Class 11 2024 Ethical Issues in Disaster and Pandemic Response PDF

NUR1 424 Ethical Issues in Disaster and Pandemic Preparedness & Response – with Global Health Themes Public Health Ethics Part 2 – Contexts – Class 11 - 2024 Copyright © 2024 Ingram School of Nursing V.1 ...

NUR1 424 Ethical Issues in Disaster and Pandemic Preparedness & Response – with Global Health Themes Public Health Ethics Part 2 – Contexts – Class 11 - 2024 Copyright © 2024 Ingram School of Nursing V.1  nursing: vaccination: public health, baby delivery, wound care Public Health Contexts Public Health Ethics in disaster/emergency planning & responses: Articulate key concepts in disaster and pandemic preparedness and planning Different steps in Emergency Planning Discuss ethical and legal considerations relevant to pandemics Articulate underlying values, principles, and process considerations in ethical analysis related to COVID-19 in Canada Discuss professional responsibilities and duties in a variety of contexts Reflect on cases, examples, and experience relevant to COVID-19 and other disaster/emergency events Global Health Ethics Articulate criticisms as to Global health Ethics Discuss ethical issues in humanitarian work, pharmaceutical access, and nursing opportunities as novice nurses Identify key questions to guide action in Global Health @ Copyright ISoN Photos used by @Miller or @CC from UnSplash V.1 Man-Made Disasters 5  Often Credited to Benjamin Franklin – but the source is a bit preparation is KEY nebulous… still a good quote! NUR1 - 424 6  Emergency Preparedness/ Disaster Planning 4 Pillars of Emergency Management ◉ Prevention and Mitigation process of minimizin, identify risk and prevent them, trying limit impact if something is already happening (environment) ◉ Preparedness simulation in school During a natural or human-made disaster, including a how are we able to respond quickly to an event, code orange protocole when the event happen, immidiate ◉ Response reaction, mobilizing responders communicable disease outbreak, nurses provide care using appropriate safety precautions in ◉ Recovery returning back to normal after event: debriefing accordance with legislation, regulations and guidelines provided by government, regulatory bodies, employers, unions and professional associations. A9 CNA Code of Ethics 7:19 PM GAME TIME what is exprected of nurses http://www.wp ro.who.int/hrh /documents/ic n_framework.p df p.49 7:19 PM 11 how Stamler et al. (2020). Community Health Nursing: A Canadian Perspective. P. 584 12 Our most recent experience: COVID-19 as a Test ‘The coronavirus pandemic is a test. It’s a test of medical capacity and political will. It’s a test of endurance and forbearance, for believers a test of religious faith. It’s a test, too, of a different kind of faith, in the strength of the ideas humans choose to help them form moral judgments and guide personal and social behavior.’ John Authers in Schwartz, M.E. (ed) (2020) The Ethics of Pandemics, Toronto: Broadview Press. P.2 Reading Which case(s) best highlight your own experiences from your practice? Reflect on the public health ethical principles discussed in last class. What are 1-2 principles that relate to the ethical considerations during a pandemic? NUR1 - 424 Lived experience: What are the ethical themes? video : -healthcare does not serve everyone equaly (equality) -covid: prioritize personal protectin (getting covid, giving covid to close people) V.1  Major Ethical Issues in Pandemic Planning -fear of catching covid and bringing home -social justice health equity Allocating scarce resources for both prevention and treatment Obligation of healthcare workers to provide care in the face of risk to self and family and reciprocal obligations of organizations to their workers Implementing coercive restrictions and social distancing measures on individuals & groups removing freedoms Obligations between countries in planning and response (MacDonald, 2013)  rationaning: only in exrreme Allocation of Resources – Scarcity Situation situation intrumental value: waht about healthcare worker who gets sick and need ICU care, who do we prioritize triage: way of doing triage changes when there is an emergency, we have ti take into account chances of recovery Emanuel, E. J., Persad, G., Upshur, R., Thome, B., Parker, M., Glickman, A.,... & Phillips, J. P. (2020). Fair allocation of scarce medical resources in the time of Covid-19. New England Journal of Medicine, 382(21), 2049-2055. Allocation of Resources in Humanitarian Crisis 18  Ethics-informed Policy intersectoral interventions negative imapct: getting covid VS mental health during quarantine -household violence "Policy decisions turn on ethical questions and on, importantly, how we should weigh the good of preventing the spread of and death from the disease against negative health impacts (short and long-term) indirectly caused by various quarantine measures, and against other social goods and values in addition to health.“ (Yeo, Moorhouse & Rodney, 2020, p. 433)  Public health ethics framework: A guide for use in response to the COVID-19 pandemic in Canada ◉ Step 1: Identify the issue and gather the relevant facts in order to clearly understand the problem ◉ Step 2: Identify and analyse ethical considerations, and Looks Familiar? prioritise the values and principles that will be upheld ◉ Step 3: Identify and assess options in light of the values and principles ◉ Step 4: Select best course of action and implement ◉ Step 5: Evaluate https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection/canadas- reponse/ethics-framework-guide-use-response-covid-19-pandemic.html 20 in scientific uncertainity: we don't know everything but preventice measure are still put into place key; population need to trust to respect values that undermine all the values 21 22 Process – Cited Government of Canada (2020) https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection/canadas-reponse/ethics-framework-guide-use-response-covid-19-pandemic.html#a2 Copyright © 2023 Ingram School of Nursing V.1  424 Professional Responsibilities in Disaster and Pandemic Response Public Health Ethics Part 2 - Contexts Copyright © 2024 V.1 Ingram School of Nursing  Examples Image: Screenshot of CBC News Article (2020). Retrieved from https://www.cbc.ca/news/canada/london/ontario-superior-court-justice-injunction-ontario-nurses-association-henley-place-london-three-other-homes-1.5543528 https://www.cbc.ca/news/canada/london/ontario-superior-court-justice-injunction-ontario-nurses-association-henley-place-london-three-other-homes- https://www.cbc.ca/news/canada/london/ontario-superior-court-justice-injunction-ontario-nurses-association-henley-place-london-three-other-homes-1.5543528 https://nationalpost.com/news/canada/quebec-coroner-to-investigate-31-deaths-at-seniors-home-near-montreal 1.5543528; Screenshot of National Post article (2020). https://nationalpost.com/news/canada/quebec-coroner-to-investigate-31-deaths-at-seniors-home-near-montreal; Screenshot of LeDroit Article (2021). Retrieved from : https://www.ledroit.com/2021/04/29/un-autre-travailleur-de-la-sante-succombe-a-la-covid-19-3e246e649185ffd900e5bf3a08911698?nor=true https://www.ledroit.com/2021/04/29/un-autre-travailleur-de-la-sante-succombe-a-la-covid-19-3e246e649185ffd900e5bf3a08911698?nor=true Balancing Duty & Risk DUTY RISK A nurse’s duty of care is not absolute (CNA 2020) we as nurse have duty society also has a duty to us; provide us safe work environment CNA Code of Ethics “During a natural or human-made disaster, including a communicable disease outbreak, nurses provide care using appropriate safety precautions in accordance with legislation, regulations and guidelines provided by government, regulatory bodies, employers, unions and professional associations.” (A9) "Nurses’ employers have a reciprocal duty to protect and support them as well as to provide necessary and sufficient protective equipment and supplies that will “maximally minimize risk” to nurses and other health-care providers." (P. 39) OIIQ Position statement on professional duties https://www.oiiq.org/documents/20147/237836/enonce-soin- protection-def.pdf Copyright © 2022 Ingram School of Nursing V.1  Deployment nurse 10 years surgery; you need to be floated elswhere ethical issue: lack of training, lack of autonomy and choice moving ressources to another (1st unit is short), justice and beneficience for patients Expertise – Comfort Keeping nursing knowledge up-to-date https://www.oiiq.org/en/covid-19-une- reaffectation-pour-contribuer-aux-efforts- de-lutte Preservation of Dignity During COVID-19 saw stark examples of neglect Actions to promote dignity: Advocacy Family-Centered Care Palliative Approach Taking into account structural vulnerability (CNA, 2020) Image: Screenshot of CBC News Article. By Kate McKenna (2020). Retrieved from https://www.cbc.ca/news/canada/montreal/chsld-herron-ciusss-ouest-de-l-%C3%AEle-de-montr%C3%A9al-slow-to-act-1.5536996  A lens for our elders "La tempête qui nous a frappés n’a fait que mettre en lumière les faiblesses structurelles du réseau déjà à bout de souffle, et ce, depuis déjà trop longtemps. Une réflexion sociétale doit être amorcée. Des projets qui ne reposent pas uniquement sur du béton, mais également sur des projets innovateurs qui mettront l’accent sur notre volonté à redéfinir la place des aînés au centre de nos préoccupations. Le choc démographique est à nos portes, il faut s’y pencher rapidement avec une lentille dédiée aux aînés." structural weakness of healthcare system was already streched before covid -agissim ; elderly no longer seen as people Me Géhane Kamel, coroner (2022)  Professional Communication -conficiendality/privacy -when you speak as a nurse there are special duty Image: Screenshot of CTV News Article. By Canadian Press Staff (2020). Retrieved from Image: Screenshot of Radio Canada Article. By Yannick Bergeron (2020). Retrieved from https://montreal.ctvnews.ca/watch-what-you-say-about-covid-19-on-social-media-quebec- https://ici.radio-canada.ca/nouvelle/1724614/richard-jette-religion-dieu-croyance-physio college-of-physicians-warns-its-members-1.4967847  424 Public Adherence, Surveillance, and Data in Disasters & Pandemics Public Health Ethics Part 2 - Contexts Copyright © 2024 Ingram School of Nursing V.1 Obligations of Citizens What obligations do citizens have to healthcare providers and to society? -respect the rules put in place by public health 0they should contribute by repsective public health measure (Wright, Peterson & Gifford, 2020) Copyright © 2024 Ingram School of Nursing V.1 “…the justification for coercive public health measures that impede individual liberty is not paternalism – for the good of the person whose liberty is being curtailed – but rather the harm principle, namely the curtailment of our right and liberties to the extent that we pose a threat to others, and related to this, pose a threat to the greater good of society. In a sense we all become “patients” of public health.” (Yeo, Moorhouse, Khan& Rodney, 2020, p. 444) What about when they don’t? What ethical questions were raised when there was push back related to public health interventions? https://globalnews.ca/news/8186324/hospital-protests- morale-blow-hcw/ Surveillance, Confidentiality & Privacy  Ethical Considerations for Contact Tracing and Data -privacy/conficiendality -consent: not acti of consent in data monitoring “Yet such uses of data may also threaten fundamental human rights and liberties during and after the COVID-19 pandemic. Surveillance can quickly traverse the blurred line between disease surveillance and population surveillance. Thus, there is a need for laws, policies and oversight mechanisms to place strict limits on the use of digital proximity tracking technologies and on any research that uses the data generated by such technologies.” (WHO, 2020, p.1) NUR1 - 424  “Is it morally permissible to use cell phones to collect/monitor location data in order to reduce the spread of Covid-19?” 1.What are the expected health benefits of the intervention for the population? 2.What are the potential burdens and harms of the intervention? (2015) Markmann et al. 3.How does the intervention affect the autonomy of the individuals in the target population? 4.Impact on equity: How are the benefits and burdens distributed? 5.Efficiency: What are the costs and opportunity costs of the intervention? NUR1 - 424 Copyright © 2022 Ingram School of Nursing V.1 canari would die V.1  THEMES whislte blowing advocacy of nurses solidarity between nurses and their team Gagnon, M., Perron, A., Dufour, C., Marcogliese, E., Pariseau-Legault, P., Wright, D. K.,... & Carnevale, F. A. (2022). Blowing the whistle during the first wave of COVID-19: A case study of Quebec nurses. Journal of Advanced Nursing, 78(12), 4135-4149. V.1 Whistle Blowing – CNA Code of Ethics Copyright © 2022 Ingram School of Nursing V.1 What should we have done better? Lessons drawn: Rapport de la Directrice 2022 – November 2022 Capacity Reduction Conditions Transparent and building of of the Transparent Communication Levers for an public health collateral Communication efficient for Collective and to ensure impacts of for Collective Engagement coherent adequate the Engagement idea of trust, you want the public to come coordinated preparation pandemic alongside response in and response and emergency in urban recovery situations food insecurity context mental heahtl we need to prepare https://santemontreal.qc.ca/fileadmin/fichiers/professionnels/DRSP/Directeur/Rapports/Rapport_de_la_directrice_2022.pdf Copyright © 2022 Ingram School of Nursing V.1 So many more issues beyond class and readings Collateral issues Family violence Educational attainment Mental health/Isolation Equity Vaccination policies Resources allocation Surgeries Nursing resources PPE Duties/Responsibility to other nations V.1  NUR1 424 Ethical Considerations for Global Health Class 11– Global Health Ethics Copyright © 2024 Ingram School of Nursing V.1  Full Circle all of us, not us VS them Yet from discomfort - Transformation Start from here Dr. Senait Fisseha Dr. Madhu Pai Vaccine + Humanitarian Opportunities Medicine Action to be invested Allocation V.1  Ethical Questions in Global Health Moral duties across Nations? North to South? Moral Relativism vs. Universalism? Resource allocation for health, research, etc… Image: Fig 1. Global health, as currently practiced, has many asymmetries in power and privilege. Image source: Madhukar Pai, with artwork by Sophie Lane. In Abimbola et al. (2021). CC BY. https://doi.org/10.1371/journal.pmed.1003604.g001 Copyright © 2024 Ingram School of Nursing https://www.theguardian.com/environment/2023/nov/03/un-climate- Tosam, M. J. (2020). https://www.lapresse.ca/debats/opinions/2023-04-05/recrutement- crisis-talks-resume-loss-damage-funding-poorest-countries international-des-infirmieres/le-pillage-de-ceux-qui-n-ont-rien.php Copyright © 2024 Ingram School of Nursing  Moral Responsibility for Global Health? Best interest Perspective Humanitarian Duty Justice and Human Rights Photo by Yannis H on Unsplash (Wolff, J.2021) Copyright © 2024 Ingram School of Nursing Global Health Ethics for Students Pinto, A. D., & Upshur, R. E. (2009). Global health ethics for students. Developing world bioethics, 9(1), 1–10. DOI: 10.1111/j.1471- 8847.2007.00209.x NUR1 - 424 Copyright © 2024 Ingram School of Nursing V.1 HUMILITY ◉ Recognizing your own limitations ◉ Life-long learning ◉ Seeking direction from host community as to needs and research questions NUR1 - 424 Copyright © 2022 Ingram School of Nursing V.1  The need for Introspection Cole, T. (2012). The white-savior industrial complex. The Atlantic, 21(1). Copyright © 2024 ngram School of Nursing INTROSPECTION Rigorous examination of one’s motives (and understanding the limited resources) One’s own privilege Colonialism, imperialism, ethnocentrism, systemic social inequality Ethics in Global Health ◉ Power imbalances - challenging patient autonomy, informed consent, issues of access ◉ Confidentiality ◉ Balancing learning needs with right to appropriate care ◉ Research issues: ○ Who benefits? Drug trials? Access to results? ○ Is it equity-linked? ◉ Voluntourism Pinto, A. D., & Upshur, R. E. (2009). Global health ethics for students. Developing World Bioethics, 9(1), 1-10.  SOLIDARITY Personhood as Interrelated – Us All Aligning Goals Ongoing Relationships Bridging Power Imbalances Terrance Osborne, CC BY-SA 4.0 V.1 Copyright © 2024 Ingram School of Nursing Humanitarian Action V.1  Humanitarian Principles we are doing better: but more conflict, covid 19, crisis overlapp, food crisis, decline of democracy, relationship deteriation harder for humanitarien to act safely, less monney for humanitarien ressources principles: -aid: save life, reduce suffering, support human dignity in time of crisis -getting help to people in criticla need - 4principle: after 2nd WW -humanity: fundamental idea that we should respond to human suffering whereever it is -imparciality: those who need it whaterver race, political opinin ect.. -neutrality: humanitarian workers don't take sides, to protect them AND the people they are helping espionage indepance: humanitarien aid does not serve any politic, military, economic or other goals, kjust there to help V.1  “As more and more people are displaced by war and social upheaval, as access to safe and dignified places to seek sanctuary are denied, and as urgent needs go unmet, the ethical issues faced by MSF and other humanitarian organisations are surely set to intensify” Need for Moral Unique Kiddell-Monroe, R., Devine, C., Pringle, J., Wong, S., & Calain, P. (2018). 15| HUMANITARIAN ETHICS IN MÉDECINS SANS FRONTIÈRES/DOCTORS Education Community Context WITHOUT BORDERS: DISCUSSING DILEMMAS AND MITIGATING MORAL DISTRESS. Humanitarian Action and Ethics, 249. V.1 V.1 HUMILITY ◉ Recognizing your own limitations ◉ Life-long learning ◉ Seeking direction from host community as to needs and research questions NUR1 - 424 V.1  “The world is characterized by actions that reflect a value system where some lives are considered infinitely more valuable than others. In global health settings, humility is crucial and helps undermine neo-colonial trends that often permeate relationships between the North and South.” (Pinto & Upshur, 2009, p. 8) NUR1 - 424 V.1 How to get involved locally? Global Health Student Groups Interprofessional Global Health Course (IPGHC – Registration soon!) Funding Organizations you believe in – Just a coffee a day! Local Organizations Medecins du Monde- https://medecinsdumonde.ca/ Many of your CBOs with whom you’re working https://www.theguardian.com/ news/audio/2018/oct/05/the- business-of-voluntourism-do- western-do-gooders-actually- do-harm-podcast Next Workshop - Reminder Discussion on Film Then your own case, or an applied case to your environment Copyright © 2022 Ingram School of Nursing V.1 References Canadian Nurses Association (2017) Code of Ethics Retrieved from: http://www.nanb.nb.ca/media/resource/Code_of_Ethics- 2017-E.pdf Canadian Nurses Association (2020). Nurses Ethical Considerations During a Pandemic. Retrieved from: https://hl-prod-ca-oc- download.s3-ca-central-1.amazonaws.com/CNA/2f975e7e-4a40-45ca-863c-5ebf0a138d5e/UploadedImages/documents/Nurses- Ethical-Considerations-during-a-Pandemic_e.pdf Kamel, H. (2022) Rapport d’enquête Loi sur la recherche des causes et des circonstances des décès POUR la protection de LA VIE humaine concernant 53 décès survenus dans des milieux d’hébergement au cours de la première vague de la pandémie de la COVID-19 au Québec. Bureau du Coroner. Retrieved from: https://www.coroner.gouv.qc.ca/fileadmin/Enquetes_publiques/2020- EP00265-9.pdf OIIQ (2020) Actualités: COVD-19 Une réaffectation pour contribuer aux efforts de lutte: Retrieved from: https://www.oiiq.org/en/covid-19-une-reaffectation-pour-contribuer-aux-efforts-de-lutte WHO (2020) Ethical considerations to guide the use of digital proximity tracking technologies for COVID-19 contact tracing – Retrieved at https://www.who.int/publications/i/item/WHO-2019-nCoV-Ethics_Contact_tracing_apps-2020.1 Wright, D., Peterson, W. & Gifford, W. (2020). Nurses’ Ethical Considerations During a Pandemic. Canadian Nurses Association. MacDonald, M. (2013). Ethics of public health. In J.L. Storch, P. Rodney, and R. Starzomski (Eds.), Toward a moral horizon: Nursing ethics for leadership and practice. Pearson. Yeo, M., Moorhouse, A., Khan, P., Rodney, P. (2020). Concepts and cases in nursing ethics (4th ed.). Broadview Press. Emanuel, E. J., Persad, G., Upshur, R., Thome, B., Parker, M., Glickman, A.,... & Phillips, J. P. (2020). Fair allocation of scarce medical resources in the time of Covid-19. New England Journal of Medicine, 382(21), 2049-2055. REFERENCES Abimbola, S., Asthana, S., Montenegro, C., Guinto, R. R., Jumbam, D. T., Louskieter, L., et al. (2021). Addressing power asymmetries in global health: Imperatives in the wake of the COVID-19 pandemic. PLoS Med 18(4): e1003604. https://doi.org/10.1371/journal.pmed.1003604 Benatar, S., & Brock, G. (Eds.). (2011). Global health and global health ethics. Cambridge University Press. Crump, J. A., Sugarman, J., & Working Group on Ethics Guidelines for Global Health Training (WEIGHT). (2010). Ethics and best practice guidelines for training experiences in global health. The American journal of tropical medicine and hygiene , 83(6), 1178-1182. Pinto, A. D., & Upshur, R. E. (2009). Global health ethics for students. Developing World Bioethics, 9(1), 1-10. Stapleton, G., Schröder-Bäck, P., Laaser, U., Meershoek, A., & Popa, D. (2014). Global health ethics: an introduction to prominent theories and relevant topics. Global health action, 7(1), 23569. Tosam, M. J. (2020). Global bioethics and respect for cultural diversity: how do we avoid moral relativism and moral imperialism?. Medicine, Health Care and Philosophy, 23, 611-620. Wolff, J. (2021). The Human Right to Health. In S. Benatar & G. Brock (Eds.), Global Health: Ethical Challenges (pp. 110–121). chapter, Cambridge: Cambridge University Press.