Global discussion 7 responses

When responding to your peers, highlight any existing connections between the ethical issue you identified and the issues identified in your peers’ posts. Do you believe the strategies they proposed for avoiding or resolving the issues could be impactful? Respectfully agree or disagree. What strategies or actions can you propose for avoiding or resolving the ethical issues identified by your peers?

Post # 1

Deborah Umanzor 

                This week our discussion is regarding ethics in population health, I have chosen to discuss the elderly. The elderly are considered a vulnerable population for which advocacy and protective policies are needed.  The older adult population is growing, Holtz (2017) states, “older adults are among the fastest growing age group”(p.43).  The World Health Organization (WHO) lists ageing as one of the ethical issues to be addressed at the March 2017 WHO meeting in Germany.  The WHO describes several ethical considerations in their report “Developing an Ethical Framework for Healthy Ageing”.  The report defines older people as “a person whose age has passed the average life expectancy at birth for that country” (WHO Report, 2017, p.13).

The report speaks to the growth of the ageing population and the need for policy and advocacy to ensure that this growing and ageing population maintain healthy productive lives while also maintaining dignity and freedom from age discrimination or abuse. The goals set forth in this report are 1.) Create living environments that support the older adult’s lifestyle and physical needs   2.) Live as healthy a life as possible well into advanced years which will change the focus of health care from curative to preventative to continuing care of chronic disease  3.) Provide support to keep elders at home and out of health care facilities whenever possible. 

The question of rationing health care services due to the extreme costs was discussed and the determination was made that all individuals, regardless of age have an inherent right to health care services and costs can be cut in other ways.  I agree that it should be the individual’s right to decide the extent of medical care that they want for themselves.  I believe it is unethical to put a price on a person’s life regardless of what others may feel is or is not a good quality of life.

The question of how to increase elder’s participation in clinical research was discussed.  Elders with multiple chronic diseases are often ineligible for clinical trials as the data becomes flawed.  I have worked as a clinical trial coordinator and most of the drug companies that sponsored the trials welcomed patients with multiple co-morbidities but there was usually an upper age limit of 80 years of age.  In my experience, some 80 year olds would have been very good research subjects.

 Next the report discussed how the current medical focus of mortality and morbidity can be changed to focus on goals and outcomes.  I was very happy to read this section of the report.  It is very encouraging to think in terms of what elders can do physically and mentally; what are their goals of care and how can we as a society help them to reach those goals rather that looking at disease processes and death rates.

As a health care profession, I can advocate for and defend the dignity of the elders that are in my care.  In my role as Director of Care Management, I along with my team, are often confronted with ethical dilemmas such as end of life issues, elder abuse, guardianship issues, invocation of Health Care Proxy and more.  I am a member of the ethics committee where we are asked the tough questions and make decisions based on legal and ethical guidelines.

Reference:

Holtz. C. (2017). Global Healthcare: Issues an Policies, Jones & Bartlett, Burlington MA

World Health Organization, 2017 Report:  Developing an Ethical Framework for Healthy

Ageing. Tubingen, Germany 18 March 2017

https://www.who.int/ethics/publications/ethical-framework-for-health-ageing/en/

Post # 2

Linda Davies 

            In February 2020, the International Committee on Taxonomy of Viruses (ICTV) named a novel virus that was permeating the world, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) commonly referred to as COVID-19 (WHO, 2020). The ethical issue currently debated is community masking. Individual rights and responsibilities have unfortunately been muddied due to sensationalized news reports, social media, the political blame game, and the absence of leadership providing a consistent message. The general perception is that people’s rights are infringed upon if community masking is required.

Interim guidelines on the use of masks to prevent the spread were released by the World Health Organization (WHO) on April 6, 2020. The main routes of transmission were identified as respiratory droplets and through contact with symptomatic people. Data gathered by WHO revealed the virus was transmitted 1-3 days prior to symptom onset and that there was no evidence to suggest that community masking would prevent exposure or transmission. Medical masks were in short supply and reserved for healthcare personnel and symptomatic patients, as they would contribute to a false sense of security if worn by all in the community (WHO, April 6, 2020). Social distancing, handwashing, and not touching one’s face were the first community preventive measures put in place. In various parts of the world masks and face coverings are worn for cultural and environmental health reasons. Therefore, WHO’s guidelines specified that country leaders were to decide the purpose of wearing a mask and charged them to provide communication and education to their public to avoid confusion and misleading information. WHO updated their guidance on June 5, 2020 to indicate that masks are one item that everyone can wear to prevent the spread of the COVID 19 (WHO, June 5, 2020). 

            WHO global health is guided by a moral and ethical compass that surrounds global initiatives of ensuring equitable distribution of healthcare services while respecting the rights and dignity of all people. (Holtz, 2017). Preventing new infections, improving capacity to prepare and respond to infectious disease and strengthening public health capacity are listed as major goals in the Centers for Disease Control (CDC) Health Challenges report. In addition, the universal right to healthcare adopted by the United Nations in 1948 affords a right to security in the event of sickness of which an individual has no control (Holtz, 2017). COVID-19 pandemic surfaced without warning and affects everyone’s right to equitable treatment and prevention measures. Dignity for all equates dignity for one. The rights of one are permissible if they do not infringe upon the rights of all. With the current pandemic, any prevention measures employed ensures humankind’s existence. 

Advocacy for change is hard but advocacy for a change with ethical implications is extremely difficult. For COVID-19, leaders needed to step up initially and not be persuaded by election affects, public misperception or media grandstanding. When the global population is dying at a very fast rate by an unknown contaminant, it requires a similar rapid consistent response. 

Ethan Weiss, MD, who worked alongside healthcare professionals in New York City tweeted on April 30, 2020, “you can’t really understand it until you see it, and that’s the problem. No one is seeing it” (Weiss, 2020). Words and statistics are not enough to show the impact of this pandemic. A balance needs to be found between lockdown panic mode and the right mix of testing, contact tracing, quarantines and enforcement of simple public health measures. An after-action report will no doubt indicate that the world was ill prepared for a promised pandemic. Lessons learned from 1918 together with advances in healthcare bring us to today where we forget to rely on facts to lead the charge in the collaborative fight against COVID-19. Strong advocates at all levels, international, national, state, and local are needed to understand the magnitude and scope of a pandemics pervasion into the global economy, academia, population health, and policy. Collaborations should be ongoing and occur before an outbreak or pandemic is declared. Public members and private organizations should work with government to understand and mitigate ethical and moral issues as they surface in any war. Everyone, regardless of healthcare coverage, has a moral and ethical responsibility to choose to help prevent death and spread of disease. 

References

Holtz, C. (2017). Global health care: Issues and policies (3rd ed.). Burlington, MA: Jones et  

Bartlett Learning. 

Weiss, E. (2020, April 30). Twitter. Retrieved from 

https://twitter.com/ethanjweiss/status/1256029025035644928

World Health Organization (WHO). (2020). Naming the coronavirus disease (COVID-19) and 

the virus that causes it. Retrieved from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/naming-the-coronavirus-disease-(covid-2019)-and-the-virus-that-causes-it#:~:text=ICTV%20announced%20%E2%80%9Csevere%20acute,two%20viruses%20are%20different.

World Health Organization. (‎2020)‎. Advice on the use of masks in the context of COVID-19: 

interim guidance, 6 April 2020. World Health Organization. https://apps.who.int/iris/handle/10665/331693. License: CC BY-NC-SA 3.0 IGO

World Health Organization. (‎2020)‎. Advice on the use of masks in the context of COVID-19: 

interim guidance, 5 June 2020. World Health Organization. https://apps.who.int/iris/handle/10665/332293. License: CC BY-NC-SA 3.0 IGO