COVID 19 - Ethics Spotlight

The COVID-19 pandemic has created or highlighted key bioethics issues that face our healthcare system and society at large. On this page, IU Center for Bioethics faculty and staff provide their analysis of the challenges emerging from COVID-19 and possible solutions.

Recent Additions

Center Faculty and Staff Write about COVID-19

Dr. Mary A. Ott: Clinician Perspectives on Ethics and COVID-19: Minding the GAP in Sexual and Reproductive Health

Dr. Aaron Carroll: Stop Expecting Life to Go Back to Normal Next Year

Selected Readings

Social Disparities

Coronavirus is hundreds of times more deadly for people over 60 than people under 40 (Nir Menachemi)

Public Health

A National Survey Assessing SARS-CoV-2 Vaccination Intentions: Implications for Future Public Health Communication Efforts ( Katharine Head, Monica Kasting, Lynne Sturm, Jane Hartsock, Gregory Zimet)

Dr. Aaron E. Carroll

Healthcare Triage

Dr. Aaron E. Carroll, Faculty Investigator at the IU Center for Bioethics and Professor of Pediatrics at IU School of Medicine, releases videos every week on his YouTube channel, Healthcare Triage. During the pandemic he and his team are answering questions and busting myths using scientific research and medical expertise.

 

 

Watch latest Covid-19 video:

Healthcare Triage Podcast

Dr. Carroll has dedicated some episodes of his podcast to answering questions and presenting research concerning the COVID-19 pandemic.

What We Can Learn from a LOT of Blood Samples - July 30, 2020

COVID-19 and Immune Symptoms in Kids - June 4, 2020

Your Coronavirus Questions Answered - March 19, 2020

 

Indiana CTSI COVID-19 Featured Expert: Aaron Carroll, MD

Aaron Carroll, MD is director of career development, education, and research training programs at the Indiana CTSI. Visit his CTSI featured expert page to see Dr. Carroll's appearances in news broadcasts and articles.

Keeping IU Healthy 

Dr. Carroll, as the director of surveillance and mitigation for IU's COVID pandemic response team, has released a series of Q&A webinars to address student and faculty questions as the university prepares to return to in-person learning fall semester. 

Ask Aaron- Back to Campus Edition - August 12, 2020

Ask Aaron - Faculty and Staff - July 30th, 2020

 

Dr. Brownsyne Tucker Edmonds

COVID-19 and the Black Community

Dr. Brownsyne Tucker Edmonds, faculty investigator at the Indiana University Center for Bioethics, and Assistant Dean for Diversity Affairs at the IU School of Medicine, spoke with WFYI to explore how COVID-19 is impacting the black community in Indianapolis. Listen Here

Ross Silverman, JD, MPH

You Asked, We Answered: How Contact Tracing Works

Ross Silverman, JD, MPH, faculty investigator at the IU Center for Bioethics, Professor of Health Policy and Management at the Indiana University Richard M. Fairbanks School of Public Health at IUPUI, and Professor of Public Health Law at the Indiana University Robert H. McKinney School of Law recently spoke with Side Effects, a public health education initiative led by WFYI Indianapolis. 

 

Dr. Mary A. Ott

TREATs Talk

Dr. Mary Ott, faculty investigator at IU Center for Bioethics and Professor of Pediatrics at IU School of Medicine, recently presented a TREATs Talk (Translational Research Ethics- Applied Topics). Her presentation, "Ethics of Virtual Engagement and Data Collection" explores ethical issues associated with increased online health appointments in the time of COVID-19. Watch Dr. Ott's presentation here and then visit the channel page to see the rest of our library.

 

Dr. Peter Schwartz

Dr. Peter H. Schwartz is the Director of the IU Center for Bioethics and Associate Professor of Medicine at IU School of Medicine. He directs the Bioethics and Subject Advocacy Program
(BSAP) of the Indiana Clinical and Translational Sciences Institute (CTSI) and co-leads the Behavioral Science and Ethics cluster of the IU Precision Health Initiative. He recently participated in a panel discussion hosted by the Online Ethics Center of the National Academy of Engineering. The diverse panel members, including distinguished bioethicist and NYU School of Medicine faculty Arthur Caplan, discussed the pros, cons, and Ethics of Challenge Studies, Avalanche Testing and other Approaches to Vaccine Development [Webinar].

Center Faculty and Staff Write about COVID-19

IUCB Blog

IUCB faculty and staff have been using our blog platform to respond to the SARS-CoV-2 pandemic through the lens of a bioethics framework. Topics covered include ethics of allocation, lessons from quarantine about isolation and connection, ethics of government and public response, and ethical violations of lock down orders. We will continue throughout the pandemic and beyond to respond to relevant topics on this site.

 

Dr. Mary A. Ott

Dr. Mary A. Ott and Caitlin Bernard, “Preserving the Reproductive Rights of Girls and Women in the Era of COVID-19: The Need for a Least Restrictive Solution,” The American Journal of Bioethics, July 27, 2020.

 

Dr. Ross D. Silverman,  JD, MPH

Ross D. Silverman, JD, MPH, faculty investigator at the IU Center for Bioethics, Professor of Health Policy and Management at the Indiana University Richard M. Fairbanks School of Public Health at IUPUI, and Professor of Public Health Law at the Indiana University Robert H. McKinney School of Law recently published a Perspective in the New England Journal of Medicine with co-authors titled Ensuring Uptake of Vaccines against SARS-CoV-2. Although a vaccine for SARS-CoV-2 is months to years away, they offer a framework to ensure adequate vaccine uptake when it is released and argue that state policy makers should apply such policies now.

 

Dr. Colin Halverson

Professors Halverson (Bioethics) and Wilson (Medical Genetics) lay out practical and ethical issues encountered in the world of direct-to-consumer genetic testing that suggest potential pitfalls and work-arounds for the rollout of direct-to-consumer COVID testing in the Journal of Community Genetics. Download a PDF of the article here:

Home Testing for COVID-19: Lessons from direct to consumer genetics

Topics and Reading from Center Faculty and Staff

In this section, IU Center for Bioethics faculty and staff share articles that address important topics related to bioethics and the COVID-19 pandemic. This section is updated regularly as new articles and topics come up, so bookmark the page and return regularly for new articles and discussion.

The world is facing unprecedented challenges in coping with the SARS-CoV-2 pandemic. The best way forward, internationally, nationally, and locally, will be through implementation of robust public health policies that are based on the latest scientific evidence. With these policies, though, come essential bioethical questions.

Deadly Delay: The FDA's Role in America's COVID-Testing Debacle (Barbara J. Evans and Ellen Wright Clayton, The Yale Law Journal Forum)

Can Coronavirus Contact Tracing Survive Reopening? (Benjamin Wallace-Wells, The New Yorker)

How Bars Are Fueling COVID-19 Outbreaks (Will Stone, NPR)

How Public Health Experts Feel about Being Wrong(Slate)

Roadmap to Pandemic Resilience(Edmond J. Safra Center for Ethics, Harvard)

National Covid-19 Testing Action Plan(The Rockefeller Foundation)

National Action Plan for Expanding and Adapting the Healthcare System for the Duration of the COVID 

Pandemic (Johns Hopkins, Bloomberg School of Public Health)

Amid the Coronavirus Crisis, a Regimen for Reentry(Atul Gawande, The New Yorker)

There Are 3 Things We Have to Do to Get People Wearing Masks(Angela Duckworth, Lyle Ungar & Ezekiel J. Emanuel, New York Times)

A National Survey Assessing SARS-CoV-2 Vaccination Intentions: Implications for Future Public Health Communication Efforts ( Katharine Head, Monica Kasting, Lynne Sturm, Jane Hartsock, Gregory Zimet)

The idea of using "Immunity Passports" to give some people special freedoms to move or work has become seriously considered during the COVID-19 pandemic, due to the unique situation of a widespread and highly contagious illness, limited effective treatments and or vaccine.  But this approach raises serious legal and ethical concerns.

Passport to freedom? Immunity passports for COVID-19 (Rebecca Brown, Julian Savulescu, Bridget Williams, & Dominic Wilkinson, Journal of Medical Ethics)

Why COVID-19 immunity passports may violate US law (Seema Mohapatra, The Conversation)

TheEthicsofCOVID-19Immunity-BasedLicenses("ImmunityPassports11    (Govind Persad & Ezekiel J. Emanuel, JAMA) 

Immunity Passports and Moral Hazard (Daniel Jacob Hemel & Anup Malani, University of Chicago, Public Law Working Paper No. 743)

Ten reasons why immunity passports are a bad idea (Natalie Kofler & Franc;oise Baylis, Nature)

New bioethics questions and challenges arise during a pandemic, including whether to cut corners in design and reporting of research to try to move faster to understanding and cure, and whether to utilize approaches involving human subjects that would not be considered acceptable in other times. 

Racial Disproportionality in Covid Clinical Trials(Daniel B. Chastain et al., New England Journal of Medicine)

A Vaccine Reality Check: So much hope is riding on a breakthrough, but a vaccine is only the beginning of the end.  (Sarah Zhang, The Atlantic) 

Against Pandemic Research Exceptionalism(Alex John London & Johnathan Kimmelman, Science)

Research During COVID(Megan Doerr & Jennifer K. Wagner, Journal of Law and the Biosciences)

One Man's Quest to Infect People with COVID-19 for Science (Andrew Zaleski, Medium)

Controversial ‘human challenge’ trials for COVID-19 vaccines gain support (Jon Cohen, Science)

Human Challenge Studies to Accelerate Coronavirus Vaccine Licensure (Nir Eyal, Marc Lipsitch, & Peter G. Smith, The Journal of Infectious DiseasesQ&A with the author. https://www.nature.com/articles/d41586-020-00927-3

The Challenges of Challenge Experiments(Susan E. Lederer, The New England Journal of Medicine)

A strategic approach to COVID-19 vaccine R&D (Lawrence Corey, John R. Mascola, Anthony S. Fauci,Francis S. Collins, Science)

This pandemic is has amplified and transformed the vast health and economic disparities that exist in the US in healthcare and society.  The following articles address why these disparities exist and highlight proposals to counter them. 

Empty Beds and Mounting Deaths: COVID-19 and U.S. Healthcare’s Systemic Failures(Jenny Hua, M.D., Ph.D., Somatosphere)

New York Doctors- Letter to NYS DOH on Public Health Impact of Eviction

No More Status Quo: A community-led action plan for addressing structural inequity during COVID-19 recovery(Hanna Love, Tunua Thrash-Ntuk, and Jennifer S. Vey, The Brookings Institute)

Association Between State-Level Income Inequality and COVID-19 Cases and Mortality in the USA(Oronce, C.I.A., Scannell, C.A., Kawachi, I. et al., Journal of  Genteral Internal  Medicine)

Why Do We Pay So Many People So Little Money?(Thomas D. Edsalls D. Edsall, The New York Times)

America Can Afford a World-Class Healthcare System: Why don't we have one? (Anne Case and Angus Deaton, NY Times)

The Covid-19 Riddle: Why Does the Virus Wallop Some Places and Spare Others?(Hannah Beech, Alissa J. Rubin, Anatoly Kurmanaev and Ruth Maclean, NY Times)

We can’t recover from a coronoavirus recession without helping young workers (Martha Ross and Nicole Bateman, Brookings Institute) 

The large and unequal impact of COVID on workers (Abigail Adams-Prassl, Teodora Boneva, Marta Golin, and Christopher Rauh, Vox)

The effect of COVID-19 and disease suppression policies on labor markets(Jonathan Rothwell and Hannah Van Drie, Brookings Institute) 

Covid-19, (In)visible Mothers, and the State (Cultural Anthropology) (Lindsay Donaldson, Society for Cultural Anthropology)

A National Survey Assessing SARS-CoV-2 Vaccination Intentions: Implications for Future Public Health Communication Efforts ( Katharine Head, Monica Kasting, Lynne Sturm, Jane Hartsock, Gregory Zimet)

The tragic history of racial mistreatment and bias in the US has always affected healthcare and research involving people of color. These disparities are now contributing to the disproportionate rates of death faced by Black Americans.

Black Lives and Health Justice (Elizabeth A. Nelson, Fairbanks Center for Medical Ethics)

Indiana's Black Death Rates from COVID-19: Institutional Sources of Disparity (Breanca Merritt, Center for Research on Inclusion & Social Policy)

Covid's Color Line - Infectious Disease, Inequality, and Racial Justice(Michele K. Evans, M.D., The New England Journal of Medicine)

Race Gaps in COVID-19 Deaths are Even Bigger Than They Appear(Tiffany Ford, Sarah Reber, Richard V. Reeves, Brookings)

Canaries in the Coal Mine: COVID-19 Misinformation and Black Communities(Brandi Collins-Dexter, Technology and Social Change Project and Harvard Kennedy School Shorenstein Center on Media, Politics and Public Policy)

Podcast with author Brandi Collins-Dexter(Lawfare podcast, July 9, 2020)

Building Racial Equity in Tech Ecosystems to Spur Local Recovery(Dell Gines and Rodney Sampson, Actionable Ideas for Economic Recovery in American Cities)

Zip Code Virus Data Show Disparities: More cases shown in poorer areas of Indiana.  (Nikki Kelly, The Journal Gazette) 

Medical Bias (John Eligon and Audra D. S. Burch, NY Times)

Other Resources from the Center and Beyond

Regenstrief Dashboard

Dr. Peter Embi, Associate Dean for Informatics and Health Services Research, IUCB faculty investigator, and President and CEO of the Regenstrief Institute, joined his colleagues in creating the Regenstrief Dashboard- an Indiana specific dashboard to track COVID-19 related cases, hospitalizations, and mortality. The information is separated by demographic and regional information.

Indiana CTSI COVID-19 Daily Digest

A partnership between the Indiana CTSl's Monon Collaborative and the Indiana FSSA to engage Indiana's nationally-recognized academic experts to evaluate and inform Indiana practices, programs, and policies.

WHO Global Health Ethics, Resources on Ethics and COVID-19

Links to statements by national ethics committees, international organizations, and national bodies and professional associations about the ethics of the SARS-CoV-2 pandemic.

Toolkit: Bioethics Resources for COVID-19

Bioethics.net has collected blog posts, resources, guidelines, and other information for people dealing with COVID-19.