Pandemics and Ethics: Development – Problems – Solutions

Contents
List of Authors
Ethical Challenges in Pandemics. Introduction
References
Pandemics and the Dignity of Man. Reflections on the History of Disease
1 Doctors, Clergy and the Management of Authorities—the Challenge of Society
2 Plague Epidemics as Crises in Medicine
3 Clergy at the Plague Front—the Importance of the Religious
4 Flight and Crime
5 The Atrocities of Everyday Life with the Plague—the Sick and Foreigners as Objects of Hatred
6 Plague Hospitals
7 The Question of Human Dignity
8 The Black Death, a Phenomenon Over Centuries
9 Brave and Less Brave Doctors
10 Thucydides at the Beginning...
11 Summary
References
Solidarity in Times of a Pandemic: Everyday Practices and Prioritization Decisions in Light of the Solidarity Concept
1 Introduction
2 Scholarly Approaches to the Concept of Solidarity
3 Solidarity in Times of a Pandemic
3.1 State of Research
3.2 The SolPan Study on Solidarity in Times of a Pandemic
4 Solidarity and Prioritization
5 Conclusion and Outlook
References
Human Rights and International Obligations in Pandemic Times—More than Health Protection
1 Introduction
2 Threatened Human Rights
2.1 Social Participation
2.2 Economic Cutbacks
2.3 Freedom of Opinion and Expression
2.4 Mobility
3 Human Rights-Based Public Health and Health Systems
3.1 (Inter-)National Health Equity
3.2 Global Health Governance
4 Outlook
References
Duties and Rights of Health Professionals During a Pandemic
1 Introduction
2 The Hippocratic Oath and its Interpretations
2.1 Altruism in Medicine and Nursing
3 Human Rights Since the Enlightenment
4 The Understanding of Statehood and Civic Duties
4.1 The State as a Community of Solidarity
4.2 Obligation to Render Assistance
4.3 Interventions by the States
4.4 Compulsory Obligation or ‘civil conscription’?
4.5 Professional Obligations
4.6 The Development of Medical Deontology
4.7 The Geneva Declaration of 1948 (Geneva Pledge)
4.8 The Geneva Declaration and the Protection of One’s Own Health
4.9 The Geneva Declaration and the Duty to Provide Assistance
4.10 The International Code of Medical Ethics of 1949 and the Medical Code of Conduct
4.11 The International Code of Medical Ethics, the National Code of and the Duty to Provide Assistance
5 Rights of Health Professionals as Employees and Self-Employed
5.1 Securing the Workplace and Workflows
5.2 Assessment of the Risk Situation
5.3 Securing Occupational Diseases
5.4 Rights of Refusal in the Context of Contractual Commitment
6 Conclusions
References
Restrictions on Fundamental Rights in the Name of Public Health. Fundamental Rights as an Regulative Elements of Proportionate Pandemic Management
1 Introduction: Fundamental Rights-Related Problems of Measures to Cope with the Pandemic
2 Restrictions on Fundamental Rights as a means of Collective Health Protection (Public Health)
2.1 Scope of Protection, Intervention, Justification
2.2 Principle of Proportinality
2.3 Democracy-Theoretically Motivated, Limited Relativization of the Binding Nature of Fundamental Rights
2.4 Precision and Proceduralization of the Principle of Proportionality
2.4.1 Overview
2.4.2 Public Health: Target Hierarchies, Target Conflicts, Weighing Parameters
2.4.3 No Freedom Restrictions for Vaccinated People?
2.4.4 Constitutional Protection of Divergent Constructions of Reality?
2.4.5 Completion of the Proportionality Thinking by Judicial Control
3 Conclusion and Outlook
References
Ethical Challenges of Resource Allocation in Pandemics
1 Introduction
2 General Requirements for a Fair Allocation of Scarce Resources
3 Prioritization of (Intensive) Medical Treatment During the Covid-19 Pandemic
4 Prioritization of SARS-CoV-2 Vaccines
5 Outlook
References
Ventilator Triage and Vaccine Rationing in Covid-19: A New Paradigm for Promoting Social Justice in Allocation with Disadvantage Indices
1 Introduction
2 Resource Scarcity During Covid-19
3 Triage in the Allocation of Ventilators
3.1 Cross-cutting Principles of Triage Frameworks
3.2 Allocation Frameworks in Societal Context
3.3 The Limitations of Allegedly Objective Data within the SOFA Points System
3.4 Specific Improvement Proposals and Important Changes in Triage Framework Programs
3.5 Interim Conclusion: The Shortfalls of Maximizing Benefits Alone Have Become Unignorable
4 Allocation of Vaccines
4.1 Overarching Principles in Allocation Framework Programs: A New Development
4.2 The Conceptual Role of Disadvantage Indices in Social Justice
4.3 The Practical Implementation of Disadvantage Indices to Promote Social Justice
4.4 Four Main Uses of Disadvantage Indices to promote Social Justice
5 Conclusion
References
Vaccination Against Infectious Diseases—A Bioethical Debate in the Pandemic
1 Introduction
1.1 Historical Aspects and Discourse on Voluntariness
2 The Right to Health—Vaccination and Ethics
2.1 Basics Using the Example of the Discussion in the Austrian Bioethics Commission on Measles Vaccination (2014/2015)
3 The Covid-19 Pandemic
3.1 Vaccine Debates in Times of a Pandemic
3.2 Placebo Control
3.3 “Human Challenge Trials”
4 Vaccination Requirement
4.1 Terminology
4.2 Healthcare Professionals
5 Information Responsibility, Conspiracy Theories and “Fake News”
6 Shortage of Vaccines—Prioritization
7 Immunity and the Exercise of Fundamental Rights in the Pandemic
8 Concluding Remarks
References
Immunity and Vaccination Certificates in the Covid-19 Crisis
1 Problem Overview: Why Individual Freedom of Choice is Important
2 Epistemic and Risk-Ethical Foundations
2.1 Epistemological Assessment
2.2 Normative Framework
3 Weighing Opportunities and Risks
3.1 Opportunities
3.2 Risks
3.3 Criteria and Methods for Weighing Up
4 Regulatory Requirements
4.1 Flexible, Self-Reflective Regulation
4.2 In Particular: Complementary (test) Procedures
4.3 Special Situations: Differential Treatment Carried Out by Private Individuals and State Travel Conditions
5 Final Considerations: Accountability as a Permanent Challenge
References
Pandemics and Research Ethics. An Overview of Central Challenges
1 Introduction
2 Challenges and Possible Solutions for Research Ethics in Pandemics
2.1 Social Value
2.2 Scientific Validity
2.3 Favorable Risk-Benefit Ratio
2.4 Fair Selection of Study Participants
2.5 Informed Consent
2.6 Collaborative Partnership
2.7 Respect for Study Participants
2.8 Independent Review
3 Overarching Fundamental Questions
3.1 Challenge Studies
3.2 Impact on Other Research
4 Summary and Final Considerations
References
Ethical and Legal Challenges of Digital Medicine in Pandemics
1 Introduction
2 New Developments in Digital Medicine and Applications in Pandemics
3 Ethics and Law
4 Selected Issues at the Intersection of Ethics and Law
4.1 Data, Privacy, and Consent
4.2 Data Access, (Intellectual) Property Rights, and Competition Law
4.3 Robustness, Cybersecurity, Liability, Accountability, and Licensing
4.3.1 Robustness and Cybersecurity
4.3.2 Liability, Accountability, and Approval
4.4 Transparency, Traceability, and Explainability
4.5 Bias, Discrimination, and Social Justice
5 Discussion
6 Conclusions and Outlook
References
‘Infodemics’: Dealing with Information in Pandemic Times from an Ethical Perspective
1 Introduction
2 Problem Description: Information Overload and the Reduction of Complexity
3 Scientific Evidence
4 Structural change in the media landscape
5 From Information to Appeal
6 Problem Solving
6.1 WHO
6.2 The ‘PubliCo’ Project
7 Conclusion
References
Ethics and Old Age in the Covid-19 Pandemic
1 Introduction
2 On the Situation of Older People in Nursing Homes During the Covid-19 Crisis
3 Self-Determination and Advance Directives
4 Social Contacts and Digitalization
5 Age Limits in Intensive Care
6 Age Discrimination: Heterogeneity of Older People
7 Against Ageism and for Intergenerational Solidarity
8 Tasks of Gerontological Research and an Ethics of Aging
References
Covid-19 Pandemic and the Protection of Older People in International Comparison. Results of Comparative Research from an Ethical Perspective
1 Introduction—Infection Control and Risks
2 Germany in International Comparison—Pandemic Measures Since March 2020
2.1 Special Precautions in Hospitals
2.2 Vaccinations—Mandatory Protection for the Elderly?
2.3 General or Selective Lockdown (Cocooning) with Age Discrimination?
2.4 Digital Covid-19-Fighting—Participation of All Age groups?
3 A Comparison of the Situation in Nursing Homes in Different Countries
3.1 Covid-19 Associated Mortality in Nursing Homes
3.1.1 Data and Methods for Quantifying Covid-19 Deaths
3.1.2 Germany
3.1.3 Spain
3.1.4 Canada
3.1.5 Australia
3.1.6 South Korea
3.1.7 Synoptic Comparison of the Countries
3.2 Measures to Protect Residents
3.2.1 Causes and Objectives
3.2.2 Five Countries on Four Continents Compared
4 Public Health Ethics for the Elderly—Comprehensive Reflection
5 Summary—Final Considerations and Outlook
References
Pandemics and Gender—The Unequal Effects of a Pandemic on Gender Equality
1 Introduction
2 Gender-Specific Effects of Public Health Measures
2.1 Gender-Based Violence
2.2 Socio-Economic Impacts
3 Gender and Health
3.1 Risk of Infection
3.2 Sexual and Reproductive Health
4 Final Considerations
References
The Roles of National Ethics Committees in Pandemics. Orientation in Times of Crisis
1 Introduction
2 National Ethics Committees
3 Activities of National Ethics Committees on Infectious Diseases, Epidemics and Pandemics
3.1 HIV/AIDS
3.2 SARS
3.3 Pandemic Influenza
3.4 Ebola
4 National Ethics Committees and Covid-19
5 Summary and Outlook
References
Clinical Ethics Consultation in the Covid-19 Pandemic. Practical Challenges for Safety and Quality
1 Introduction
2 Digital and Telephone Consultation for Safety from Infection
3 Video Conferences for Protected Consultation in the Event of Covid-19
4 “Distancing” in Design and as an Object of Consultation
5 Consequences of Covid-19 as a Topic of Ethics Consultation in the Clinic
6 Consultations on Quality Assurance for Research and Clinical Trials
7 Bedside Allocation? Ethics Advice on Triage and Justice
8 Summary—Consultation for Quality Assurance in Medicine
References
Religion, Pandemics and Ethics. A Diaconal-Ethical Perspective on the Covid-19 Pandemic
1 The Covid-19 Pandemic as an Ethical Challenge and Test of Endurance
2 Religion in Times of Covid-19
3 Christian Ethics
4 Human Dignity, Freedom and Responsibility
5 Allocation Questions
6 Ethical Culture and Dealing with Border Experiences and Guilt
7 Dying in Times of Covid-19
8 Outlook
References
Pandemics, Medicine and Ethics. An Outlook
References