Operationalizing Equity in Surgical Prioritization

The allocation of critical care resources and triaging patients garnered a great deal of attention during the COVID-19 pandemic, but there is a paucity of guidance regarding the ethical aspects of resource allocation and patient prioritization in ‘normal’ circumstances for Canadian healthcare systems. One context where allocation and prioritization decisions are required are surgical waitlists, which have been globally exacerbated due to the COVID-19 pandemic. In this paper, we detail the process used to develop an ethics framework to support prioritization for elective surgery at The Hospital for Sick Children, Toronto, a tertiary pediatric hospital. Our goal was to provide guidance for the more value-laden aspects of prioritization, particularly when clinical urgency alone is insufficient to dictate priority. With this goal in mind, we worked to capture familial, relational, and equity considerations. As part of our institution’s concerted efforts to ethically and effectively address our surgical backlog, an ethics working group was formed comprising clinicians from surgery, anesthesiology, intensive care, a hospital bioethicist, a parent advisor, and an academic bioethics researcher. A reflective equilibrium process was used to develop an ethics framework. To this end, the same methodology was used to create a support for patient prioritization that identifies clinically and morally relevant factors for prioritization among medically similar surgical cases, with a substantive goal being to identify and redress health inequities in surgical prioritization, inasmuch as this is possible. While further steps are needed to validate several aspects of the framework, our research suggests that an ethics framework grounded in the practical realities of hospital operations provides consistency, transparency, and needed support for decisions that are often left to individual clinicians, as well as an opportunity to reflect upon the presence of health inequities in all domains of healthcare delivery

Mist Netting Bias, Species Accumulation Curves, and the Rediscovery of Two Bats on Montserrat (Lesser Antilles)

Mist nets are commonly used to survey bat populations and to estimate bat biodiversity, but several studies have found that mist net capture data and methods are biased due to a number of factors, including size and placement of nets, and the frequency at which investigators check their nets. Despite the wealth of literature and anecdotal reports, few investigators have quantified the interactions of bats with mist nets directly. We employed night vision camcorders to monitor bat behavior when bats encountered a mist net and then utilized these data to reevaluate years of survey data collected on Montserrat, Lesser Antilles. We recorded 2,523 bat passes during 43.3 hours of videotaping in July 2005 and June 2006. Observations conducted on successive nights provide evidence of avoidance-learning behavior in bats. When a mist net was present, 5.4% of bats in the airspace came into contact with the net giving an overall capture rate of 3.2% (range 0–10.3%). Mist nets are not accurately sampling bats that utilize flyways on Montserrat and such fieldwork thereby generates potentially misleading data. Biodiversity assessments and conservation guidelines based on short-term mist net surveys alone are not sufficient or reliable in regards to bats. A pragmatic solution to reduce mist net bias is to repeatedly sample a target region, utilize a variety of netting sites, use variable net sets, and carefully analyze species accumulation curves

Bioethics for Neonatal Cardiac Care

BACKGROUND: Clinicians caring for neonates with congenital heart disease encounter challenges with ethical implications in daily practice and must have some basic fluency in ethical principles and practical applications. METHODS: Good ethical practice begins with a thorough understanding of the details and narrative of each individual case, examination via classic principles of bioethics, and further framing of that translation into practice. RESULTS: We explore some of these issues and expand awareness through the lens of a case presentation beginning with fetal considerations through end-of-life discussions. CONCLUSIONS: We include specific sections that bring attention to shared decision-making, research ethics, and outcomes reporting. We review empirical evidence and highlight recommendations