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Introduction

  • Italy's COVID-19 scenario: Ethical challenges due to resource scarcity and patient overload.
  • Focus on duty of care, fidelity, and resource scarcity, revealing complex ethical landscape.
  • Clash between optimal care and resource constraints leads to a moral dilemma.

Duty of Care and Fidelity

  • Duty of care and fidelity in healthcare.
  • Primary duty of healthcare providers: Save lives and prioritize patient well-being.
  • Resource scarcity leading to difficult decisions, potentially compromising duty of care and fidelity (David et al., 2019).

Utilitarianism and Beneficence

  • Utilitarianism: Maximize benefits for the majority.
  • Alignment with beneficence: Promote patient well-being (Kahane et al., 2018).
  • SIAARTI guidelines prioritizing patients with higher therapeutic success chances (Tam, 2021).

Deontological Ethics and Non-Maleficence

  • Deontological ethics: Adhere to rules and duties (Tseng & Wang, 2021).
  • Non-maleficence principle: Avoid harm to individuals.
  • Tension of potentially withholding care conflicting with non-maleficence (Meier et al., 2022).

Distributive Justice and Resource Allocation

  • Distributive justice: Equitable resource allocation.
  • SIAARTI guidelines prioritizing successful therapeutic outcomes (Sesta et al., 2020).
  • Ethical challenge: Denying care based on age or health status (Persad, 2019) .
  • Potential negligence as a legal concern.
  • Elements: Duty of care, breach, causation, harm (Cypher, 2020).
  • Resource constraints questioning alignment with care standards.

Nurses’ Decision-Making and Australian Legislation

  • Australia's nursing decision-making framework: Standards, ethics, legislation (Gullick et al., 2019).
  • AHPRA's Registered Nurse Standards for Practice emphasizing quality care (APHRA, 2023).
  • ICN's Code of Ethics for Nurses influencing actions (ICN, 2021).
  • The Australian Nursing and Midwifery Federation (ANMF), serving as the professional body for nurses and midwives (ANMF, 2022)

Conclusion

In conclusion, this presentation underscores the intricate ethical landscape of healthcare decisions amid resource constraints. The scenario's clash between the duty of care and limited resources underscores a moral dilemma. The analysis of utilitarianism, deontology, justice, and legal concerns highlights the complexity healthcare professionals navigate.

Australia's nursing framework exemplifies dedication to ethical standards. This discussion emphasises ongoing ethical discourse, education, and interdisciplinary collaboration to ensure morally sound decisions. The pandemic has magnified the vital role of ethics, prompting introspection on the values guiding medical practice into the future

References

Australian Health Practitioner Regulation Agency. (2023). Registration Standards. https://www.ahpra.gov.au/Registration/Registration-Standards.aspx

Australian Nursing and Midwifery Federation. (2022). Policies, Guidelines & Position Statements. https://www.anmf.org.au/resources/policies-guidelines-position-statements

Cypher, R. L. (2020). Demystifying the 4 elements of negligence. The Journal of Perinatal & Neonatal Nursing , 34 (2), 108-109. https://doi.org/10.1097/JPN.0000000000000479

David, E., DePierro, J. M., Marin, D. B., Sharma, V., Charney, D. S., & Katz, C. L. (2021). COVID-19 pandemic support programs for healthcare workers and implications for occupational mental health: A narrative review. Psychiatric Quarterly , 1-21. https://doi.org/10.1007/s11126-021-09952-5

Gullick, J., Lin, F., Massey, D., Wilson, L., Greenwood, M., Skylas, K., & Gill, F. J. (2019). Structures, processes and outcomes of specialist critical care nurse education: an integrative review. Australian Critical Care , 32 (4), 331-345. https://doi.org/10.1016/j.aucc.2018.09.007

International Council of Nurses. (2021). The ICN Code of Ethics for Nurses. https://www.icn.ch/system/files/documents.pdf

Jakimowicz, S., Perry, L., & Lewis, J. (2018). Insights on compassion and patient-centred nursing in intensive care: A constructivist grounded theory. Journal of Clinical Nursing , 27 (7-8), 1599-1611. https://doi.org/10.1111/jocn.14231

Jung, M. (2020). A legal consideration of distributive justice and rights to health in the COVID-19 era. 보건교육건강증진학회지 , 37 (3), 101-114. http://ekhep.or.kr/xml/25682/25682.pdf

Kahane, G., Everett, J. A., Earp, B. D., Caviola, L., Faber, N. S., Crockett, M. J., & Savulescu, J. (2018). Beyond sacrificial harm: A two-dimensional model of utilitarian psychology. Psychological Review , 125 (2), 131. https://psycnet.apa.org/doi/10.1037/rev0000112

Meier, L. J., Hein, A., Diepold, K., & Buyx, A. (2022). Algorithms for ethical decision-making in the clinic: A proof of concept. The American Journal of Bioethics , 22 (7), 4-20. https://doi.org/10.1080/15265161.2022.2040647

Persad, G. (2019). Evaluating the legality of age-based criteria in health care: From nondiscrimination and discretion to distributive justice. BCL Rev. , 60 , 889. https://heinonline.org/HOL

Pilbeam, C., Tonkin-Crine, S., Martindale, A. M., Atkinson, P., Mableson, H., Lant, S., & Gobat, N. (2022). How do healthcare workers ‘do’guidelines? Exploring how policy decisions impacted UK healthcare workers during the first phase of the COVID-19 pandemic. Qualitative Health Research , 32 (5), 729-743. https://doi.org/10.1177/10497323211067772

Sesta, L., Mondello, C., Cardia, L., Mondello, E., Baldino, G., & Spagnolo, E. V. (2020). COVID-19 in Italy. Clinical emergency and bioethical perspectives. Euromediterranean Biomedical Journal , 15 . https://iris.unipa.it/retrieve/handle.pdf

Tam, K. I. (2021). An ethical conundrum: Palliative care in the COVID-19 pandemic. Palliative & Supportive Care , 19 (2), 127-128. https://doi.org/10.1017/S1478951521000055

Tseng, P. E., & Wang, Y. H. (2021). Deontological or utilitarian? An eternal ethical dilemma in outbreak. International Journal Of Environmental Research and Public Health , 18 (16), 8565. https://doi.org/10.3390/ijerph18168565

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