Volume 10, Issue 1 (3-2022)                   Jorjani Biomed J 2022, 10(1): 84-95 | Back to browse issues page


XML Print


1- Department of Corrective Exercise and Sport Injury, Faculty of Sport Sciences, University of Guilan, Rasht, Iran
2- 1. Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran.2. Burn and Regenerative Medicine Research Center, Guilan University of Medical Sciences, Rasht, Iran. , sami.karkhah@yahoo.com
3- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
4- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran.
5- Department of Medical-Surgical Nursing, Nasibeh School of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran
6- 1. Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, Iran.2. Burn and Regenerative Medicine Research Center, Guilan University of Medical Sciences, Rasht, Iran.
Abstract:   (4158 Views)

Background and Objective: Since December 2019, the widespread outbreak of COVID-19 has led to a major public health issue worldwide. With the spread of the COVID-19 pandemic, a series of ethically challenging issues arose that put pressure on healthcare systems around the world. This narrative review aims to comprehensively review the literature focusing on ethical challenges and coping strategies about issues related to the healthcare system and social issues during the COVID-19 pandemic.
Material and Methods: This narrative review was conducted via international databases including PubMed/MEDLINE, Web of Science, and Scopus using keywords extracted from medical subject headings such as "COVID-19", "2019-nCoV disease", "2019 novel coronavirus infection", "Ethics", "Bioethical Issues", "Morals", "Coping Skills", "Coping Skill", "Coping Strategies", and "Coping Strategy" from December 2019 to January 2022.
Results: In general, ethical issues during the COVID-19 pandemic can be divided into two categories: 1) issues related to the healthcare system and 2) social issues. Issues related to the healthcare system can be divided into two categories: 1) lack of resources, equipment and facilities, and manpower, and 2) problems in patient care such as triage and informed consent. Social issues can be divided into four categories: 1) community engagement, 2) crisis management capacity in remote rural communities, 3) discrimination and health equity, and 4) vaccination. Coping with ethical challenges in crises such as COVID-19 requires changing health empowerment policies and strategies based on evidence-based research. On the other hand, overcome on these challenges requires interdisciplinary collaboration and fast efficient decisions.
Conclusion: Overall, the present study introduced ethical challenges and coping strategies during the COVID 19 pandemic. The experience gained from this pandemic can be considered by managers and policymakers of health care systems for coping with ethical challenges.


Full-Text [PDF 594 kb]   (987 Downloads) |   |   Full-Text (HTML)  (1232 Views)  

 With the spread of the COVID-19 pandemic, a series of ethically challenging issues arose that put pressure on healthcare systems around the world.
 Ethical issues can be divided into two categories: 1) issues related to the healthcare system and     2) social issues.
 Coping with ethical challenges in crises such as COVID-19 requires changing health empowerment policies and strategies based on evidence-based research.
 Overcome on ethical challenges requires interdisciplinary collaboration and fast efficient decisions.
Type of Article: Review Article | Subject: General medicine
Received: 2021/12/13 | Accepted: 2022/04/9 | Published: 2022/03/30

References
1. Emami Zeydi A GM, Shaikhi Sanandaj F, Panahi R, Mortazavi H, Karimifar K, et al. Coronavirus disease 2019 (COVID-19): A literature review from a nursing perspective. BioMedicine. 2021;11(3):5-14. [DOI] [PMID] [PMCID] [Google Scholar]
2. Karkhah S, Ghazanfari MJ, Shamshirian A, Panahi L, Molai M, Zeydi AE. Clinical features of patients with probable 2019 novel coronavirus infected pneumonia in Rasht, Iran: A retrospective case series. Open Access Macedonian Journal of Medical Sciences. 2020;8(T1):16-22. [view at publisher] [DOI] [Google Scholar]
3. Monfared A, Moghadamnia Mt, Karkhah S, Maroufizadeh S, Asadian Rad M, Kheirkhah J, et al. A Survey for Predictors of Mortality among COVID-19 Patients: A Retrospective Study from Iran. Jorjani Biomedicine Journal. 2021;9(4):13-21. [view at publisher] [Google Scholar]
4. Mobayen M, Ghazanfari MJ, Feizkhah A, Zeydi A, Karkhah S. Effects of COVID-19 pandemic on burns care. Burns: Journal of the International Society for Burn Injuries. 2022. [DOI] [PMCID] [Google Scholar]
5. Ghazanfari MJ, Karkhah S, Taghadosi M. POTENTIAL INTERACTIONS BETWEEN CARDIOVASCULAR AND COVID-19 MEDICATION REGIMENS AMONG PATIENTS WITH HEART FAILURE. Pakistan Heart Journal. 2022;55(1):92-3. [view at publisher] [DOI] [Google Scholar]
6. Organization WHO Coronavirus (COVID-19) Dashboard 2022 [Available from: https://covid19.who.int/.
7. Ghazanfari MJ, Emami Zeydi A, Panahi R, Ghanbari R, Jafaraghaee F, Mortazavi H, et al. Moral distress in nurses: Resources and constraints, consequences, and interventions. Clinical Ethics. 2021:14777509211034142. [view at publisher] [DOI] [Google Scholar]
8. Zeydi AE, Ghazanfari MJ, Suhonen R, Adib-Hajbaghery M, Karkhah S. Effective interventions for reducing moral distress in critical care nurses. Nursing Ethics.09697330211062982. [view at publisher] [Google Scholar]
9. Calia C, Reid C, Guerra C, Oshodi A-G, Marley C, Amos A, et al. Ethical challenges in the COVID-19 research context: a toolkit for supporting analysis and resolution. Ethics & Behavior. 2021;31(1):60-75. [view at publisher] [DOI] [Google Scholar]
10. Gilbert M, Dewatripont M, Muraille E, Platteau J-P, Goldman M. Preparing for a responsible lockdown exit strategy. Nature medicine. 2020;26(5):643-4. [view at publisher] [DOI] [PMID] [PMCID] [Google Scholar]
11. Javadi-Pashaki N, Ghazanfari MJ, Miri S, Karkhah S. Decreased life expectancy among older people during the COVID-19 pandemic: A public health issue. Jorjani Biomedicine Journal. 2021;9(4):62-4. [Google Scholar]
12. Bruno B, Shalowitz DI, Arora KS. Ethical challenges for women's healthcare highlighted by the COVID-19 pandemic. Journal of medical ethics. 2021;47(2):69-72. [DOI] [PMID] [PMCID] [Google Scholar]
13. Cox S. To dispense or not to dispense: Lessons to be learnt from ethical challenges faced by pharmacists in the COVID‐19 pandemic. Developing world bioethics. 2021;21(4):193-200. [view at publisher] [DOI] [PMID] [PMCID] [Google Scholar]
14. Sobh Z, El-Banna AS. COVID-19 pandemic: Ethical challenges of healthcare and research. Zagazig Journal of Forensic Medicine. 2021;19(1):1-10. [view at publisher] [DOI] [Google Scholar]
15. Guttman N, Lev E. Ethical issues in COVID-19 communication to mitigate the pandemic: dilemmas and practical implications. Health Communication. 2021;36(1):116-23. [view at publisher] [DOI] [PMID] [Google Scholar]
16. Hsu NS, Hendriks S, Ramos KM, Grady C. Ethical considerations of COVID-19-related adjustments to clinical research. Nature medicine. 2021;27(2):191-3. [view at publisher] [DOI] [PMID] [Google Scholar]
17. Association BM. COVID-19-ethical issues. A guidance note. British Medical Association. 2020.
18. Chiumento A, Rahman A, Frith L, Snider L, Tol WA. Ethical standards for mental health and psychosocial support research in emergencies: review of literature and current debates. Globalization and health. 2017;13(1):1-19. https://doi.org/10.1186/s12992-017-0264-2 [view at publisher] [DOI] [PMID] [PMCID] [Google Scholar]
19. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Bmj. 2021;372. [view at publisher] [DOI] [PMID] [PMCID] [Google Scholar]
20. McGuire AL, Aulisio MP, Davis FD, Erwin C, Harter TD, Jagsi R, 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. 2020;20(7):15-27. [view at publisher] [DOI] [PMID] [Google Scholar]
21. Emanuel EJ, Persad G, Upshur R, Thome B, Parker M, Glickman A, et al. Fair allocation of scarce medical resources in the time of Covid-19. Mass Medical Soc; 2020. p. 2049-55. [view at publisher] [DOI] [PMID] [Google Scholar]
22. Mascha EJ, Schober P, Schefold JC, Stueber F, Luedi MM. Staffing with disease-based epidemiologic indices may reduce shortage of intensive care unit staff during the COVID-19 pandemic. Anesthesia and analgesia. 2020;131(1):24. [view at publisher] [DOI] [PMID] [PMCID] [Google Scholar]
23. Chan PS, Berg RA, Nadkarni VM. Code blue during the COVID-19 pandemic. Circulation: Cardiovascular Quality and Outcomes. 2020;13(5):e006779. [view at publisher] [DOI] [PMID] [PMCID] [Google Scholar]
24. Mahendradhata Y, Andayani NLPE, Hasri ET, Arifi MD, Siahaan RGM, Solikha DA, et al. The capacity of the Indonesian healthcare system to respond to COVID-19. Frontiers in public health. 2021;9:887. [view at publisher] [DOI] [PMID] [PMCID] [Google Scholar]
25. Biddison ELD, Faden R, Gwon HS, Mareiniss DP, Regenberg AC, Schoch-Spana M, et al. Too many patients… a framework to guide statewide allocation of scarce mechanical ventilation during disasters. Chest. 2019;155(4):848-54. [view at publisher] [DOI] [PMID] [Google Scholar]
26. Cook AF, Hoas H. Ethics and rural healthcare: What really happens? What might help? The American Journal of Bioethics. 2008;8(4):52-6. [view at publisher] [DOI] [PMID] [Google Scholar]
27. Quinn SC, Kumar S. Health inequalities and infectious disease epidemics: a challenge for global health security. Biosecurity and bioterrorism: biodefense strategy, practice, and science. 2014;12(5):263-73. [view at publisher] [DOI] [PMID] [PMCID] [Google Scholar]
28. Ramos E, Zamudio MI. In Chicago, 70% of Covid-19 deaths are black. NPR-WBEZ Chicago Available from: https://www wbez org/stories/in-chicago-70-of-covid-19-deaths-are-black/dd3f295f-445e-4e38-b37f-a1503782b507. 2020.
29. Holman N, Knighton P, Kar P, O'Keefe J, Curley M, Weaver A, et al. Risk factors for COVID-19-related mortality in people with type 1 and type 2 diabetes in England: a population-based cohort study. The lancet Diabetes & endocrinology. 2020;8(10):823-33. [view at publisher] [DOI] [Google Scholar]
30. Fakih MG, Ottenbacher A, Yehia B, Fogel R, Miller C, Winegar A, et al. COVID-19 hospital prevalence as a risk factor for mortality: an observational study of a multistate cohort of 62 hospitals. BMJ quality & safety. 2022;31(1):45-53. [view at publisher] [DOI] [PMID] [PMCID] [Google Scholar]
31. O'Driscoll M, Dos Santos GR, Wang L, Cummings DA, Azman AS, Paireau J, et al. Age-specific mortality and immunity patterns of SARS-CoV-2. Nature. 2021;590(7844):140-5. [view at publisher] [DOI] [PMID] [Google Scholar]
32. Kiem CT, Massonnaud CR, Levy-Bruhl D, Poletto C, Colizza V, Bosetti P, et al. A modelling study investigating short and medium-term challenges for COVID-19 vaccination: From prioritisation to the relaxation of measures. EClinicalMedicine. 2021;38:101001. [view at publisher] [DOI] [PMID] [PMCID] [Google Scholar]
33. Wouters OJ, Shadlen KC, Salcher-Konrad M, Pollard AJ, Larson HJ, Teerawattananon Y, et al. Challenges in ensuring global access to COVID-19 vaccines: production, affordability, allocation, and deployment. The Lancet. 2021. [view at publisher] [DOI] [Google Scholar]
34. Skjefte M, Ngirbabul M, Akeju O, Escudero D, Hernandez-Diaz S, Wyszynski DF, et al. COVID-19 vaccine acceptance among pregnant women and mothers of young children: results of a survey in 16 countries. European journal of epidemiology. 2021;36(2):197-211. [view at publisher] [DOI] [PMID] [PMCID] [Google Scholar]
35. Bubar KM, Reinholt K, Kissler SM, Lipsitch M, Cobey S, Grad YH, et al. Model-informed COVID-19 vaccine prioritization strategies by age and serostatus. Science. 2021;371(6532):916-21. [view at publisher] [DOI] [PMID] [PMCID] [Google Scholar]
36. Sandmann FG, Davies NG, Vassall A, Edmunds WJ, Jit M, Sun FY, et al. The potential health and economic value of SARS-CoV-2 vaccination alongside physical distancing in the UK: a transmission model-based future scenario analysis and economic evaluation. The Lancet Infectious Diseases. 2021. [view at publisher] [DOI] [Google Scholar]
37. Lapolla A, Dalfrà M, Burlina S. Vaccination against COVID-19 infection: the need of evidence for diabetic and obese pregnant women. Acta Diabetologica. 2021;58(12):1581-5. [view at publisher] [DOI] [PMID] [PMCID] [Google Scholar]
38. Powers AC, Aronoff DM, Eckel RH. COVID-19 vaccine prioritisation for type 1 and type 2 diabetes. The Lancet Diabetes & Endocrinology. 2021;9(3):140-1. [view at publisher] [DOI] [Google Scholar]
39. Farrell TW, Ferrante LE, Brown T, Francis L, Widera E, Rhodes R, et al. AGS position statement: resource allocation strategies and age‐related considerations in the COVID‐19 era and beyond. Journal of the American Geriatrics Society. 2020;68(6):1136-42. [view at publisher] [DOI] [PMID] [PMCID] [Google Scholar]
40. Control CfD, Prevention. Strategies to mitigate healthcare personnel staffing shortages. 2020. [view at publisher] [Google Scholar]
41. Javadi‐Pashaki N, Ghazanfari MJ, Karkhah S. COVID‐19 pandemic: An opportunity to promote e‐learning in the nursing profession. Journal of clinical nursing. [view at publisher] [Google Scholar]
42. Ogunkola IO, Adebisi YA, Imo UF, Odey GO, Esu E, Lucero-Prisno DE, 3rd. Rural communities in Africa should not be forgotten in responses to COVID-19. Int J Health Plann Manage. 2020;35(6):1302-5. [view at publisher] [DOI] [PMID] [PMCID] [Google Scholar]
43. Bagenstos SR. May hospitals withhold ventilators from COVID-19 patients with pre-existing disabilities? Notes on the law and ethics of disability-based medical rationing. Notes on the law and ethics of disability-based medical rationing (March 24, 2020). 2020;130:20-007. [DOI] [Google Scholar]
44. Gur-Arie R, Jamrozik E, Kingori P. No jab, no job? Ethical issues in mandatory COVID-19 vaccination of healthcare personnel. BMJ global health. 2021;6(2):e004877. [view at publisher] [DOI] [PMID] [PMCID] [Google Scholar]

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.