Children are returning to classrooms amid another wave of Covid cases, but some public health leaders have leaned into the message that “most of us” can ignore the continued presence of Covid by taking just “a few basic steps,” such as staying up to date with vaccinations. “Most of us,” however, does not include families with young babies, among other groups for whom these steps are unavailable or insufficient.

In its early days, bioethics emphasized patient autonomy in the doctor-patient relationship. But patient autonomy is not the be-all and end-all principle to follow in all health care settings. Especially in lethal, airborne infectious disease pandemics.

A massive wave of Covid infections has begun now that China has ended much of its zero Covid policy. Three steps ought to be taken.

The best case scenario for immunocompromised people like me would be universal masking in all public spaces. But I am willing to compromise.

The Center for Disease Control and Prevention’s revised guidelines have done away with universal masking at health care facilities, making masking optional if community Covid transmission isn’t high. It’s the latest attempt of public health officials to adapt their guidance to meet the country’s fatigued sensibilities. Some patients will be at risk.

President Biden recently declared that the Covid-19 “pandemic is over.”  Some public health experts agreed with this assessment; others disagreed.  What cannot be disputed is that nearly 12,000 Americans have...

It’s back-to-school season in the United States, the third one during the Covid pandemic, but the first in which all schoolchildren are eligible for Covid vaccines. Yet fewer than a third of children ages 5 to 11 are fully vaccinated, while the percentage of those under 5 who have started–let alone completed–vaccination is in the low single digits. Why? The answers are complicated.

This week, the United States saw two momentous public health events: one million deaths attributed to Covid and the 198th mass shooting of the year. Both the pandemic and gun shootings are threats to public health that are not being adequately addressed.

The California legislature appears to have caved to pressure from opponents of a Covid vaccine mandate for schoolkids. I’d prefer to think of it as a wise and strategic retreat from a battle that mandate advocates could not win.

As mask mandates are rolled back and friends and neighbors debate the risks and benefits of masks and the merits or permissibility of mandating their use, we can catch a glimpse of the considerable extent to which values depend heavily on something other than pure reason. It’s a bit disappointing, perhaps. But it might be a useful lesson for democracy.

As I sit here in my office at the Slovak Medical University in Bratislava, my colleagues are experiencing great moral anguish because of Russia’s invasion of neighboring Ukraine. Simultaneously, we are also confronting the Omicron wave of the Covid-19 pandemic. The war complicates and burdens health care here and in other border nations exponentially, and especially so in combination with the pandemic.

Caregivers are not visitors. Hospital policies that restrict visits from family caregivers can harm patients.

The recognition of the social injustices surrounding the pandemic is an important opportunity to understand the longstanding links between health and social and global justice.

When Covid-19 vaccines first became available last year, Somali Muslims in Minnesota--the largest Somali Muslim population in North America-- were fearful and, consequently, their vaccination rate was low and their Covid-19 rate was high. But health professionals and community representatives worked together to understand and overcome their vaccine hesitancy.

There has been much criticism of the decision by the Centers for Disease Control and Prevention (CDC) to let Covid-infected people who are feeling better to stop quarantining after five days and simply wear a mask. But this sort of pragmatic decision has a long history in public health.

Pfizer recently announced that its trials in children 2 to 5 years old produced a weaker than expected antibody response and that it would hold off requesting authorization from the Food and Drug Administration. This news creates opportunities – and additional challenges – for off-label use of Covid-19 vaccines in children,

The role of doctors, nurses and other clinicians is to treat patients without passing judgment and to fulfill their fiduciary duty. However, the Covid-19 pandemic has muddled these obligations.

Some health care providers are prioritizing patients who are fully vaccinated against Covid-19 over those who are unvaccinated. This is unethical.

Children have suffered both physical and mental illness during the pandemic. Nearly 200 children in the United States have died. Acute mental health crises increased during the pandemic. Getting children immunized is the best way to get back to normal. We suggest an option that would permit children under 5 to be vaccinated without waiting until traditional prospective randomized trials can be completed.

Like the pandemic, uncertainty, growing confidence, and the return of doubt come in waves. The Omicron variant is just the latest twist in this plot.

In a 1988 essay on pandemics, Nobel laureate Joshua Lederberg wrote, “We have no guarantee that the natural evolutionary competition of viruses with the human species will always find ourselves the winner.”

In a new essay in the Hastings Center Report, we argue it is not. Yet the practice is prohibited.

States and school boards around the country are engaged in a debate about whether to require middle and high school students to be fully vaccinated against Covid-19. The debate is not so much about whether to mandate. It's when to do so.

Faced with mandatory Covid vaccination, students and employees have appealed to religion as grounds for exemption. This latest conscience war within our culture wars presents a minefield of legal and philosophical complexities for states and health care systems.

The pandemic has laid bare the significant shortcomings of a health system rooted in an unsustainable financial model that exploits the physical and emotional labor of its nurses.

The commitments made by the wealthiest countries to share Covid vaccines and funding for international cooperation mechanisms are crucial, but insufficient. They reflect the “securitization of health,” a 21st century phenomenon whereby states turn health issues into national security issues.

In South Carolina, where I live, we are not just ignoring good arguments, but actually legislating on the basis of bad ones. The budget rule, Proviso 1.108, threatens the funding of schools that require masks.

The opposition to mask and vaccine mandates transcends the issue of individual liberty.

As the Covid-19 pandemic continues to strain health systems’ capacity to provide adequate care for critically ill patients, should patients’ vaccination status be considered in making triage decisions? This question sparked debate recently after the leak of an internal memo of the North Texas Mass Critical Care Guideline Task Force that proposed using patients’ Covid-19 vaccination status as a factor to assign intensive care beds.

The Covid-19 pandemic has significantly affected the practice of clinical research. Researchers and IRBs have felt an urgency to respond more quickly than usual, aware that lives are at stake.

As the parent of a child under 5 years old, I am worried about what lies ahead for kids and Covid-19. The more contagious Delta variant is widely circulating, infecting...

Why is the FDA dragging its feet in approving Covid vaccines for children under 12? Justifications lack moral weight.

The moral justification for mandating covid vaccination for health care workers is clear. But what happens if some health care workers still refuse to be vaccinated, and there aren't enough vaccinated staff to care for all the patients in a hospital?

Colleges and universities have an ethical obligation to mandate covid vaccines to protect the health and futures of both their students and the larger communities, in addition to promoting equality through education.

Many hospitals are providing incomplete or subpar professional medical interpretation to the patients who need it--many of whom are disproportionately affected by Covid.

The pandemic magnified the inherent difficulty and stress of conversations involving life-sustaining treatment by forcing clinicians and patients to engage in life-altering discussions via telephone and video conference, restricting nonverbal communication and eye contact, and eliminating the benefit of simply having another person nearby in time of crisis.

The American myth of rugged individualism, which often means “pulling yourself up by your own bootstraps,” is outdated, was never completely accurate. It is on full display during the coronavirus pandemic, contributing to cases and deaths.

The United States, Russia, and China support temporary patent waivers for Covid vaccines. The waivers, which need support from other countries, would likely save lives in low- and middle-income countries.

In Costa Rica, where I live, only 24% of the population has received at least one vaccine dose because we have received very small amounts of vaccines. The Costa Rican president suggested that every person who can travel to the U.S. to get the jab, should do it. Vaccine tourism, then, seems to be another promising business opportunity for the powerful countries that have accumulated vaccines instead of redistributing them soon and fairly.

Many Latin American countries are being devastated by excessive loss of life from Covid-19, many sectors of society falling below the poverty line, and health systems being overwhelmed. As collateral damage, some countries in the region are witnessing an eruption of populism and autocratic trends and an increasing erosion of already weak and unstable democracies. Can bioethics be a useful tool for managing this crisis? Argentina provides a case study.

The C.D.C.'s latest policy guidance that people who have been fully vaccinated against the coronavirus virus no longer need to wear face masks indoors gets the science right, but policymaking wrong.

Citing the Yellow Card as precedent for Covid-19 travel passes that exempt those with proof of vaccination from testing and quarantine mandates when crossing certain borders is an erroneous policy assumption that could prolong the pandemic and imperil global health.

My partner and I are thinking a lot about this question. Moderna and Pfizer trials are running in our community–at the children’s hospital where I work as a clinical ethicist....

Anniversaries are complicated. In rehabilitation psychology, the anniversary of an accident that caused a brain or spinal cord injury can be a time for profound gratitude and for grief. Now that we have passed the one-year anniversary of the Covid pandemic, each of us continues to deal with the repercussions and wondering what the "new normal" may look like.

As access to vaccines increases, the popular press reports waning demand for vaccines in rural residents and points to vaccine hesitancy. But there may be other reasons why doses distributed to rural areas remain unclaimed.

Disagreements among biomedical experts regarding whether the scientific evidence supports delaying the second shot of Covid-19 vaccines or pausing the AstraZeneca and Johnson & Johnson vaccines because of very rare side effects bring to the fore missing aspects in exhortations to trust biomedical experts.

The pandemic is not over, but light is beginning to crest the horizon. Vaccination rates, especially among older adults and their caregivers, are rising. As we begin to relax physical...

The World Health Organization recently released a long-anticipated report on SARS-CoV-2 origins, based on 28 days of field research and site visits in China conducted jointly by 17 international and...

There are a whole lot of us who think that, if we had dementia and were unable to live independently, we would prefer death. The idea that someone suffering from dementia and confined to a nursing home might actually welcome death is apparently so taboo that it cannot be openly contemplated.

Is it wrong for doctors to judge their patients’ choices? I have reflected on this question while being on the frontline of the Covid-19 pandemic in New York City. Health...

As Covid-19 continues to plague the United States, insufficient attention has been paid to the role that incarcerated persons play in the persistence of this pandemic and the work that...

The Covid-19 vaccine rollout is currently a hub of individual, sociopolitical, and ethical activity.  As we watch the numbers of daily doses administered rising, we may feel engaged in a...

Reparations in various forms of compensation to the American victims of preventable Covid, who may experience lifelong health effects, is obligatory.

Now, with limited distribution of vaccines with varying degrees of efficacy there is renewed interest in immunity passports; more accurately described as vaccination certificates. What remains to be determined is who may use this documentation for what purpose.

Willingness to be vaccinated is not the only factor that may reduce vaccination rates. Fear is a powerful deterrent for individuals in hidden populations, especially undocumented immigrants. Even if their work or other circumstances place them at high risk of infection, many would be unlikely to risk the consequences of coming forward to be vaccinated.

Vaccine navigators have emerged as a response to the complexity of mass vaccination for Covid-19.

Congress recently announced plans for an independent commission to investigate the facts and causes of the January 6 insurrection at the U.S. Capitol. This 1/6 Commission is to be modelled after the 9/11 Commission. A national commission to investigate the disaster that the Covid-19 virus has caused in America must also be launched.

Fewer vaccines are going to Black people. While it’s easy to fall back on vaccine hesitancy as an excuse, systemic racism is to blame.

Science has replaced populism in the White House. For the first time, the president's science advisor will be elevated to cabinet rank. There are other good omens, as well.

Vaccine hesitancy is a concern around the world, but negative attitudes among Muslims in particular toward some coronavirus vaccines have been the focus of attention in the media. Some scholars in Asia recently issued fatwa against the Chinese Covid-19 vaccine. Media coverage has characterized the Muslim world as a hotspot for vaccine hesitancy, but experts point out biases in this coverage and explain the underlying reasons.

Last month, with concerns over the supply and coordinated administration of coronavirus vaccines escalating, the Centers for Disease Control and Prevention conceded that “any available mRNA COVID-19 vaccine” may be used to complete vaccination in “exceptional situations” preventing multi-dose manufacturer matching. While presented solely as a last resort, this guidance reflects a dilemma currently sweeping across the medical and health policy worlds: given limited supply, should vaccination efforts—still only authorized for emergency use in this country—deviate from evidence-driven, studied regimens to maximize individuals reached?

A third Covid vaccine candidate moving closer to potential FDA authorization is less effective than the two Covid vaccines already authorized in the United States. Is it ethical to offer a vaccine with lower efficacy? Is it ethical not to offer it in a public health emergency?

Vaccine allocation guidelines that prioritize people at greatest risk of Covid-19 require considerable administrative work (sometimes taking weeks). This is creating a bottleneck that has resulted in doses stuck in freezers not in arms. There's a better, more ethical way to allocate vaccines.

Contrary to the expectations of many fertility clinics, demand for egg freezing has increased sharply during the Covid-19 pandemic, highlighting longstanding ethical concerns about egg freezing clinics.

Around the world, an alarming percentage of Covid-19 deaths occurred in long-term care facilities. Some of these deaths may have been avoided by changes in design. It's time that bioethicists to take a closer look at the built health care environment.

Finally, the Centers for Disease Control and Prevention is working on developing standards for masks to see which ones actually block viruses. In the meantime, though, we should all be acting on what we do know about the effectiveness of various masks against Covid.

Suppose you are young, healthy, employed in a health care system and that your line of work does not require leaving the low-risk comfort of your home. Now suppose that your employer offers you a vaccine. You know there are others in your community who are at greater risk of contracting and dying from Covid-19 than you. Should you accept the dose?

The headlines are terrifying: A highly contagious new variant of the coronavirus is circulating in England. As the story spread, politicians and media outlets reported a devastating statistic: the new strain is 70% more transmissible than other strains of the virus. This has led to new lockdowns; many border closures; flight cancellations; and people fleeing the U.K. by train, boat, and plane. But is any of this necessary? Is the world suffering from mutation panic?

Beginning this week, guarded vehicles loaded with the first Covid-19 vaccine authorized in the United States are fanning out to hospitals across the country. In vaccine prioritization protocols health care workers, along with nursing home residents, make up phase “1a” – those who are first in line to be vaccinated. While much attention has been paid to who should come next, less is known about how hospitals are allocating vaccine doses among their staff. For many medical centers, the first shipments will only be enough to vaccinate a fraction of their workers. Who goes first within the “1a” category, and how are such decisions made?

A Covid-19 vaccine developed by Pfizer and BioNTech has received emergency authorization in the United States and has been authorized in the countries, and a vaccine by Moderna is likely to be authorized soon. In spite of this good news, at least for the first couple of years, Covid-19 vaccines will be a scarce resource. Because low-income countries are likely to lose out in the scramble to get access to them, there have been calls for global solidarity. While equitable allocation of vaccines around the world would be ideal, it is unrealistic as a near-term goal.

The year 2020 will be remembered as the first year of the coronavirus pandemic. But the pandemic was not alone in creating fear and dismay and raising ethical questions. Think of the rise in antisemitism, police violence against Black people, protests against immigration, and rallies by groups espousing Nazi slogans and symbols. Hate crimes, including murder, are the highest in years, according to the most recent FBI report, and were particularly aimed at Jews and Hispanics. Asian-Americans have been targeted as carriers of the so-called “China virus.”

One of the most surprising aspects of the Covid-19 pandemic for those of us who teach the history of public health is how unwilling many Americans have been to adopt health measures to protect others. Over the Thanksgiving holiday, tens of millions of Americans traveled, despite the fact that the Centers for Disease Control and Prevention urged them to stay home and the overall death rate from the coronavirus is approaching 300,000. Should recent events make us revisit aspects of the history of public health? And how can these stories inform future public health efforts during pandemics?

The procurement of human plasma as a potential therapy for Covid-19 is one of the latest examples of bioethics nationalism, defined by Jonathan Moreno in this blog as “distinct bioethics standards [which] are formally proclaimed as a matter of right by a sovereign state.” The race for a Covid cure pushes at the weak seams in the international liberal order in much the same way that Covid appears to be pushing at health care systems.

The Food and Drug Administration's rigorous guidance for an emergency use authorization of a Covid vaccine was met by resistance from the White House, since some of the terms would make it virtually impossible to issue a vaccine-related emergency authorization before Election Day. Understanding the ethical dimensions of issuing it for a vaccine can provide clarity on the necessity of the FDA’s stringent guidelines.

Multiple candidate vaccines for coronavirus are being evaluated scientifically in a process of unprecedented speed, and thousands of individuals around the world have volunteered to participate in placebo-controlled phase III field trials. If, or when, one of these candidate vaccines is proved to be safe and effective and receives an emergency use authorization by the Food and Drug Administration, will it continue to be ethical to enroll participants in other coronavirus trials that randomize half of them to a placebo?

Empathy does not need to dissipate as we endure medical training. Both the pandemic and the national reckoning over racial injustice and police brutality have touched every aspect of life as we know it, and medical training and education have been no exception.

In an essay published in Scientific American, we call for immediate and intensive research into the possibility that exposure to one of the coronaviruses that cause the common cold could decrease the severity of Covid-19, and could be leveraged to expand what’s been called “pre-existing” immunity to the disease by deliberate transmission of common cold coronaviruses. Here, we expand on our proposal.

Volunteering for a Covid-19 vaccine trial satisfied my altruistic goals and harmonizes with my Hindu beliefs. But I am troubled that a drug company is going to profit from my altruism and my religious obligations.

In New Zealand we have been saved from the worst devastations of Covid-19 by a firm government, courage and care for one another, and our geographic “moat.” With the recent minor surge of cases, our government has, once again, encouraged us to respond as a team of 5 million. We have been guided by the slogan “Be kind.”

As multiple Covid vaccine candidates enter clinical trials and hopefully move closer to approval, one important unanswered question is how to compensate the rare cases of serious vaccine harm.

Covid isn’t merely overshadowing the drug overdose crisis—it’s directly worsening it.

Physicians have been vocal in condemning the anti-lockdown protests while endorsing and even participating in the Black Lives Matter protests. This has led to criticism of the medical community for being inconsistent and hypocritical. What does an ethical analysis reveal?

I am hard-of-hearing; I wear two hearing aids, and Covid-19 has made all forms of human interaction extraordinarily difficult.

Along with the announcement that his government had approved Sputnik V, the supposed Russian coronavirus vaccine, Vladimir Putin also indulged in a moment of paternal pride: Wanting to confirm his personal confidence in the vaccine, he mentioned that one of his daughters was among the early recipients. This raises a couple of intriguing questions: Which daughter was it? And why does it matter?

The Covid-19 pandemic continues to test and occasionally overwhelm health care institutions. Many practitioners may face the ethically challenging scenario of having to ration ventilators while triaging patients in “crisis care.” Ventilator shortages have led to innovative ventilator design “hacks.” Are these improvised ventilators ethical?

The global crisis created by the coronavirus pandemic and the rush to create and distribute a vaccine widely hoped to be a “silver bullet” that can facilitate a return to “normalcy” threatens to upend seven decades of assumptions about bioethical norms.

Personal ventilators used by people with disabilities should not reallocated to people with Covid-19. Triage protocols should be immediately clarified and explicitly state that personal ventilators will be protected in all cases.

As more workplaces open up, a seldom-used legal action is being taken against employers charged with inadequately protecting employees from the coronavirus: public nuisance lawsuits.

A central mandate of the ADA is to make the goods of society accessible to people with disabilities and overcome their segregation in civil society through reasonable accommodation that allows them to go to work, live with their neighbors, and avoid institutionalization. But let’s not delude ourselves with historic sentimentality as disability law is placed under tremendous stress by the pandemic.

I knew that being a foster parent would be demanding, but I was unprepared for the extent of the challenges, which were exacerbated by the pandemic.

Is it unrealistic to believe that phone apps for digital Covid contact tracing can be designed and regulated in ways that prevent the information they collect from being misused? It's worth remembering surveillance of Vietnam War protesters and Martin Luther King Jr.

With some reluctance, I’ve come to the sad realization the COVID-19 pandemic has been a stress test for bioethics, a field of study that intersects medicine, law, the humanities and the social sciences. As both a physician and medical ethicist, I arrived at this conclusion after spending months at what was once the epicenter of the pandemic: New York City. I was overseeing a 24/7 bioethics consultation service.

Several states, including Ohio, Alabama, Arkansas, Texas, Iowa, and Oklahoma, declared abortion a nonessential service at some point during the pandemic, meaning that it was effectively banned until the crisis passed. Supporters of the policies maintain that abortion is an elective procedure whose medical resources are better off used in the fight against the pandemic. But abortion opponents have been taking advantage of the current circumstances to limit abortion access.

Before there was the Covid-19 pandemic, there was Pandemic. This tabletop game, in which players collaborate to fight disease outbreaks, debuted in 2007. Expansions feature weaponized pathogens, historic pandemics, zoonotic diseases, and vaccine development races. Game mechanics modelled on pandemic vectors provide multiple narratives: battle, quest, detection, discovery. There is satisfaction in playing “against” disease–and winning. Real pandemic is not as tidy as a game. But can games support understanding about the societal challenges we now face? Yes.

The Covid-19 pandemic is unlikely to end until there is a safe, effective, and widely distributed vaccine. How soon can researchers achieve this goal? The answer largely depends on which strategies researchers are willing to adopt. One potential strategy is to conduct human challenge studies, in which researchers give an experimental vaccine to healthy volunteers and then test—or “challenge”—the vaccine by purposely exposing volunteers to the virus. Although a growing number of voices are calling on researchers to employ this strategy, the proposal is generating a heated debate about the ethics of such research.

The United States leads the world in coronavirus cases and deaths. Although many people have called out the inadequacies of our health care system, Covid-19 has exposed the most significant shortcomings. The need for change can no longer be ignored. Here are three lessons from this pandemic that should be leveraged for change.

Growing isolation, financial challenges and disease burden during the Covid-19 pandemic threaten to worsen the mental health needs of the entire U.S. population. These challenges are heightened among immigrants with untreated chronic mental health conditions as they experience added psychological distress owing to harsh immigration policies and worsening structural barriers to health during the pandemic.

Covid-19 is a matter of public and global health ethics, and the pandemic is currently accelerating cooperation within and contributions from these fields. A meeting on June 27, hosted by the European Union and Global Citizen, is the latest example another global pledging event on June 27, will include governments and large institutions, as well as individuals and communities worldwide.

The rewards of social distancing are beginning to accrue in former hotspots such as Seattle, the New York metropolitan area, and the San Francisco Bay Area, where the number of new Covid-19 cases requiring hospitalization is declining. Assuming the rewards hold in the face of pressures to reopen the economy, hospitals will now face challenges of reopening their own nonpandemic services for patients whose elective surgeries and other procedures were postponed. Which patients should get priority?

One of the factors considered most important by dying patients and their families is the opportunity to be together. For many of our hospitalized patients in palliative care, the presence of loved ones at the bedside is such a given that we don’t even address it explicitly in advance care planning discussions. So, it comes as no surprise that Covid- 19-related visitor restrictions affecting hospitalized patients might impact end-of-life decision-making, potentially in ways that are ethically problematic.

Experts in infectious disease and public health warn that the Covid-19 pandemic will be with us until there is an effective vaccine, possibly 12 to 18 months in the future. This situation has given rise to calls for human challenge studies, in which healthy volunteers are injected with an experimental vaccine and then infected with the disease to test the vaccine’s efficacy. Is this ethically justifiable?

We have reached a very sad, painful moment in the United States. It feels like a cascade of calamities, one compounding the next. An infectious disease pandemic that we cannot yet cure has precipitated an economic crisis. An episode of police brutality against a black man has added the name George Floyd to a long list of victims of unfair policing practices in black communities. Bioethicists have not been doing enough in our professional capacities to actively denounce or address the persistent problems of structural racism. We invite our fellow bioethics colleagues to join us in candid, uncomfortable conversations about what we can and should be doing differently.

The major success story of health care ethicists in the pandemic has been their role in establishing ventilator triage policies. But they have more to offer the C-suite of health care institutions.

When scientists first suggested population-wide social distancing as the only feasible way to suppress Covid-19, they were the first to admit it may not work in a free society. We are now months into placing mass restrictions on human behavior to suppress a virus that lacks an effective vaccine or treatment. Now is the time to ask: is this the authoritarian nightmare many feared, or will freedom and democracy survive Covid-19?

In places where Covid-19 is increasing – and in preparation for a possible second wave of the pandemic-- hospitals are preparing to triage critical resources if necessary. Some are prioritizing health care workers for ventilators. We think this is a mistake.

It takes less time than ever to publish papers. But is quality sacrificed by doing bioethics at warp speed, especially during the Covid pandemic?

Protesters questioning the ongoing need for lockdown measures aimed at controlling Covid19 are marching to make their concerns known, in some cases with arms and other military paraphernalia. Some ethicists think these protectors should sign a pledge to forego scarce medical care in the name of their political ideas. We disagree.

Hospitals in the United States are losing money taking care of patients with Covid-19. The pandemic casts a harsh spotlight on the misallocation of health care resources in the U.S.

Older black Americans are half as likely as older whites to have advanced directives. My patient, a black man in his 70s,, first made his wishes known when he was in the hospital with Covid-19.

The cries of millions of people in Sub-Saharan Africa and in low- and middle-income countries elsewhere who are struggling to stay alive because of Covid-19 and the lockdowns call for us to revisit the conceptual framework of the human right to health.

Covid-19 is making bioethics more relevant than ever. The ethical dilemmas raised by the pandemic are urgent and heart-wrenching. Who should get a ventilator if we do not have enough? How can we protect the most vulnerable from discrimination in the face of difficult triage decisions? How do we weigh individual liberty against the public interest of keeping people confined? While such questions are not new for bioethicists, the need to answer them urgently, globally, and in very concrete settings, creates unprecedented circumstances. Is this an opportunity for bioethics to learn some important lessons? What should post-Covid bioethics look like?

Covid-19 is teaching us the stern lesson that economic well-being and health justice are two sides of the same coin. To weather pandemics and restore the social contact that economic life demands, we need to sign a new social contract with public health.

Some bioethicists support age-related rationing of ventilators during the Covid-19 pandemic as a way to save the most lives. But that goal might be better realized without strict age cutoffs.

There's a long history of conflict between the institution of medicine, bioethics, and the disability community. With Covid-19 disproportionately affecting people with disabilities, we must do everything we can to avoid a triage decision-making process that pushes disabled people to the side. One important action is to appoint people with disabilities, and especially those of color, to hospital triage committees. To our knowledge, no hospital or state crisis standards of care protocol mandates this kind of representation.

Of all the “isms,” ageism is arguably the hardest to address because old age neither a valued stage of life nor an identity that many claim. The coronavirus pandemic may have made that effort even harder.

Covid-19 imposes burdens in different—but very serious—ways on different individuals and groups. We see it in policies that address what to do in the face of shortages of scarce resources. We begin by challenging a common claim—that people with disabilities as a group will be harmed by triage policies that consider patients’ prospect of medical benefit.

The Covid-19 pandemic has been characterized by many unknowns, chief among them in the world of pediatric ethics is the question of separating mothers who are infected or suspected of being infected from their newborns after delivery to reduce the risk of mother-to-child transmission. Guidance on this issue is conflicting.

The Covid-19 pandemic has imposed tremendous risk on doctors, nurses, and other health care workers not seen in a century. It is time to reconsider prioritization of health care workers’ access to scare critical resources. Historically, for multiple reasons, health care workers have not been prioritized for access to medical care during a pandemic. However, given the unprecedented circumstances surrounding the Covid-19 pandemic, it is justifiable to prioritize health care workers when all else is equal between two patients.

As Covid-19 continues to spread throughout the United States, doctors, nurses, and oth-er clinicians are facing unmistakable tragedies. But something less perceptible is afoot. Empathy in medicine is under siege.

Despite the disruptive changes to my undergraduate medical ethics class this semester, my students have learned a lot about the paradox that the coronavirus presents: it is an unprecedented event, beyond the experience of nearly everyone alive today, and yet it puts on grim display the well-known problems of inequality that chronically plague the United States. Since week six of the semester, I have readjusted each unit on the syllabus to address some of the ethical issues that Covid-19 has brought to the fore, familiar challenges that have been stressed and distorted in astonishing ways by the pandemic.

Around the world, governments are looking for safe ways to lift unprecedented restrictions on public activities to curb the spread of Covid-19. So-called immunity passports could be key to the effort to selectively ease restrictions for people presumed to be immune to the virus. But there are scientific and ethical questions to be worked out before they can be deployed. .

Dilemmas that clinicians face in the coronavirus pandemic–who gets the ventilator, the 80-year-old grandmother or the 20-year-old student?–are the bread and butter of mainstream bioethics. In medical school, my classmates and I memorized the four principles (beneficence, nonmaleficence, justice, and autonomy), which we were told would help us make hard clinical decisions in ethically ambiguous terrain. But Covid-19 shows that medical ethics means much more than what generally falls under bioethics. Medical ethics is deeply political, and to act ethically in medicine means engaging the larger context in which it operates.

There is little doubt about the urgent need for Covid-19 treatment. But premature publication of definitive recommendations based on inappropriate conclusions grounded in scant, hastily-acquired data serve only at best to confuse and at worst mislead at a time when tensions are high and need for help is great.

Double-blind randomized clinical trials are the gold standard for answering the scientific question of whether a drug produces any effect, positive or negative, in Covid-19 patients. But is rational for a patient to choose to try a drug such as chloroquine for Covid-19 outside of a trial? Some patients may correctly hold that they have little to lose.

As the world reels from the Covid-19 pandemic, two things have become very clear: the health impacts of the disease are devastating, but the aggressive social distancing policies currently being used to flatten the curve also have serious costs. As a result, the question of when and how to reopen the nation is on everyone’s mind. Do we open quickly in an effort to kick-start the economy? Or do we remain under lockdown as long as possible to stop the spread of the virus?

Congregational rituals of religious communities around the world have attracted attention for their possible threat of spreading the coronavirus. Negative Media coverage has generally depicted members of religious communities as more or less “reckless” groups whose “fanatic” convictions can make them harm others from inside or outside their religious traditions. However, what hasn’t been discussed is how this issue should be approached as a complex bioethical issue that concerns people worldwide. With the beginning of Ramadan, paying attention to the nuances and complexities of this issue becomes especially pressing.

The Covid-19 outbreak has forced health care providers, administrative officials, and the general public to each play their part in doing no harm to others. It may come as a surprise to many people, but health care workers may unknowingly spread Covid-19 in their communities simply by wearing scrubs in public.

Previously-stated DNR status would seem irrelevant to ventilator allocation, and yet some existing and proposed guidelines for triage during a public health emergency list DNR status in the list of criteria for excluding patients from getting ventilators or other life-saving health care. This approach is in direct opposition to the generally agreed-upon goal of maximizing the number of survivors, and could result in confusion and public mistrust of the health care system.

It’s been painful to watch health leaders twist themselves into moral knots denying that recently created ventilator rationing guidance will differentially affect Blacks, Latinx, and other people of color. On television, in newspapers, and on listservs, when the predicted disproportionate impacts of these policies are raised, some bioethicists-often white, stonewall. Or repeat a policy’s assertions that race, ethnicity, disability, etc. are irrelevant to care decisions. Or default to the intent of the policymakers.

I helped develop guidelines for the ethical allocation of scarce resources during a public health emergency, such as a pandemic..I hope my contributions have an impact. I especially hope to see my work used since it emphasizes the perspectives of minority and underserved communities, who tend to have less voice in health policy. But now I find myself dreading the use of my work.

In the rush to find a Covid-19 vaccine and one or more drugs to treat the deadly disease, concerns are being raised that ethical standards for conducting human clinical trials and the evidentiary standards for determining whether interventions are safe and effective, might be loosened.

Canada has a fraction of the number of cases of Covid-19 as the U.S. Canadians feel vulnerable. But Canadians and Americans need to find ways to build and maintain trust within and across our borders.

Do the elderly have special obligations during a pandemic, that is, something more than the duty we all have for hand washing, social distancing, and so on? I believe the answer is, yes, and foremost among these is an obligation for parsimonious use of newly scarce and expensive health care resources.

This week, the Department of Health and Human Services Office of Civil Rights resolved one of many civil rights complaints alleging discrimination on the basis of disability–the first instance of federal intervention to enforce civil rights laws in rationing protocols since the beginning of the Covid-19 crisis. But more work is needed to protect patients with disabilities in the allocation of scarce medical resources.

As a 71-year-old bioethicist, I consider rationing mechanical ventilation based on age to be one morally relevant criterion during the Covid-19 pandemic.

As hospitals and public health authorities devise triage protocols to allocate scarce critical-care resources during the Covid-19 pandemic, people with disabilities are expressing alarm that these protocols devalue them and exacerbate long-entrenched ableism in health care. Lawsuits alleging disability discrimination in have been filed in Washington and Alabama. The U.S. Office for Civil Rights is investigating disability discrimination complaints in triage protocols. The challenge is to develop protocols that will minimize discrimination in the health care system.

One-third of all new GoFundMe campaigns in the United States are for COVID-19-related needs. This shows where we have failed as a society. It is a makeshift response to institutional failures and not a fair or sustainable solution to crises.

While patients can and do recover from coronavirus infections, there are currently no approved treatments that are known to work against COVID-19.

Since the initial outbreak in Wuhan last December, the national and global responses to COVID-19 have been in ethics freefall.

Influenza and coronavirus cause similar symptoms probably through similar modes of transmission. What is unique about coronavirus is that misinformation, missteps, conspiracies, and cover-ups have left their mark on public trust.