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  • 1
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    Oxford University Press
    Publication Date: 2024-03-28
    Description: In the response to this pandemic, two vital, but controversial ethical questions are we should allocate ventilators to patients with severe respiratory failure, and how we should distribute vaccines to people at risk of contracting coronavirus. There There are opposing ethical views about how to prioritise, and countries have taken different different differentdifferentapproaches. There There is a strong ethical argument that policies should take a pluralistic approach to allocation that reflectsreflects reflectsreflectsreflectsmultiple ethical values - both because of the diversity of viewpoints within communities and the recognition that there are competing relevant ethical values. In this chapter, I look at the epistemic and normative problems raised by pluralistic allocation in this pandemic and suggest implications for future pandemics. I summarise some of the relevant evidence about the public’s views and values relating to prioritisation. I also explore some practical approaches to prioritisation of scarce resources in the face of contrasting and competing ethical values
    Keywords: Pandamic; ethics; vaccines; ventilators ; thema EDItEUR::J Society and Social Sciences::JB Society and culture: general::JBF Social and ethical issues::JBFV Ethical issues and debates
    Language: English
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  • 2
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    Oxford University Press
    Publication Date: 2024-03-31
    Description: The COVID-19 pandemic has been a defining defining event of the 21st century. Global estimates of excess mortality indicate that it has taken fifteen fifteen million lives over 2020-21 (Knutson et al. 2022). It has closed national borders, put whole populations into quarantine and devastated economies. Almost half of workers in low or middle income countries lost a job or business due to the pandemic (Anonymous 2021). The International Monetary Fund has estimated a global loss to the world economy of US$12trillion by the end of 2021 (Bill and Melinda Gates Foundation 2020). It led to a rise in rates of extreme poverty for the first firstfirst time in 25 years, with 37 million additional people experiencing this in 2020. The pandemic toll and the cost of measures taken to combat it—both effective effectiveeffectiveeffectiveeffectiveeffective and ineffective—has ineffective—has ineffective—hasineffective—hasineffective—hasineffective—hasineffective—has ineffective—has been paid in human lives, mental and physical suffering,suffering, suffering, suffering,suffering, and economic hardship. The costs will continue to be paid by individuals and societies for decades to come. While the COVID-19 pandemic has been catastrophic, it is not unique. It is not as severe as Spanish influenza, estimated to have killed between 50-100 million people. Recent MERS and SARS epidemics were more deadly to those infected, but less contagious. Future influenza pandemics, perhaps like the hypothetical example above, undoubtedly lie ahead. We await ‘Disease X’, the World Health Organisation’s placeholder name for “a serious international epidemic … caused by a pathogen currently unknown to cause human disease.” In some ways, the COVID-19 pandemic has been a wake up-call. Children who have been home-schooled during the COVID pandemic will almost certainly face another pandemic in their lifetime – one at least as bad—and potentially much worse—than this one.
    Keywords: COVID-19 Pandamic; ethics ; thema EDItEUR::M Medicine and Nursing::MJ Clinical and internal medicine::MJC Diseases and disorders::MJCJ Infectious and contagious diseases ; thema EDItEUR::J Society and Social Sciences::JB Society and culture: general::JBF Social and ethical issues::JBFV Ethical issues and debates
    Language: English
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  • 3
    Publication Date: 2022-05-12
    Description: This chapter distinguishes between essential features of the zone of parental discretion and the longstanding concept of a grey zone in neonatal treatment decision-making. The grey zone has traditionally described a gestational age range where the outcomes of medical treatment for newborn infants are uncertain, and therefore parents have discretion to choose between resuscitation or palliative care options. In contrast, the ZPD refers to a space where parents may make decisions for their child (not restricted to newborns) even if their decisions conflict with the decisions a clinician would make. A key difference between the two zones is that the boundaries of the grey zone are defined on the basis of published evidence about medical outcomes, whereas the boundaries of the ZPD are based on the broader but arguably vaguer notion of harm to the particular child. The grey zone has usually been defined in terms of gestational age. Wilkinson argues instead for a prognosis-based grey zone in neonatal treatment decision-making, which incorporates a range of prognostic factors rather than focusing solely on gestational age.
    Keywords: Neonates ; ill ; decisions ; bic Book Industry Communication::M Medicine
    Language: English
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  • 4
    Publication Date: 2024-03-31
    Description: What should happen when doctors and parents disagree about what would be best for a child? When should courts become involved? Should life support be stopped against parents' wishes? The case of Charlie Gard, reached global attention in 2017. It led to widespread debate about the ethics of disagreements between doctors and parents, about the place of the law in such disputes, and about the variation in approach between different parts of the world. In this book, medical ethicists Dominic Wilkinson and Julian Savulescu critically examine the ethical questions at the heart of disputes about medical treatment for children. They use the Gard case as a springboard to a wider discussion about the rights of parents, the harms of treatment, and the vital issue of limited resources. They discuss other prominent UK and international cases of disagreement and conflict. From opposite sides of the debate Wilkinson and Savulescu provocatively outline the strongest arguments in favour of and against treatment. They analyse some of the distinctive and challenging features of treatment disputes in the 21st century and argue that disagreement about controversial ethical questions is both inevitable and desirable. They outline a series of lessons from the Gard case and propose a radical new “dissensus” framework for future cases of disagreement.
    Keywords: child; doctor; ;parents; disagreement; ethics; medical treatment; medical ethics ; thema EDItEUR::M Medicine and Nursing::MB Medicine: general issues::MBD Medical profession::MBDC Medical ethics and professional conduct
    Language: English
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  • 5
    Publication Date: 2021-03-26
    Description: Background Many patients at the end of life require analgesia to relieve pain. Additionally, up to 1/5 of patients in the UK receive sedation for refractory symptoms at the end of life. The use of sedation in end-of-life care (EOLC) remains controversial. While gradual sedation to alleviate intractable suffering is generally accepted, there is more opposition towards deliberate and rapid sedation to unconsciousness (so-called “terminal anaesthesia”, TA). However, the general public’s views about sedation in EOLC are not known. We sought to investigate the general public’s views to inform policy and practice in the UK. Methods We performed two anonymous online surveys of members of the UK public, sampled to be representative for key demographic characteristics (n = 509). Participants were given a scenario of a hypothetical terminally ill patient with one week of life left. We sought views on the acceptability of providing titrated analgesia, gradual sedation, terminal anaesthesia, and euthanasia. We asked participants about the intentions of doctors, what risks of sedation would be acceptable, and the equivalence of terminal anaesthesia and euthanasia. Findings Of the 509 total participants, 84% and 72% indicated that it is permissible to offer titrated analgesia and gradual sedation (respectively); 75% believed it is ethical to offer TA. Eighty-eight percent of participants indicated that they would like to have the option of TA available in their EOLC (compared with 79% for euthanasia); 64% indicated that they would potentially wish for TA at the end of life (52% for euthanasia). Two-thirds indicated that doctors should be allowed to make a dying patient completely unconscious. More than 50% of participants believed that TA and euthanasia were non-equivalent; a third believed they were. Interpretation These novel findings demonstrate substantial support from the UK general public for the use of sedation and TA in EOLC. More discussion is needed about the range of options that should be offered for dying patients.
    Electronic ISSN: 1932-6203
    Topics: Medicine , Natural Sciences in General
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  • 6
    Publication Date: 2021-09-01
    Print ISSN: 1078-8956
    Electronic ISSN: 1546-170X
    Topics: Biology , Medicine
    Published by Springer Nature
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