumonia,” The New England Journal of Medicine 382, 13 (March 26, 2020) 1199-1207.
Raj Verma, “China’s Diplomacy and Changing the COVID-19 Narrative,” International Journal: Canada’s Journal of Global Policy Analysis (June 8, 2020) 248-258.
Rashmi Mabiyan, “Fauci Says Human Challenge Trials not Ethically Justified, Experts Disagree,” ET Health World, July 31, 2020.
Richard Huxtable, “COVID-19: Where is the National Ethical Guidance?” BMC Medical Ethics (01 May, 2020) 1-3.
Robert Farley, “US Accuses Chinese Hackers of Stealing COVID Vaccine Research,” The Diplomat, July 22, 2020.
Sahil Joshi, “Maharashtra Government Takes over 80% Beds in Private Hospitals,” India Today, 22.05.2020.
Samuel Volkin, “Digital Contact Tracing Poses Ethical Challenges,” Johns Hopkins University (HUB), May 26, 2020.
Sanjay Kumar, “Scientists Scoff at Indian Agency’s Plan to have COVID-19 Vaccine Ready for Use Next Month,” ScienceMag.Org, July 6, 2020.
Shika Salaria et al, “CDR Use for COVID Contact Tracing on for Months in Uttar Pradesh,” Times News Network, August 18, 2020.
Sidharth Yadav, “Coronavirus: In Madhya Pradesh, Power Play during a Pandemic,” The Hindu, 25 April, 2020.
Stephen Collinson, “Trump’s Outrageous Refusal to Lead is Making the Pandemic Worse,” CNN, July 17, 2020.
Sumitra DebRoy, “Don’t Escalate Treatment, Say Kin of Critical Seniors,” Times of India, 07.07.2020.
Tech2 News Staff, “Aarogya Setu: Lack Of Data Privacy Laws, Transparent Policies Make App Worrisome, Say MIT Researchers,” Firstpost, May 11, 2020.
The Congregation for the Doctrine of the Faith (2008), Dignitas Personae.
The Editorial Board, “We the People, in Order to Defeat the Coronavirus,” New York Times, May 1, 2020.
The Editorial Board, “We the People, in Order to Defeat the Coronavirus,” New York Times, May 1, 2020.
White House, “Text of President Donald Trump’s Speech in Motera Cricket Stadium in Ahmedabad, Feb. 24, 2020.”
World Bank, COVID-19 Crisis through a Migration Lens, April 2020, 27.
World Health Organization (Working Committee), “Key Criteria for the Ethical Acceptability of COVID-19 Human Challenge Studies,” 6 May, 2020. www.app.who.int., 5.
World Health Organization, “Rolling Updates on the Coronavirus Disease (COVID-19), https://www.who.int/emergencies/diseases/novel-coronavirus-2019/events-as-they-happen; accessed 17.08.20.
Worldometer, “COVID-19 Coronavirus Pandemic,” https://www.worldometers.info/coronavirus/; accessed September 30, 2020.
Yang, “Wuhan officials tried to cover up COVID-19,” 250.
Zeynep Tufekci, “How the Coronavirus Revealed Authoritarianism’s Fatal Flaw,” The Atlantic, February 22, 2020.
