Moral Burden Research Articles

Ethical Aspects of “Do Not Resuscitate” Orders in the Context of the Covid-19 Pandemic

” Do not resuscitate” order (DNR) is issued to avoid cardio-pulmonary resuscitation in situations when it becomes futile. Like any other medical procedure, it's based on the “maximum benefit – minimum risk” principle, on one hand, while also respecting the patient's autonomy and dignity. However, they are influenced by the urgency of the situation and the patient's inability to decide. The COVID-19 pandemic poses additional challenges for the process of taking a decision regarding resuscitation. The number of those who need intensive care is increasing daily and, implicitly, of the situations in which it is necessary to make decisions regarding resuscitation. In the meanwhile, health systems across the world are overwhelmed, lacking equipment, and medical staff. Doctors are facing the situation when they should assume, with a great moral burden, the responsibility for the DNR decision, taken unilaterally, by a pragmatic approach, justified by the potential wasting of time and resources, and exposure to the virus. Such a paternalistic approach ignores the patient's view on his/her own treatment, depriving him/her of the right to autonomy. However, when the alternative is death, whatever the risk, it should be accepted. It becomes a problem to determine the extent and conditions of such a decision. The international data on the DNR decisions taken by doctors and the criteria on which they were based are analyzed in the article. The authors conclude that when it is difficult to resuscitate all patients, and the DNR decision is ethically unacceptable, creating a protocol dedicated to the state of crisis, which would protect both doctors and patients is of critical importance.

Prioritising \u2018already-scarce\u2019 intensive care unit resources in the midst of COVID-19: a call for regional triage committees in South Africa

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 (CCSSA) 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 and critical care facilities with as much support and resources as possible in the face of impending pandemic demand. Following a discussion of the ethical considerations and potential challenges in applying the CCSSA guidelines, the authors propose a framework for regional triage committees adapted to the South African context.DiscussionBeyond the national CCSSA guidelines, the clinician has many additional ethical and clinical considerations. No single ethical approach to decision-making is sufficient, instead one which considers multiple contextual factors is necessary. Scores such as the Clinical Frailty Score and Sequential Organ Failure Assessment are of limited use in patients with COVID-19. Furthermore, the clinician is fully justified in withdrawing ICU care based on medical futility decisions and to reallocate this resource to a patient with a better prognosis. However, these decisions bear heavy emotional and moral burden compounded by the volume of clinical work and a fear of litigation.ConclusionWe propose the formation of Provincial multi-disciplinary Critical Care Triage Committees to alleviate the emotional, moral and legal burden on individual ICU teams and co-ordinate inter-facility collaboration using an adapted framework. The committee would provide an impartial, broader and ethically-sound viewpoint which has time to consider broader contextual factors such as adjusting rationing criteria according to different levels of pandemic demand and the latest clinical evidence. Their functioning will be strengthened by direct feedback to national level and accountability to a national monitoring committee. The potential applications of these committees are far-reaching and have the potential to enable a more effective COVID-19 health systems response in South Africa.

Moderasi Pendidikan Islam dan Tantangan Masa Depan

This study aims to elaborate on the moderation of education and the challenges of education in the future. This study uses literature study method. The results of the study show that students are a group that is very vulnerable to being carried away by the flow of religious radicalism. A very young age and considered to be unstable, with a passionate spirit, and a strong desire to enforce religious teachings more comprehensively makes this young group who is within the scope of an educational institution to become the most vulnerable social group to be infiltrated and become the target of radical groups that convey religious understandings and attitudes that are rigid and tend to be superficial. On the other hand, new challenges have begun to emerge, such as advances in science and technology, democratization, and moral decadence that have surrounded human life in this era. So a special strategy is needed to be able to instill moderate Islamic values ​​in students by utilizing teaching and learning activities and parenting patterns that exist in the community or in educational institutions. Because Islamic educational institutions have a moral and social burden to participate in finding the right solution or solution in order to prepare superior human resources who have strong competitiveness for the advancement and harmony of religion, nation and state.

The adaptive moral challenge of COVID-19

This author offers of narrative of hope in response to the coronavirus pandemic by viewing it as a wake-up call to lean into the adaptive moral challenge of stewardship for the future of humanity and the planet. Acknowledging the many material and social benefits of a global regime of free market urbanism built on advances in science and technology, this is a point in geohistory, the Anthropocene, when the impact of human activities on the Earth has begun to outcompete natural processes. The coronavirus has illuminated systemic moral failures and new moral challenges of the Anthropocene that call for adaptive response if we are to build a hopeful future for humanity and the planet. Pointing to millennia of human adaptive response to threats and disasters, the author asserts an evolutionary hardiness attributable as much to moral capacities as rational intelligence as a singularly defining trait fueling millennia of human adaptive learning and thrival. The current pandemic is the latest point in humanity’s moral evolution of adaptive response to moments of urgent threat that have tested, expanded, and defined our character and moral capacities as a species. Rather than falter under the moral burden of the coronavirus threat and its consequences, the author views this pivotal point as an opportunity to stretch human moral horizons by taking responsibility for the urgent moral challenges we have created and inventing new ethical frameworks and tools that will lead us to new moral understandings and solutions to the moral challenges we face.

Urinary System Iatrogenic Injuries: Problem Review

Introduction: From May to December 2019, a literature review of the urinary system iatrogenic injury problem was performed. The most cited, representative articles in PubMed, Scopus, and WoS databases dedicated to this problem were selected. Urinary system iatrogenic injuries include ureter, bladder, urethra, and kidney traumas. It is widely thought that the main causes of such injuries are urological, obstetric, gynecological, and surgical operations on the retroperitoneal space, pelvis, or perineum. Methods: The purpose of the study is to describe all aspects of the iatrogenic injure problem, under the established scheme and for each of the most damaged organs: the urethra, bladder, kidney, and ureter. The treatment of confirmed iatrogenic injuries largely depends on the period of its detection. Modern medical procedures provide conservative or minimally invasive treatment. An untimely diagnosis worsens the treatment prognosis. “Overlooked” urinary system trauma is a serious threat to society and a particular patient. Thus, incorrect or traumatic catheterization can lead to infection (RR 95%) and urethral stricture (RR ≥11–36%), and percutaneous puncture nephrostomy can cause the risk of functional renal parenchyma loss (median 5%), urinary congestion (7%), or sepsis (0.6–1.5%). Results: Lost gain, profits, long-term and expensive, possibly multistage treatment, stress and depression, and the risks of suicide put a heavy financial, moral, and ethical burden on a person and society. Also, iatrogenic injury might have legal consequences. Discussion/Conclusion: Thus, the significant problem of urinary tract iatrogenic injuries is still difficult to solve. There is a need to implement mandatory examining algorithms for patients at risk, as well as the multidisciplinary principle for all pelvic surgery.

Ethics of emerging infectious disease outbreak responses: Using Ebola virus disease as a case study of limited resource allocation.

Emerging infectious diseases such as Ebola Virus Disease (EVD), Nipah Virus Encephalitis and Lassa fever pose significant epidemic threats. Responses to emerging infectious disease outbreaks frequently occur in resource-constrained regions and under high pressure to quickly contain the outbreak prior to potential spread. As seen in the 2020 EVD outbreaks in the Democratic Republic of Congo and the current COVID-19 pandemic, there is a continued need to evaluate and address the ethical challenges that arise in the high stakes environment of an emerging infectious disease outbreak response. The research presented here provides analysis of the ethical challenges with regard to allocation of limited resources, particularly experimental therapeutics, using the 2013–2016 EVD outbreak in West Africa as a case study. In-depth semi-structured interviews were conducted with senior healthcare personnel (n = 16) from international humanitarian aid organizations intimately engaged in the 2013–2016 EVD outbreak response in West Africa. Interviews were recorded in private setting, transcribed, and iteratively coded using grounded theory methodology. A majority of respondents indicated a clear propensity to adopt an ethical framework of guiding principles for international responses to emerging infectious disease outbreaks. Respondents agreed that prioritization of frontline workers’ access to experimental therapeutics was warranted based on a principle of reciprocity. There was widespread acceptance of adaptive trial designs and greater trial transparency in providing access to experimental therapeutics. Many respondents also emphasized the importance of community engagement in limited resource allocation scheme design and culturally appropriate informed consent procedures. The study results inform a potential ethical framework of guiding principles based on the interview participants’ insights to be adopted by international response organizations and their healthcare workers in the face of allocating limited resources such as experimental therapeutics in future emerging infectious disease outbreaks to ease the moral burden of individual healthcare providers.

Strategies of Combating Corruption in Nigeria: The Islamic Perspective

Corruption has become a pandemic and a moral burden that bedeviled the world. Corruption is a practice that permeates all societal segments, sectors, activities and it takes various shapes, forms, dimensions, classifications and manifestations. Nearly all countries of the world are affected by the endemic of corruption albeit, in different magnitude with some having lower incidence while others a high rate of occurrence. Corruption has constituted itself as a political and socioeconomic problem worldwide because it leads to misgovernance, deprivation, inequality and squander of scarce public resources which have the concomitant repercussions of poverty, insecurity, joblessness, hunger and malnutrition, poor healthcare services delivery and low quality education. The problem of corruption took a new dimension when it continuously defies various strategies and alternatives proffered by nation-states, international organisations and agencies. One of the outstanding measures that permanently proves workable is the Islamic model which forbids the practice of corruption and ties it with moral burden and spiritual integrity. Hence, this study presented an alternative model with reference to Nigeria as the area of study. The study utilised a conceptual descriptive approach where documented sources were consulted and analysed. The study discovered that despite the existence of various anti-graft agencies, corruption continues in Nigeria unabated which portrays the need for adopting a different approach and that has been provided as the Islamic perspective. The study recommends among several others that the Islamic ethics and morals of detesting corrupt practices and the accompanied sanctions should be integrated in the crusade against corruption.

Moral Sensitivity, Empathy and Prosocial Behavior: Implications for Humanization of Nursing Care.

Humanization of nursing is related to certain social and moral variables. Moral sensitivity, empathy, and prosocial behavior help understand a situation and make decisions that benefit the patient. The objective of this study is to find out how these variables are related, and define the differences in moral sensitivity, empathy, and prosocial behavior in humanization of nursing. We also analyzed the mediating role of empathy in the relationship between moral sensitivity and prosocial behavior. The sample was made up of 330 Spanish nurses aged 22 to 56, who completed the HUMAS Scale and adapted versions of the Basic Empathy Scale, the Moral Sensitivity Questionnaire, and the Prosocial Behavior Scale. Descriptive analyses, bivariate correlations and multiple mediation models were calculated. The results found significantly different mean scores between all the groups in responsibility and moral strength, cognitive empathy, and prosocial behavior, and in moral burden, the differences were in the high-humanization-score group compared to the low-score group. Furthermore, the mediation models showed the mediating effect of cognitive empathy between the responsibility, strength, and moral burden factors on prosocial behavior, but not of affective empathy. The study concluded that humanization in nursing is closely related to moral sensitivity, cognitive empathy, and prosocial behavior. This facilitates a helping, caring, and understanding attitude toward patient needs, but without the affective flooding that affective empathy can lead to.

The Moral Burden on Economists: Darrick Hamilton’s 2017 NEA Presidential Address

In his 2017 presidential address to the National Economic Association (NEA), Professor Darrick Hamilton warned that treating economics as a morally neutral “science,” and the discipline’s limited attention to structural barriers and overemphasis individual agency, has resulted in bad economics, and bad policy particularly as it relates to racial disparity.

Non-safety costs: A novel methodology for an ex-ante evaluation

The costs related to occupational safety or, more precisely, non-safety aspects in the industry represent a moral and economic burden for individuals, employers and governments. Despite the importance of these costs, firms rarely recognize the real cost of non-safety and the opportunity to invest in improving their safety management system. The time and resources needed to collect appropriate, historical data for the evaluation of non-safety costs are indeed a problem for firms, most of all for small and medium enterprises. This paper develops a methodology for an ex-ante evaluation of non-safety costs, with a specific focus on SMEs, based on the collection of easily deducible data. In particular, the different cost items related to non-safety costs and the factors influencing them are identified. The cost functions for each cost item and, subsequently, the shapes of the cost functions are determined; this allows to cluster firms according to the shapes of functions of each cost item, as well as to understand which are the main occupational safety and health factors that distinguish different small and medium enterprises into peculiar groups. An example application of the methodology in a sample of Italian SMEs is proposed. The application paves the way to some remarks for policy and industrial decision-makers and advice for further research.

The application of family stress management of the quality of life on breast cancer patients

Background: Breast cancer is a malignant tumor that grows around the breast area and can metastasize to other organs of the body. The complaint that is often felt by patients is that it is very severe pain that reduces the patient's ability to carry out daily activities and will affect the patient's quality of life. The role of the family is important in improving the quality of life of patients, with the moral and material burdens of the family that can affect the family in caring for patients. This study aims to determine the quality of life in breast cancer patients after family stress management interventions. Methods: This research method is a qualitative research design with one group pre-test to post-test with consecutive sampling technique on 22 samples. Data analysis methods used were univariate analysis and bivariate analysis with the non-parametric statistical test Wilcoxon signed rank test.Results: The results showed that the asymp.sig value was 0.004 so that it was smaller than 0.05 which showed that there were differences between stress management interventions before and after the interventions. Conclusion: Family stress management interventions affect the quality of life of breast cancer patients.

Adherence and the Moral Construction of the Self: A Narrative Analysis of Anticoagulant Medication.

In this article, we examine illness narratives to illuminate the discursive work that patients undertake to construct themselves as “good” and adherent. Biographical narrative interviews were undertaken with 17 patients receiving anticoagulation for stroke prevention in atrial fibrillation, from five English hospitals (May 2016–June 2017). Through pluralistic narrative analysis, we highlight the discursive tensions narrators face when sharing accounts of their medicine-taking. They undertake challenging linguistic and performative work to reconcile apparently paradoxical positions. We show how the adherent patient is co-constructed through dialogue at the intersection of discourses including authority of doctors, personal responsibility for health, scarcity of resources, and deservingness. We conclude that the notion of medication adherence places a hidden moral and discursive burden of treatment on patients which they must negotiate when invited into conversations about their medications. This discursive work reveals, constitutes, and upholds medicine-taking as a profoundly moral practice.

Utility of Liver Transplantation Within the Bounds of Non-futility

To evaluate the measures of utility of liver transplant within the bounds of non-futility for controversial and high-risk scenarios associated with greatest transplant benefit and also possibilities of high futility. Liver organ allocation policies are routinely adjusted to be in line with the Final Rule, maximizing transplant opportunities and minimizing futile transplants. Transplanting patients with high survival benefit is the construct of the liver allocation models with “sickest first” approach, but such policies have unintended consequences of futile transplants which raise ethical controversies and moral burdens on transplant physicians. Various adjustments are proposed to make the liver organ allocation models effective in high-risk scenarios which yield greatest transplant benefit for patients and satisfaction for the transplant physicians while minimizing disappointment among them from reduced futile efforts. They also offer ethical and effective allocation strategies of scare medical resource, i.e., liver.

Correction to: Moral Burden of Bottom-Line Pursuits: How and When Perceptions of Top Management Bottom-Line Mentality Inhibit Supervisors’ Ethical Leadership Practices

Correction to: Moral Burden of Bottom-Line Pursuits: How and When Perceptions of Top Management Bottom-Line Mentality Inhibit Supervisors’ Ethical Leadership Practices

'And breathe…'? The sociology of health and illness in COVID-19 time.

'And breathe…'? The sociology of health and illness in COVID-19 time.

Legal Issues of Resource Allocation in the COVID-19 Pandemic - Between Utilitarianism and Life Value Indifference

The COVID-19 pandemic poses unprecedented challenges for the German health care system. What is already the case in some other countries, may occur in Germany in the near future also: Faced with limited ICU resources, doctors will be forced to decide which patients to treat and which to let die. This paper examines the legal implications of such decisions. It takes up arguments from the general discussion on prioritization in medicine. A constitutional hurdle for the application of utilitarian criteria (in particular patients' age or social role) comes from the principle that every human life is of equal value and must not be traded off against others ("life value indifference"). However, the limits that the Grundgesetz (German Basic Law) sets for state actions do not apply directly to doctors. According to the Musterberufsordnung (professional code of conduct), doctors act based on their conscience and the requirements of medical ethics and humanity. The implications of this normative standard for the prioritizing in an exceptional situation as the COVID 19 pandemic have not been sufficiently clarified. This uncertainty leads to emotional and moral burdens for doctors. The authors conclude that the German law grants a limited freedom of choice that allows physicians to apply utilitarian criteria in addition to purely medical decision algorithms.

Lingering guilt and shame: Emotional burdens upon those who intended but failed to apologize

ABSTRACT Prior research has shown that greater willingness to apologize for an offense is prompted by greater guilt but lesser shame. Yet little work examined whether apologies indeed resolve moral emotions. This study investigated how the absence of apology psychologically affects harm-doers when they recall a past offense. Undergraduates (N = 284) were randomly assigned to one of the four experimental conditions wherein they recalled a past incident in which they hurt, offended, angered, or had some other negative effect on another person. Harm-doers who intended but failed to apologize reported greater PFQ-2 state guilt and shame, compared to others who refused to apologize or whose apologies were rejected. However, similar results were not found for ESS state shame. Results suggest that failing to apologize may impede transgressors from relieving moral emotional burdens, but only for those who intended to apologize.

The relationship between coronary artery disease and depression and anxiety scores.

Coronary artery disease (CAD) is one of the severe diseases that may cause significant moral and financial burden on society today. There are many studies in the literature on whether psychiatric disorders may cause CAD or an increase in prevalence after CAD. Although many studies have emphasized the importance of early diagnosis and treatment of depression in CAD patients, clinicians do not attach much attention to depression in daily practice. Several scales have been developed that are comfortable to use to describe anxiety and depression in CAD patients. High depression and anxiety scores predicted by psychological symptom scales following CAD treatment are closely related to treatment success and prognosis of the CAD. We believe that patients with CAD should be followed carefully for the diagnosis of depression and anxiety disorders; since the treatment of them may improve the prognosis of CAD.

The Moral Burdens of Police Wrongdoing

When addressing the burdens borne by victims of police wrongdoing, we often overlook moral harms in focusing on the physical and psychological harms that they suffer. These moral harms undermine the moral status of the victim, her ability to consistently pursue the values she endorses, and her character. Victimhood is a morally significant social role. Victimhood imposes normative standards that measure the moral or political status of victim. Conforming to these standards affects our assessment of the conduct of the victim and her moral standing. Considering the victims’ role provides important insights into contemporary practices of policing in the United States. The physical and verbal acts of the police often force race-based degradation upon racially subordinated groups. There is often no morally good way out of racially discriminatory encounters when the choice is to degrade oneself or suffer violence or even death. In these encounters, whatever happens, the police intentionally wrong their target. The police require African Americans to perform deference-rituals that often mimic the ways in which African Americans were required to supplicate themselves during the eras of slavery and segregation. Whilst surviving these degradading encounters may itself be an act of resistance, nonetheless point of degradation is to compromise the victim’s self-worth. The wrong inflicted is to compromise the value of self-respect, leading to a morally blemished life. Accordingly, one of the consequences of police oppression is to inflict race-targeted moral, not merely psychological or physical, harm on the people they police. Worse, how we respond to the threat of police violence morally undermines our roles and relationships with those we would keep safe from police violence. To avoid the physcial harms of policing, we often given “the talk” to advise the people we love and seek to protect—our children, our siblings, our friends—to behave deferentially towards the police in degrading ways that undermine the value of self-respect. This advice, though it is also an act of resistance, undermines other duties we owe to the people we love: duties to promote their flourishing, for example. The reach of police oppression thus extends to taint even the most private and cherished moments that we share with those we love precisely at the point we express that love. This is the insidious feature of moral oppressoin. Finally, we should recognize that this form of oppression could be avoided if bystanders would recognize and respond to the moral burdens of policing. Unfortunately, however, the majority of bystanders in the United States fail to care sufficiently to act on their moral duty to prevent oppression. This thoughtlessness is itself a form of disrespect, which is a moral wrong that passively or actively supports racial oppression.

The older surgical patient - to operate or not? A state of the art review.

The increasing age and subsequent medical complexity of patients presenting for surgery grants the opportunity to examine the processes and delivery of peri-operative care. There is a need to redesign peri-operative pathways allowing room for shared decision making and personalised, evidence-based care. In times of financial constraint, this is no easy task. However, neglecting to transform services now may lead to challenges in the sustainability of the provision of peri-operative care in the long-term. Challenges in redesigning peri-operative care pathways include identification and optimisation of those at highest peri-operative risk to inform the difficult conversations surrounding the appropriateness of surgery. The moral burden of these conversations on patient and professionals alike is increasingly recognised and managing this issue requires innovative models of collaborative, multidisciplinary and interprofessional working. To operate or not can be a challenging question to answer with a number of different perspectives to consider; not least that of the patient.