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Health Care Ethics

Introduction to HIV and the Criminalization of Sickness

The unforeseen and unexpected challenges raised by the COVID-19 disease outbreak have put immense strain on medical services, all over the world. The sheer enormity of figures combined with increasing disease infectiousness has caused country-wide lockdowns around the globe's vast swaths. A group required to function as normal in these tough circumstances are the health care professionals (HCP). The consequent effect of the COVID-19 outbreak on the mental health of frontline health care workers' (HCW) is attracting valid attention (Yin et al., 2020). Aside from being quite specific, the dilemmas of health care professionals can also have broader implications for providing medical care. As these thoughts predominate in the mind, contrasted with other concerns like taking care of their family's needs, their own mental and physical health requirements, as well as demands for work and treatment, HCW 's judgment could become tainted. In such a pandemic scenario HCW’s have the right to take care of themselves and can object in taking care of patients. As their own continuous heath risk will impact clinical judgment, the risks of medical mistakes increase, and therefore the burnout risk increases.

There is every reason for health professionals to be worried about their well-being. More than 60 physicians who treated Italian COVID-19 patients have now died from contracting the disease at work (Medscape, 2020). Even more, had been very critically ill. A detailed list of 'Fallen Coronavirus Heroes' compiled by medical school professor at Harvard University, Michael C. Gibson, documents (as of March 31, 2020) the death of 119 health care workers who died of COVID-19 infections they contracted while treating an infected patient (Gössling et al., 2020). Perhaps a brief look at the news tells us several doctors and nurses are hesitant to treat COVID-19 infected patients. The lack of safety equipment for the HCP also gives them the right to say no for the treatment of infected patients. The number of personal protective equipment (PPE) in the Queensland state of Australia is not adequate, writes Alex Markwell, the state's Clinical Senate President. Bulgaria has witnessed a surge of practitioners stepping down, the Zimbabwean HCPs striking over the shortage of safety materials and the UK professionals have repeatedly warned that the lack of adequate safety equipment places their personal lives in danger (Schuklenk, 2020). The number is almost definitely considerably higher and, for some time to come, it is likely to increase regularly. There could be no denying that the number of deaths will be substantial among health care system professionals who are responsible for COVID-19 patients all across the globe.

 In response to reports about shortage of HCPs during anticipated COVID-19 disease outbreaks, a local government of North-Rhine Westphalia, one of Germany's most populated areas, strongly contemplated implementing a draft form of mandatory healthcare service for workers (The Local, 2020). Little did doctors realize when they entered the practice that the governments intended to force them into mandatory service at some stage later down the line, just like soldiers. What then is it that health care practitioners owe us in an epidemic like the present one. As patients, people rely on HCP and expect them to provide competent treatment, as they have specialized qualifications because they have the privilege of delivering this care. It is not as if the people will turn around and go somewhere if there is an insufficient number of physicians on call at the local hospital's ICU.

 Although the HCP take a public pledge in their graduation ceremonies to represent the greater good, also modeled on the Geneva Declaration of the World Medical Association. Before the 1994 edition of that famous text, HCPs vowed to provide treatment, without any ifs or objections. However, in the latest version of that text, you won't see the pledge replicated so that solution doesn't answer the problem at hand (Schuklenk & Zolf, 2018). It is not surprising, the HCP of the world has awoken to the risks of making claims they can neither stay true to the pledge seeing them practically. The shortage of available PPE for the health care providers had been due to an accident or it is deliberately done. One would argue that healthcare professionals would be willing to accept a certain high level of risk, but in the existing crisis, the shortage of safety equipment is genuinely intentional. The HCP cannot neglect the praise they are getting from the people and the governments of countries. It was good to see the Prime Minister and Chancellor of the UK standing outside 10 Downing Street on global news shows, enthusiastically applauding the courage of the country's HCPs (NDTV, 2020). But the patriotism they were praising is a clear, preventable result of the welfare reforms of their leadership.

There was an implied willingness to take chances as doctors accepted to bargain their career which they have made for the community. Monopoly privileges, a big social status, and even huge salaries do not come easy. HCPs knew that if they were to pay attention to the issue of their world health classes, illnesses like Ebola and others would rear their outbreaks in their professions, and entering the profession would mean having a responsibility to provide treatment. During the starting few years of the HIV outbreak, whenever an illness with such a virus implied sure demise, legislative bodies of doctors announced that physicians on duty to be taken care of in most nations. A misguided interpretation is that reduced death rates would settle COVID-19 (Hoppe, 2017). What makes COVID-19 unique is that the focus of the HIV epidemic has been on PPE's accessibility to health care professionals which is reversed now. In such a scenario, if health care providers were to follow uniform procedures and have the right safety equipment, they would have had small chances of getting HIV. We find ourselves in a very different position with COVID-19, in most countries.

The hospitals will be at the forefront of their policies, strategies, and best operating procedures for their staff and practitioners in health care. Primary care, protective equipment, and risk management procedures should be explicitly indicated on the hospital website. health-care staff should be constantly updated on the proper use of PPE to resolve their safety issues while using resources rationally at the same time. Simple identification of potential issues and measures followed to address them will allay fears and encourage HCW's to emotionally brace themselves for obstacles. Since in this pandemic duty is undeniably stressful, hospitals can probably give shortened shift work (for example, 5−7 h) per working day to avoid exhaustion. The organizations should consider providing their workers with housing and quarantine amenities. If resource limitations remain, these facilities should be made accessible to the HCW's at least during the COVID duty period because most of them might not even feel confident going back home to their families. Before heading to the frontline, the pre-counseling of HCW can help alleviate issues or provide possibilities to explain safety issues.

 The moral and ethical dilemmas should be addressed in advance such that HCW's are trained mentally to manage these scenarios. At this level of participation in mental health, practitioners will bring value to the experience by making the use of their unique experience in pandemic management and problem-solving skills. Maintaining a support cell for COVID at each hospital setting would serve as a help for personal health care and support for HCW. It also provides a platform for HCW to discuss unresolved problems and help prevent exhaustion, which may often feel overwhelmed by the caring requirements. As already mentioned, each HCW matters, and their mental wellbeing also contributes to workplace productivity. Health care team leaders should be trained to recognize emotional exhaustion in young doctors because early detection and intervention are essential in such a scenario. When an HCW has respiratory problems and does not want to risk anyone, they must stay back and justify their decision properly. If they are in doubt, applying the ethical self-test which can answer that "if my colleague at work has symptoms, would I like to have him around at my workplace” can help in decision making.

Conclusion on HIV and the Criminalization of Sickness

There is no reason why nurses and doctors might be considered morally unwilling to risk their well-being in this pandemic when we choose governments that hungered them with the appropriate resources to safely do their job. Actions have repercussions. People should be thankful to all the health care provider who can take care of COVID-19 patients, in the lack of PPE. However, we do not have any right to take it for granted that there will be health care providers available when we will need them. It will eliminate uncertainty, promote personal choices, and minimize prejudice by setting uniform procedures for HCW's in that regard. Exceptional times require more than precedent for practice. It is believed that all such steps would assist hospitals and team members in ensuring that employees and health care personnel have the greatest working conditions possible. All these measures will inspire and encourage frontline health care workers to efficiently work while saving ourselves for yet another day at the same time.

References for HIV and the Criminalization of Sickness

Gössling, S., Scott, D. & Hall, C. (2020). Pandemics, tourism, and global change: A rapid assessment of COVID-19. Journal of Sustainable Tourism, 1-20.

Hoppe, T. (2017). Punishing disease: HIV and the criminalization of sickness. University of California Press.

Medscape. (2020). More than 60 doctors in Italy have died in the COVID-19 pandemic. Retrieved from https://www.medscape.com/viewarticle/927753

NDTV. (2020). Watch: UK's youngest royals join in applauding health workers. Retrieved from https://www.ndtv.com/world-news/watch-boris-johnson-rishi-sunak-lead-britains-tribute-to-health-workers-2201635

Schuklenk, U. (2020). What healthcare professionals owe us: Why their duty to treat during a pandemic is contingent on personal protective equipment (PPE). Journal of Medical Ethics, 2020, 1-4.

Schuklenk, U., & Zolf, B. (2018). Professionalism and the Ethics of Conscientious Objection Accommodation in Medicine. In The Palgrave Handbook of Philosophy and Public Policy (pp. 609-621). Palgrave Macmillan, Cham.

The Local. (2020). What's the latest on coronavirus in Germany and what do I need to know? Retrieved from https://www.thelocal.de/20200303/whats-the-latest-on-coronavirus-in-germany-and-what-do-i-need-to-know

Yin, Q., Sun, Z., Liu, T., Ni, X., Deng, X., Jia, Y. & Liu, W. (2020). Posttraumatic stress symptoms of health care workers during the corona virus disease 2019 (COVID‐19). Clinical Psychology & Psychotherapy, 2019, 1-22.

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