Indian journal of medical ethics
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The COVID-19 pandemic has posed several challenges to the Indian healthcare system. Here, we examine the situation in India considering the moral and ethical imperatives of decision making for public health. Currently, in the absence of proven therapies, empirical evidence is being used for treatment of Covid-19 disease. ⋯ Appropriate use of evidence is required. In the ethics context and in the interest of the larger public good, we suggest the inclusion of simple and safe measures from AYUSH systems in the integrative protocols for prophylaxis and treatment of Covid-19. Keywords: AYUSH systems, Covid-19, pandemic, prophylaxis, evidence, empirical evidence, priority setting, public health decision making, global health emergencies,complementary medicine, integrative healthcare.
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The Covid-19 pandemic has meant that all available health workers have been summoned to serve the community. Here, I describe my first experience as a resident doctor of shift duty in the Covid ICU of a large municipal hospital in Mumbai, with its accompanying fears and discomforts, all contributing to learning painful but valuable lessons.. Keywords: Covid-19, ICU, pandemic, public health system, learning.
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Indian J Med Ethics · Apr 2020
Clinical ethics during the Covid-19 pandemic: Missing the trees for the forest.
The SARS-CoV2 pandemic has exposed the acute vulnerability of the health systems of countries worldwide. While countries are scrambling to contain the spread of the infection, the focus is largely on infection prevention strategies such as isolation, quarantine, physical distancing, hand hygiene, cough etiquette and country-wide lock-down. Important ethical concerns arise in the context of the public health interventions. ⋯ This article focuses on the ethical conflicts between the largely public health- driven focus of the Covid19 prevention and containment measures versus patient-centred care for those who suffer the illness and the consequent moral distress of healthcare providers. The key argument is for countries to mainstream clinical ethics considerations for care of patients with Covid-19 as well as "non-Covid-19" illnesses. Keywords: SARS-CoV2, Covid 19, clinical ethics, duty to care, allocation of scarce resources, moral distress.
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Early last month, the Italian Society of Anaesthesia was forced to publish the above guideline (1) for the country's hospitals. Besides the rising cases of infection, the doctors realised that patients required up to 15-20 days of intensive care as the disease progressed (2). In the face of medical resource scarcities, the guideline established that everyone could not be saved from the coronavirus. And a massive death toll ensued.
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Indian J Med Ethics · Apr 2020
Non-communicable disease management in vulnerable patients during Covid-19.
It is now well established that non-communicable diseases (NCD), like diabetes mellitus, hypertension,, respiratory and heart disease, particularly among the elderly, increase the susceptibility to COVID-19 disease. Mortality in 60%-90% of the COVID-19 cases is attributed to either one or more of these comorbidities. However, healthcare management for control of COVID-19 involves public health and policy decisions that may critically undermine the existing health needs of the most vulnerable NCD patients. ⋯ In the absence of effective public health interventions, socioeconomically vulnerable patients are likely to become non-adherent increasing manifold their risk of disease complications. In this context, the feasibility of dispensing longer than usual drug refills for chronic NCD conditions at functional government health facilities, home delivery of essential drugs, running dedicated NCD clinics at PHCs, and utilisation of telemedicine opportunities for care and support to patients warrant aggressive exploration. Keywords: Covid-19, NCDs, Medical ethics, epidemic, India.