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A Bioethical Perspective For Covid-19 Infectious Disease Pandemic

Yıl 2020, Sayı: 3, 365 - 371, 01.09.2020

Yeşim Işıl Ülman

Öz

Infectious diseases are major public health concerns as they cause deaths, disabilities, and provoke epidemics and pandemics. Although they are transmitted from animal to man, from man to man by pathogenic microorganisms, they are detectable, curable, and preventable diseases. Historically there have been significant scientific achievements whilst struggling with infectious diseases by means of immunization, such as smallpox, chickenpox vaccinations. As a matter of fact, the COVID-19 infectious disease which was caused by novel coronavirus SARSCoV-2 was first detectable in China in December 2019, and it soon triggered a global pandemic spreading most continents and countries world wide. As well as understanding what to do in scientific, medical, legal, economic, sociological aspects in the fight against the pandemic, there is a need to question “how” this struggle should be conducted. This takes us to analyze the ethical dimension of the issue, according to bioethics principles

Anahtar Kelimeler

Ethics bioethics public health infectious diseases COVID-19 Pandemic

Kaynakça

  • Jacobson JA. Infectious diseases ethics. In: Singer PA, Viens AM, editors. Cambridge Textbook of Bioethics, 3rd ed. NY: Cambridge University Press; 2009. p.481–6. https://www.dphu.org/uploads/ attachements/books/books_5318_0.pdf
  • Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395:497–506. [CrossRef]
  • CDC, Coronavirus Disease 2019 (COVID-19); American Thoracic Society What is COVID-19? Worldometer Age, Sex, Existing Conditions of COVID-19 Cases and Deaths. Erişim tarihi: 01.06.2020. https://www.worldometers.info/coronavirus/ coronavirus-age-sex-demographics/
  • WHO Timeline - COVID-19. https://www.who.int/news-room/ detail/27-04-2020-who-timeline---covid-19 Erişim tarihi: 01.06.2020.
  • Klugman C. Ethics of Pandemics: Coronavirus and Large Scale Quarantine. Bioethics Net 2020. http://www.bioethics.net/2020/01/ ethics-of-pandemics-coronavirus-and-large-scale-quarantine/ Erişim tarihi: 01.06.2020
  • WHO Worldometer. https://www.worldometers.info/coronavirus/ Erişim tarihi: 31.05.2020
  • United Nations, Department of Economic and Social Affairs Social Inclusion, Everyone Included: Social Impact of COVID-19. https:// www.un.org/development/desa/dspd/everyone-included- covid-19.html Erişim tarihi: 01.06.2020
  • Huxtable R. COVID-19: where is the national ethical guidance? BMC Med Ethics 2020; 21:1–3. [CrossRef] https://doi.org/10.1186/s12910- 020-00478-2 Erişim tarihi: 01.06.2020
  • Fritz Z, Huxtable R, Ives J, Paton A, Slowther AM, Wilkinson D. Ethical road map through the covid-19 pandemic. BMJ 2020;369:m2033. [CrossRef]
  • Unites Nations UNESCO Universal Declaration on Bioethics and Human Rights, 19 October 2005 http://portal.unesco.org/en/ ev.php-URL_ID=31058&URL_DO=DO_TOPIC&URL_SECTION=201. html Erişim tarihi: 01.06.2020
  • Kass NE. An Ethics Framework for Public Health. Am J Pub Health 2001;91:1176–82. [CrossRef]
  • Childress J, Faden RR, Gaare RD, Gostin LO, Kahn J, Bonnie RJ, et al. Public Health Ethics: Mapping the Terrain. J Law Med Ethics 2002;30:170–8. [CrossRef]
  • Kayı İ, Sakarya S. Policy Analysis of Suppression and Mitigation Strategies in the Management of an Outbreak Through the Example of COVID-19 Pandemic. Infect Dis Clin Microbiol 2020;2:30–41. [CrossRef]
  • Veatch RM. Ethics of Promoting Herd Immunity. Fam Community Health 1987;10:44–53. [CrossRef]
  • Council of Europe Committee on Bioethics: COVID-19: Human rights principles must guide health decisions https://www.coe.int/en/ web/bioethics/-/covid-19-human-rights-principles-must-guide- health-decisio-1 Erişim tarihi: 01.06.2020
  • Upshur R. The Ethics of Quarantine. Virtual Mentor 2003;5:393–5. [CrossRef]
  • Lewnard JA, Lo NC. Scientific and ethical basis for social-distancing interventions against COVID-19. Lancet Infect Dis 2020;20:631–3. [CrossRef]
  • Lei R, Qiu R. Report from China: Ethical Questions on the Response to the Coronavirus. Hastings Center Bioethics Forum Essay. The Hastings Center 2020. https://www.thehastingscenter.org/report- from-china-ethical-questions-on-the-response-to-the-coronavirus/ Erişim tarihi: 01.06.2020.
  • Le TT, Andreadakis Z, Kumar A, Román RG, Tollefsen S, Saville M, Mayhew S. The COVID-19 vaccine development landscape. Nat Rev Drug Discov 2020;19:305–6. [CrossRef]
  • UNESCO Universal Declaration on Bioethics and Human Rights, 19 October 2005. Erişim tarihi: 18.04.2020. https:// en.unesco.org/themes/ethics-science -and-technology/ bioethics-and-human-rights
  • Türk Tabipleri Birliği COVID-19: Hekimlerin (Sağlık Çalışanlarının) hak ve yükümlülükleri, Sağlık Bakanlığı ve işverenlerin sorumlukları; 3 Nisan 2020. https://www.ttb.org.tr/haber_goster.php?Guid=70e89cf6- 75a2-11ea-b329-aa051764b049 Erişim Tarihi: 01.06.2020.
  • Slowther A, Mitchell S. COVID-19: In focusing on intensive care we must not lose sight of the wider professional duty to care for all patients. J Med Ethics April 3, 2020. Erişim tarihi: 01.06.2020. https://blogs.bmj.com/medical-ethics/2020/04/03/covid-19-in- focussing-on-intensive-care-we-must-not-lose-sight-of-the-wider- professional-duty-to-care-for-all-patients/
  • Medscape, In Memoriam: Healthcare Workers Who Have Died of COVID-19. April 1 2020. https://www.medscape.com/ viewarticle/927976 Erişim: 01.06.2020
  • Lei R, Qiu R. Chinese Bioethicists: Silencing Doctor Impeded Early Control of Coronavirus. The Hastings Center 2020. https://www. thehastingscenter.org/coronavirus-doctor-whistleblower/ Erişim tarihi: 01.06.2020.
  • Fenton E. Personal Protective Equipment for front-line health workers: an ethical imperative. J Med Ethics 2020 https://blogs.bmj. com/medical-ethics/2020/03/31/personal-protective-equipment- for-front-line-health-workers-an-ethical-imperative/?int_ source=trendmd&int_campaign=usage-042019&int_medium=cpc Erişim tarihi: 01.06.2020
  • Schuklenk U. Health Care Professionals Are Under No Ethical Obligation to Treat COVID-19 Patients. J Medical Ethics 2020. https://blogs.bmj.com/medical-ethics/2020/04/01/health-care- professionals-are-under-no-ethical-obligation-to-treat-covid-19- patients/ Erişim tarihi: 01.06.2020
  • American College of Emergency Physicians ACEP Policy Statement, Code of Ethics; January 2017. p.13. https://www.acep.org/ globalassets/new-pdfs/policy-statements/code-of-ethics-for- emergency-physicians.pdf
  • American Medical Association (AMA) Code of Medical Ethics: Allocating Limited Health Care Resources Code of Medical Ethics Opinion 11.1.3 https://www.ama-assn.org/delivering-care/ethics/ allocating-limited-health-care-resources Erişim tarihi: 01.06.2020.
  • Emanuel E, Persad G, Upshur R, Thome B, Parker M, Glickman, A, et al. Fair Allocation of Scarce Medical Resources in the Time of Covid-19. N Engl J Med 2020;382:2049–55. [CrossRef]
  • White DB, Katz MH, Luce JM, Lo B. Who Should Receive Life Support During a Public Health, Emergency? Using Ethical Principles to Improve Allocation. Ann Intern Med 2009;150:132–8. [CrossRef]
  • World Health Organization. Guidance for managing ethical issues in infectious disease outbreaks. World Health Organization. 2016. https:// apps.who.int/iris/handle/10665/250580 Erişim tarihi: 01.06.2020.
  • Human Rights Watch, Rights Risks to Older People in COVID-19 Response Combat Ageism; Ensure Access to Health Care, Services, April 7, 2020 https://www.hrw.org/news/2020/04/07/rights-risks- older-people-covid-19-response Erişim tarihi: 01.06.2020.
  • UNESCO Report of the International Bioethics Committee on the Bioethical Response to the Situation of Refugees, SHS/YES/IBC- 24/17/2 REV.2 Paris, 15 September 2017. https://unesdoc.unesco. org/ark:/48223/pf0000248721 Erişim tarihi: 01.06.2020.
  • Razai MS, Oakeshott P, Kankam H, Galea S, Stokes-Lampard H. Mitigating the psychological effects of social isolation during the covid-19 pandemic. BMJ 2020;369:m1904. [CrossRef]
  • Roesch E, Amin A, Gupta J, García-Moreno G. Violence against women during covid-19 pandemic restrictions. BMJ 2020;369:m1712. [CrossRef]
  • Kadın Cinayetlerini Durduracağız Platformu, Korona Günlerinde Kadınlar için Şiddetten Korunma Kılavuzu 28.03.2020 http:// k adincinayetlerinidurduracagiz.net/acik lamalar/2899/ koronagunlerindekadinlaricin-siddetten-korunma-kilavuzu Erişim tarihi: 01.06.2020.
  • Council of Europe Oviedo Convention on Human Rights and Biomedicine https://www.coe.int/en/web/conventions/full-list/-/ conventions/treaty/164 ; Oviedo Convention Additional Protocol to the Convention on Human Rights and Biomedicine, concerning Biomedical Research https://www.coe.int/en/web/conventions/full- list/-/conventions/treaty/195 M.26, Erişim tarihi: 01.06.2020
  • World Health Organization. Guidance for managing ethical issues in infectious disease outbreaks. World Health Organization. 2016. https://apps.who.int/iris/handle/10665/250580 Erişim tarihi: 01.06.2020.
  • Shah SK, Miller FG, Darton TC, Duenas D, Emerson C, Lynch HF, et al. Ethics of controlled human infection to study COVID-19. Science 2020;368:832–4. [CrossRef]
  • Marmot M. Social determinants of health inequalities. Lancet. 2005;365:1099‐1104. [CrossRef]
  • Godlee F. Racism: the other pandemic. BMJ 2020;369:1. [CrossRef]
  • Nuffield Council on Bioethics, Ethical considerations in responding to the COVID-19 pandemic Rapid policy briefing. https://www. nuffieldbioethics.org/assets/pdfs/Ethical-considerations-in- responding-to-the-COVID-19-pandemic.pdf Erişim tarihi: 01.06.2020.

COVID-19 Enfeksiyon Hastalığı Salgınına Biyoetik Açıdan Bakış

Yıl 2020, Sayı: 3, 365 - 371, 01.09.2020

Yeşim Işıl Ülman

Öz

Enfeksiyon hastalıkları, hayvandan insana, insandan insana bulaşabilen, tanı konabilir, tedavi edilebilir, iyileştirilebilir ve önlenebilir hastalıklardır. İnsanlarda hastalık, sakatlık ve ölüme neden olabildiklerinden, enfeksiyon hastalıklarıyla mücadele önemlidir. Tıp ve bilim tarihi açısından bakıldığında, insanlık, enfeksiyon hastalıklarıyla mücadelede bağışıklama yöntemiyle önemli başarılar elde etmiştir. 2019 Aralık ayında Çin’de ilk kez saptanan yeni koronavirüs SARS-CoV-2 , COVID-19 adı verilen akut solunum yolu enfeksiyon hastalığına yol açmış; kısa sürede dünya üzerinde yayılarak pandemiye dönüşmüş, toplumsal ve ekonomik sorunlara yol açmıştır.Salgınla mücadelede bilimsel olarak ne yapmak gerektiğini anlamanın yanı sıra bu mücadelenin “nasıl” yapılacağının, hangi tutum ve davranışlarla yönetileceğinin, bir başka deyişle, meselenin etik boyutunun sorgulanmasına ihtiyaç vardır. COVID-19 salgını ile mücadelede, kanıta dayalı bilimsel, tıbbi müdahale sürerken; biyoetik açıdan, gelişmelerin açıklık, şeffaflık ve gerçekçilikle kamuoyuyla paylaşıldığı; herkese eşitlikle muamele edildiği, karantina ve izolasyon durumlarında kişi özerkliğinden, toplum sağlığı adına orantılı, ölçülü fedakarlık beklendiği; insanlar, hastaneler, birimler ve ülkeler arasında dayanışma ve işbirliğinin desteklendiği; hükümetlerin hesap verilebilirlikle halkın ihtiyaçlarına cevap verebildiği, iktisadi hayatın karşılıklı işbirliği ve dayanışma ile desteklendiği, insan haklarına ve onuruna uygun; insani, çoğulcu, çevreye, biyosfere, biyoçeşitliliğe, gelecek nesillere saygılı ve sorumlu tutum ve davranışlarla salgın yönetimi önerilir

Anahtar Kelimeler

Etik biyoetik halk sağlığı enfeksiyon hastalıkları COVID-19 Pandemisi

Kaynakça

  • Jacobson JA. Infectious diseases ethics. In: Singer PA, Viens AM, editors. Cambridge Textbook of Bioethics, 3rd ed. NY: Cambridge University Press; 2009. p.481–6. https://www.dphu.org/uploads/ attachements/books/books_5318_0.pdf
  • Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395:497–506. [CrossRef]
  • CDC, Coronavirus Disease 2019 (COVID-19); American Thoracic Society What is COVID-19? Worldometer Age, Sex, Existing Conditions of COVID-19 Cases and Deaths. Erişim tarihi: 01.06.2020. https://www.worldometers.info/coronavirus/ coronavirus-age-sex-demographics/
  • WHO Timeline - COVID-19. https://www.who.int/news-room/ detail/27-04-2020-who-timeline---covid-19 Erişim tarihi: 01.06.2020.
  • Klugman C. Ethics of Pandemics: Coronavirus and Large Scale Quarantine. Bioethics Net 2020. http://www.bioethics.net/2020/01/ ethics-of-pandemics-coronavirus-and-large-scale-quarantine/ Erişim tarihi: 01.06.2020
  • WHO Worldometer. https://www.worldometers.info/coronavirus/ Erişim tarihi: 31.05.2020
  • United Nations, Department of Economic and Social Affairs Social Inclusion, Everyone Included: Social Impact of COVID-19. https:// www.un.org/development/desa/dspd/everyone-included- covid-19.html Erişim tarihi: 01.06.2020
  • Huxtable R. COVID-19: where is the national ethical guidance? BMC Med Ethics 2020; 21:1–3. [CrossRef] https://doi.org/10.1186/s12910- 020-00478-2 Erişim tarihi: 01.06.2020
  • Fritz Z, Huxtable R, Ives J, Paton A, Slowther AM, Wilkinson D. Ethical road map through the covid-19 pandemic. BMJ 2020;369:m2033. [CrossRef]
  • Unites Nations UNESCO Universal Declaration on Bioethics and Human Rights, 19 October 2005 http://portal.unesco.org/en/ ev.php-URL_ID=31058&URL_DO=DO_TOPIC&URL_SECTION=201. html Erişim tarihi: 01.06.2020
  • Kass NE. An Ethics Framework for Public Health. Am J Pub Health 2001;91:1176–82. [CrossRef]
  • Childress J, Faden RR, Gaare RD, Gostin LO, Kahn J, Bonnie RJ, et al. Public Health Ethics: Mapping the Terrain. J Law Med Ethics 2002;30:170–8. [CrossRef]
  • Kayı İ, Sakarya S. Policy Analysis of Suppression and Mitigation Strategies in the Management of an Outbreak Through the Example of COVID-19 Pandemic. Infect Dis Clin Microbiol 2020;2:30–41. [CrossRef]
  • Veatch RM. Ethics of Promoting Herd Immunity. Fam Community Health 1987;10:44–53. [CrossRef]
  • Council of Europe Committee on Bioethics: COVID-19: Human rights principles must guide health decisions https://www.coe.int/en/ web/bioethics/-/covid-19-human-rights-principles-must-guide- health-decisio-1 Erişim tarihi: 01.06.2020
  • Upshur R. The Ethics of Quarantine. Virtual Mentor 2003;5:393–5. [CrossRef]
  • Lewnard JA, Lo NC. Scientific and ethical basis for social-distancing interventions against COVID-19. Lancet Infect Dis 2020;20:631–3. [CrossRef]
  • Lei R, Qiu R. Report from China: Ethical Questions on the Response to the Coronavirus. Hastings Center Bioethics Forum Essay. The Hastings Center 2020. https://www.thehastingscenter.org/report- from-china-ethical-questions-on-the-response-to-the-coronavirus/ Erişim tarihi: 01.06.2020.
  • Le TT, Andreadakis Z, Kumar A, Román RG, Tollefsen S, Saville M, Mayhew S. The COVID-19 vaccine development landscape. Nat Rev Drug Discov 2020;19:305–6. [CrossRef]
  • UNESCO Universal Declaration on Bioethics and Human Rights, 19 October 2005. Erişim tarihi: 18.04.2020. https:// en.unesco.org/themes/ethics-science -and-technology/ bioethics-and-human-rights
  • Türk Tabipleri Birliği COVID-19: Hekimlerin (Sağlık Çalışanlarının) hak ve yükümlülükleri, Sağlık Bakanlığı ve işverenlerin sorumlukları; 3 Nisan 2020. https://www.ttb.org.tr/haber_goster.php?Guid=70e89cf6- 75a2-11ea-b329-aa051764b049 Erişim Tarihi: 01.06.2020.
  • Slowther A, Mitchell S. COVID-19: In focusing on intensive care we must not lose sight of the wider professional duty to care for all patients. J Med Ethics April 3, 2020. Erişim tarihi: 01.06.2020. https://blogs.bmj.com/medical-ethics/2020/04/03/covid-19-in- focussing-on-intensive-care-we-must-not-lose-sight-of-the-wider- professional-duty-to-care-for-all-patients/
  • Medscape, In Memoriam: Healthcare Workers Who Have Died of COVID-19. April 1 2020. https://www.medscape.com/ viewarticle/927976 Erişim: 01.06.2020
  • Lei R, Qiu R. Chinese Bioethicists: Silencing Doctor Impeded Early Control of Coronavirus. The Hastings Center 2020. https://www. thehastingscenter.org/coronavirus-doctor-whistleblower/ Erişim tarihi: 01.06.2020.
  • Fenton E. Personal Protective Equipment for front-line health workers: an ethical imperative. J Med Ethics 2020 https://blogs.bmj. com/medical-ethics/2020/03/31/personal-protective-equipment- for-front-line-health-workers-an-ethical-imperative/?int_ source=trendmd&int_campaign=usage-042019&int_medium=cpc Erişim tarihi: 01.06.2020
  • Schuklenk U. Health Care Professionals Are Under No Ethical Obligation to Treat COVID-19 Patients. J Medical Ethics 2020. https://blogs.bmj.com/medical-ethics/2020/04/01/health-care- professionals-are-under-no-ethical-obligation-to-treat-covid-19- patients/ Erişim tarihi: 01.06.2020
  • American College of Emergency Physicians ACEP Policy Statement, Code of Ethics; January 2017. p.13. https://www.acep.org/ globalassets/new-pdfs/policy-statements/code-of-ethics-for- emergency-physicians.pdf
  • American Medical Association (AMA) Code of Medical Ethics: Allocating Limited Health Care Resources Code of Medical Ethics Opinion 11.1.3 https://www.ama-assn.org/delivering-care/ethics/ allocating-limited-health-care-resources Erişim tarihi: 01.06.2020.
  • Emanuel E, Persad G, Upshur R, Thome B, Parker M, Glickman, A, et al. Fair Allocation of Scarce Medical Resources in the Time of Covid-19. N Engl J Med 2020;382:2049–55. [CrossRef]
  • White DB, Katz MH, Luce JM, Lo B. Who Should Receive Life Support During a Public Health, Emergency? Using Ethical Principles to Improve Allocation. Ann Intern Med 2009;150:132–8. [CrossRef]
  • World Health Organization. Guidance for managing ethical issues in infectious disease outbreaks. World Health Organization. 2016. https:// apps.who.int/iris/handle/10665/250580 Erişim tarihi: 01.06.2020.
  • Human Rights Watch, Rights Risks to Older People in COVID-19 Response Combat Ageism; Ensure Access to Health Care, Services, April 7, 2020 https://www.hrw.org/news/2020/04/07/rights-risks- older-people-covid-19-response Erişim tarihi: 01.06.2020.
  • UNESCO Report of the International Bioethics Committee on the Bioethical Response to the Situation of Refugees, SHS/YES/IBC- 24/17/2 REV.2 Paris, 15 September 2017. https://unesdoc.unesco. org/ark:/48223/pf0000248721 Erişim tarihi: 01.06.2020.
  • Razai MS, Oakeshott P, Kankam H, Galea S, Stokes-Lampard H. Mitigating the psychological effects of social isolation during the covid-19 pandemic. BMJ 2020;369:m1904. [CrossRef]
  • Roesch E, Amin A, Gupta J, García-Moreno G. Violence against women during covid-19 pandemic restrictions. BMJ 2020;369:m1712. [CrossRef]
  • Kadın Cinayetlerini Durduracağız Platformu, Korona Günlerinde Kadınlar için Şiddetten Korunma Kılavuzu 28.03.2020 http:// k adincinayetlerinidurduracagiz.net/acik lamalar/2899/ koronagunlerindekadinlaricin-siddetten-korunma-kilavuzu Erişim tarihi: 01.06.2020.
  • Council of Europe Oviedo Convention on Human Rights and Biomedicine https://www.coe.int/en/web/conventions/full-list/-/ conventions/treaty/164 ; Oviedo Convention Additional Protocol to the Convention on Human Rights and Biomedicine, concerning Biomedical Research https://www.coe.int/en/web/conventions/full- list/-/conventions/treaty/195 M.26, Erişim tarihi: 01.06.2020
  • World Health Organization. Guidance for managing ethical issues in infectious disease outbreaks. World Health Organization. 2016. https://apps.who.int/iris/handle/10665/250580 Erişim tarihi: 01.06.2020.
  • Shah SK, Miller FG, Darton TC, Duenas D, Emerson C, Lynch HF, et al. Ethics of controlled human infection to study COVID-19. Science 2020;368:832–4. [CrossRef]
  • Marmot M. Social determinants of health inequalities. Lancet. 2005;365:1099‐1104. [CrossRef]
  • Godlee F. Racism: the other pandemic. BMJ 2020;369:1. [CrossRef]
  • Nuffield Council on Bioethics, Ethical considerations in responding to the COVID-19 pandemic Rapid policy briefing. https://www. nuffieldbioethics.org/assets/pdfs/Ethical-considerations-in- responding-to-the-COVID-19-pandemic.pdf Erişim tarihi: 01.06.2020.
Toplam 42 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Bölüm Collection
Yazarlar

Yeşim Işıl Ülman

Yayımlanma Tarihi 1 Eylül 2020
Yayımlandığı Sayı Yıl 2020Sayı: 3

Kaynak Göster

EndNote Ülman YI (01 Eylül 2020) COVID-19 Enfeksiyon Hastalığı Salgınına Biyoetik Açıdan Bakış. Acıbadem Üniversitesi Sağlık Bilimleri Dergisi 3 365–371.