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Publications

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Normative Analysis and Ethical Evaluation of Clinical Ethical Guidelines Published in the Context of Intensive Care Triage During Covid-19 Pandemic

Esra Aksoy, Merve Nur Koçak Öztürk, İlhan İlkılıç

ABSTRACT

Throughout the COVID-19 pandemic, the rapid increase in the number of cases during certain periods has caused a high occupancy rate in intensive care units. Faced with a sudden and rapid increase in the number of patients, a lack of medical resources or its possibility led to ethical discussions on the immediate and equitable distribution of resources in intensive care units. This has not only given impetus to the ethical debate, but many medical professional organisations in Europe have published guidelines for triage of critical care which contain ethical criteria. In this study, some of the ethical triage guides have been normatively analyzed and ethically evaluated.

Objective: The aim of this study is to identify and determine the parameters and normative concepts contained in the guidelines for triage published by the intensive care associations of Germany, Austria, Belgium, France, England, Switzerland and Italy. The results of this investigation were also critically and ethically evaluated and reflected.

Materials and Methods: Critical normative analysis and ethical evaluation of clinical ethical guidelines published by intensive care and anaesthesia associations of the above-mentioned countries.

Results: Although the studied triage guides used common parameters and similar normative concepts, there are significant differences between them. These differences were determined to be related to the triage criteria used, triage objectives, age factor, priority given to certain social groups and the application of different treatments to Covid-19 patients.

Conclusion: Although the European countries that have published triage guides come from the same cultural tradition, the normative criteria and concepts they used in the triage guides are considered different values and priorities in their rankings. These differences may be due to the current political and ethical culture, also to the current economic and socio-cultural resources and their strategies for using their resources. Because of these facts and the reasons which we found, they should be considered in the preparation of ethical triage guidelines in Turkey.

 

Keywords: Covid-19, triage, resource allocation, ethical guidelines, intensive care

Normative Analysis and Ethical Evaluation of Curfew and Restrictions as a Public Health Measure During the Covid-19 Pandemic

Ayşenur Daldaban Berberoğlu, Tuğba Doğan, İlhan İlkılıç

ABSTRACT

Countries have declared various public health measures and have taken measures to protect public health in the fight against the COVID-19 pandemic. These measures aim to protect the health of society and individuals, prevent and restrict the spread of the disease; on the other hand, they also restrict fundamental rights and freedoms. Our research aimed at conducting normative analysis and ethical evaluation of curfew and restrictions as a public health measure during the COVID-19 pandemic with focusing on some epidemiological research results. The definition and function of proportionality as an ethical principle in the application of such measures were examined. Basic theses were developed and some recommendations were made for ethical orientation by revealing the importance and necessity of moral virtues such as responsibility and solidarity in the fight against the pandemic.

Objective: Evaluating the effectiveness of curfew and restriction measures from an ethical perspective reveals the impact of cultural differences and the sense of solidarity and responsibility on the pandemic.

Materials and Methods: Five studies in the PubMed biomedical database that used data from

various countries, compared the effectiveness of the measures, epidemiologically analyzed the effectiveness of partial lockdown and complete lockdown on the spread of the pandemic, and examined the period between January 2020 and August 2020 (approximately the period of first-wave) were selected in accordance with the purpose of our research, analyzed and evaluated in terms of ethics.

Results: Although curfew and restrictions violate fundamental rights and freedoms, they are ethically necessary to protect public health and maintain health services without failures. To this end, different results have been achieved after the same or similar measures in different countries. The strictness of the measures taken is not directly proportional to their efficiency.

Conclusion: Curfew and restrictions, which have been declared as a public health measure, violate and restrict fundamental rights and freedoms; however, they are acceptable when evaluated ethically. The beneficial and harmful consequences of these measures should be evaluated according to the principle of proportionality. Furthermore, the moral merits of responsibility and solidarity should be consulted in order to be successful expeditiously and reduce aggrievements as much as possible.

Keywords: COVID-19 pandemic, public health ethics, curfew and restriction, proportionality, solidarity, responsibility

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I'm a publication name. Click here to add your own text and edit me. I'm a great place for you to tell your great story.

I'm a paragraph. Click here to add your own text and edit me. It's easy. Just click “Edit Text” or double click me to add your own content and make changes to the font. I'm a great place for you to tell a story and let your users know a little more about you.

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IU Istanbul Faculty of Medicine, Department of History of Medicine and Ethics - English Program Campus, 34093 Istanbul Fatih Capa

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