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Rivista Italiana di Medicina Legale e del Diritto in campo sanitario

Rivista: Rivista Italiana di Medicina Legale (e del Diritto in campo sanitario)
Anno: 2020
Fascicolo: n. 2
Editore: Giuffrè Francis Lefebvre
ISSN: 1124-3376
Autori: Tozzo Pamela, Gabbin Andrea, Politi Caterina, Caenazzo Luciana
Titolo: FOCUS ON COVID-19 EMERGENZA COVID-19: QUESTIONI DI ETICA DELLA SALUTE PUBBLICA DA UNA PROSPETTIVA GLOBALE. UN’ANALISI PRELIMINARE IN QUATTRO STEP
Pagine: pp. 1056-1054
Keywords: COVID-19, etica della salute pubblica, emergenza sanitaria, ricerca, privacy, big data

L’emergenza sanitaria da COVID-19, tutt’ora in corso, sta paralizzando i sistemi sanitari di tutto il mondo, a causa dell’elevato numero di richieste di terapie intensive (in termini sia di dispositivi medici che di personale specializzato), portando ad una rapida saturazione delle risorse disponibili. Questa situazione rende doverose alcune riflessioni di etica della salute pubblica, tra cui: i temi dell’appropriatezza clinica, della proporzionalità delle cure e della corretta allocazione delle limitate risorse; l’arduo processo decisionale davanti a cui può trovarsi il professionista sanitario; l’innegabile ritardo nella preparazione a fronteggiare emergenze sanitarie di questo calibro (cosiddetta preparedness); la lotta alla disinformazione; l’importanza della collaborazione a livello internazionale nella ricerca e di un’alleanza tra istituzioni, sanità ed imprese e degli sforzi per incrementare la fiducia dei cittadini e delle istituzioni nei confronti delle autorità sanitarie; la gestione dei big data ed, in particolare, la cogente necessità di individuare soluzioni che, pur nel rispetto della privacy dell’individuo, consentano un agevole accesso ai suoi dati sanitari a fini sia diagnostici che di ricerca; il rischio di stigma sociale legato al COVID-19.

Nel presente testo, gli Autori esplorano in una analisi in quattro step alcuni dei principali aspetti etici sollevati nell’attuale contesto emergenziale, analizzati da un punto di vista di salute pubblica piuttosto che di scelte operate dal singolo professionista sanitario, auspicando che le riflessioni proposte possano risultare utili anche nella preparazione e risposta ad eventuali future emergenze.

FOCUS ON COVID-19 EMERGENZA COVID-19: QUESTIONI DI ETICA DELLA SALUTE PUBBLICA DA UNA PROSPETTIVA GLOBALE. UN’ANALISI PRELIMINARE IN QUATTRO STEP


1) World Health Organization.Coronavirus disease (COVID-19) Pandemic. Disponibile su: www.who.int/emergencies/diseases/novel-coronavirus-2019.
2) Marotta N, Zirilli O. (2015). Disastri e catastrofi: rischio, esposizione, vulnerabilità e resilienza. Maggioli Editore, Ravenna (Italia), pp. 32-33.
3) O’Mathúna DP, Gordijn, B, Clarke M. (2014). Disaster Bioethics: Normative Issues When Nothing is Normal. 1st ed. Netherlands: Springer, Dordrecht, pp. 13-22.
4) Menachery VD, Yount BL Jr, Debbink K, Agnihothram S, et al. Corrigendum: A SARS-like cluster of circulating bat coronaviruses shows potential for human emergence. Nat Med. 2016;22(4):446.
5) Presidenza del Consiglio dei Ministri. (2020). Covid-19: la decisione clinica in condizioni di carenza di risorse e il criterio del “triage in emergenza pandemica”. In: Comitato Nazionale per la Bioetica.
6) International Committee of the Red Cross. (1994). The Code of Conduct for the International Red Cross and Red Crescent Movement and Non-Governmental Organizations (NGOs) in Disaster Relief. Disponibile su: https://www.icrc.org/en/doc/resources/documents/publication/p1067.htm.
7) Lavezzo E, Franchin E, Ciavarella C, et al.Suppression of COVID-19 outbreak in the municipality of Vo, Italy. medRxiv. 2020.04.17.20053157.
8) Kelman I. Operational Ethics for Disaster Research. Int J Mass Emergency Disasters. 2005;23(3):141-158.
9) Lancet T. COVID-19: learning from experience. The Lancet. 2020; 395(10229):1011.
10) Editorial. Big hopes for big data. Nat Med. 2020; 26(1):1.
11) Caenazzo L, Tozzo P, Rodriguez D. Ethical issues in DNA identification of human biological material from mass disasters. Prehosp Disaster Med. 2013;28(4):393–396.
12) Caenazzo L, Tozzo P, Pegoraro R. Biobanking research on oncological residual material: a framework between the rights of the individual and the interest of society. BMC Med Ethics. 2013; 14:17.
13) Caenazzo L, Tozzo P, Borovecki A. Ethical governance in biobanks linked to electronic health records. Eur Rev Med Pharmacol Sci. 2015; 19(21): 4182-4186.
14) Moussa M, Demurjian SA. (2017). Differential privacy approach for big data privacy in healthcare. In Tamane S., Solanki VK & Dey N in: Privacy and Security Policies in Big Data. IGI Global, Hershey, PA, USA.
15) Price WN 2nd, Cohen IG. Privacy in the age of medical big data. Nat Med. 2019; 25(1):37‐43.
16) Kummitha RKR. Smart technologies for fighting pandemics: The techno- and human- driven approaches in controlling the virus transmission. Gov Inf Q. 2020; 101481.
17) Servick K. (2020). Cellphone tracking could help stem the spread of coronavirus. Is privacy the price? Science Magazine. Disponibile su: 10.1126/science.abb8296. Visionato il 20 Maggio 2020.
18) Polina E, Busvine D. (2020). European mobile operators share data for coronavirus fight. Reuters. Disponibile su: https://www.reuters.com/article/us-health-coronavirus-europe-telecoms/europeanmobile-operators-share-data- for-coronavirus- fight- idUSKBN2152C2. Visionato il 20 Maggio 2020.
19) Apple. (2020). Apple and Google partner on COVID-19 contact tracing technology. Disponibile su: https://www.apple.com/uk/newsroom/2020/04/apple-and-google-partner-on-covid-19-contact-tracing-technology. Visionato il 20 Maggio 2020.
20) Jeong EY. (2020). South Korea tracks virus patients’ travels and publishes them online. The Wall Street Journal. Disponibile su: https://www.wsj.com/articles/south-korea-tracks-virus-patientstravelsand-publishes-them-online-11581858000?mod=searchresults&page=1&pos=2&mod=article_inline. Visionato il 20 Maggio 2020.
21) Wang CJ, Ng CY, Brook RH. Response to COVID-19 in Taiwan: Big Data Analytics, New Technology, and Proactive Testing. JAMA. 2020; 323(14):1341–1342.
22) Ko H, Leitner JM, Kim E et al. (2017). Structure and Enforcement of Data Privacy Law in South Korea. Disponibile su: https://ssrn.com/abstract=2904896. Visionato il 20 Maggio 2020.
23) Park S, Choi GJ, Ko H. Information Technology-Based Tracing Strategy in Response to COVID-19 in South Korea – Privacy Controversies. JAMA. 2020; 10.1001/jama.2020.6602.
24) Jie S. (2020). Big data, grid management support disease control in Quzhou. Disponibile su: https://www.globaltimes.cn/content/1179731.shtml. Visionato il 20 Maggio 2020.
25) Krolik A, Satariano A. (2020). As coronavirus survillance escalates, personal privacy plummets. Disponibile su: https://www.nytimes.com/2020/03/23/technology/coronavirus-surveillance-trackingprivacy. Visionato il 20 Maggio 2020.
26) Editorial. (2017). The world’s most valuable resource is no longer oil, but data. Disponibile su: https://www.economist.com/leaders/2017/05/06/the-worlds-most-valuable-resource-is-no-longer-oil-but-data. Visionato il 20 Maggio 2020.
27) Shaffer, L. WHO wants to bring order to health data. Nat Med. 2020; 26:2–3.
28) Gostin LO, Bayer R, Fairchild AL.Ethical and legal challenges posed by severe acute respiratory syndrome: implications for the control of severe infectious disease threats. JAMA. 2003; 290(24): 3229-3237.
29) Tay Swee Kian C, Lateff F.Infectious diseases law and severe acute respiratory syndrome - Medical and legal responses and implications: The Singapore experience. Aplar Journal of Rheumatology. 2004;7: 123-129.
30) Abbas AR, Alsafi Z, Rahman A et al. Today’s actions shape tomorrow’s world: is the Coronavirus Pandemic (COVID-19) eroding our privacy? International Journal of Surgery. 2020; 79.
31) Kelion L. (2020). UK coronavirus app must respect privacy rights. Disponibile su: https://www.bbc.co.uk/news/technology-52003984. Visionato il 20 Maggio 2020.
32) Bruns DP, Kraguljac NV e Bruns TR.COVID-19: Fatti, considerazioni culturali e rischio di stigmatizzazione. Journal of Transcultural Nursing. 2020. Disponibile su: https://doi.org/10.1177/1043659620917724.Visionato il 20 Maggio 2020.
33) International Federation of Red Cross, United Nations Educational, Scientific and Cultural Organization, World Health Organization. Social Stigma associated with COVID-19. Disponibile su: https://www.unicef.org/documents/social-stigma-associated-coronavirus-disease-covid-19.
34) Brooks SK, Webster RK, Smith LE, et al.The psychological impact of quarantine and how to reduce it: Rapid review of the evidence. Lancet. 2020; 395(10227):912-920.
35) Zhai Y, Du X. Mental health care for international Chinese students affected by the COVID-19 outbreak. Lancet Psychiatry. 2020;7(4):e22
36) Anderson RM, Heesterbeek H, Klinkenberg D, et al.How will country-based mitigation measures influence the course of the COVID-19 epidemic? Lancet. 2020; 395(10228):931-934.
37) Lewnard JA, Lo NC. Scientific and ethical basis for social distancing interventions against COVID-19. Lancet Infect Dis. 2020. Disponibile su: https://doi.org/10.1016/S1473-3099(20)30190-0. Visionato il 20 Maggio 2020.
38) UNAIDS. Rights in the time of COVID-19-Lessons from HIV for an effective, community-led response. 2020. Disponibile su: https://www.unaid s.org/en/resou rces/docum ents/2020/human-rights-and-covid-19. Visionato il 20 Maggio 2020.
39) World Health Organization. Mental health and psychosocial considerations during the COVID-19 outbreak. 2020. Disponibile su: https://www.who.int/news-room/campaigns/connecting-the-world-to-combat-Coronavirus/healthyathome/healthyathome---mental-health?gclid=EAIaIQobChMI_Kj4nKPC6QIVkuvtCh0S3ghgEAAYASAAEgIdQ_D_BwE. Visionato il 20 Maggio 2020.
40) Person B, Sy F, Holton K, et al. Fear and stigma: The epidemic within the SARS outbreak. Emerging Infectious Diseases. 2004; 10(2):358-363.
41) Budhwani H, Sun R.Creating COVID-19 Stigma by Referencing the Novel Coronavirus as the “Chinese virus” on Twitter: Quantitative Analysis of Social Media Data. J Med Internet Res. 2020; 22(5):e19301.
42) Logie CH, Turan JM.How Do We Balance Tensions Between COVID-19 Public Health Responses and Stigma Mitigation? Learning from HIV Research. AIDS Behav. 2020 Apr 7:1-4.
43) Roderick BW.Epidemics, Privacy Rights and Public Concerns: The Hong Kong SARS Experience. (2006). In: European Commission - Science and Society Workshop: Globalisation and New Epidemics: Ethics, Security and Policy Making. Brussels, Belgium.
44) World Health Organization. Mental health and psychosocial considerations during the COVID-19 outbreak. 2020. Disponibile su: WHO/2019-nCoV/MentalHealth/2020.1. Visionato il 20 Maggio 2020.
45) Ho CS, Chee CY, Ho RC. Mental health strategies to combat the psychological impact of COVID-19 beyond paranoia and panic. Ann Acad Med Singap. 2020; 49(1):1-3.
46) Adams JG, Walls RM. Supporting the health care workforce during the COVID-19 global epidemic. JAMA Netw Open. 2020. Disponibile su: https://doi.org/10.1001/jama.2020.3972.
47) Lai J, Ma S, Wang Y et al.Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA Netw Open. 2020; 3(3):e203976.
48) Rajkumar RP. COVID-19 and mental health: A review of the existing literature. Asian J Psychiatr. 2020; 52:102066.
49) Sani G, Janiri D, Di Nicola M et al.Mental health during and after the COVID-19 emergency in Italy. Psychiatry Clin Neurosci. 2020. Disponibile su: 10.1111/pcn.13004. doi:10.1111/pcn.13004.
50) Pfefferbaum B, North CS. Mental Health and the Covid-19 Pandemic. N Engl J Med. 2020; 10.1056/NEJMp2008017.
1) World Health Organization.Coronavirus disease (COVID-19) Pandemic. Disponibile su: www.who.int/emergencies/diseases/novel-coronavirus-2019.
2) Marotta N, Zirilli O. (2015). Disastri e catastrofi: rischio, esposizione, vulnerabilità e resilienza. Maggioli Editore, Ravenna (Italia), pp. 32-33.
3) O’Mathúna DP, Gordijn, B, Clarke M. (2014). Disaster Bioethics: Normative Issues When Nothing is Normal. 1st ed. Netherlands: Springer, Dordrecht, pp. 13-22.
4) Menachery VD, Yount BL Jr, Debbink K, Agnihothram S, et al. Corrigendum: A SARS-like cluster of circulating bat coronaviruses shows potential for human emergence. Nat Med. 2016;22(4):446.
5) Presidenza del Consiglio dei Ministri. (2020). Covid-19: la decisione clinica in condizioni di carenza di risorse e il criterio del “triage in emergenza pandemica”. In: Comitato Nazionale per la Bioetica.
6) International Committee of the Red Cross. (1994). The Code of Conduct for the International Red Cross and Red Crescent Movement and Non-Governmental Organizations (NGOs) in Disaster Relief. Disponibile su: https://www.icrc.org/en/doc/resources/documents/publication/p1067.htm.
7) Lavezzo E, Franchin E, Ciavarella C, et al.Suppression of COVID-19 outbreak in the municipality of Vo, Italy. medRxiv. 2020.04.17.20053157.
8) Kelman I. Operational Ethics for Disaster Research. Int J Mass Emergency Disasters. 2005;23(3):141-158.
9) Lancet T. COVID-19: learning from experience. The Lancet. 2020; 395(10229):1011.
10) Editorial. Big hopes for big data. Nat Med. 2020; 26(1):1.
11) Caenazzo L, Tozzo P, Rodriguez D. Ethical issues in DNA identification of human biological material from mass disasters. Prehosp Disaster Med. 2013;28(4):393–396.
12) Caenazzo L, Tozzo P, Pegoraro R. Biobanking research on oncological residual material: a framework between the rights of the individual and the interest of society. BMC Med Ethics. 2013; 14:17.
13) Caenazzo L, Tozzo P, Borovecki A. Ethical governance in biobanks linked to electronic health records. Eur Rev Med Pharmacol Sci. 2015; 19(21): 4182-4186.
14) Moussa M, Demurjian SA. (2017). Differential privacy approach for big data privacy in healthcare. In Tamane S., Solanki VK & Dey N in: Privacy and Security Policies in Big Data. IGI Global, Hershey, PA, USA.
15) Price WN 2nd, Cohen IG. Privacy in the age of medical big data. Nat Med. 2019; 25(1):37‐43.
16) Kummitha RKR. Smart technologies for fighting pandemics: The techno- and human- driven approaches in controlling the virus transmission. Gov Inf Q. 2020; 101481.
17) Servick K. (2020). Cellphone tracking could help stem the spread of coronavirus. Is privacy the price? Science Magazine. Disponibile su: 10.1126/science.abb8296. Visionato il 20 Maggio 2020.
18) Polina E, Busvine D. (2020). European mobile operators share data for coronavirus fight. Reuters. Disponibile su: https://www.reuters.com/article/us-health-coronavirus-europe-telecoms/europeanmobile-operators-share-data- for-coronavirus- fight- idUSKBN2152C2. Visionato il 20 Maggio 2020.
19) Apple. (2020). Apple and Google partner on COVID-19 contact tracing technology. Disponibile su: https://www.apple.com/uk/newsroom/2020/04/apple-and-google-partner-on-covid-19-contact-tracing-technology. Visionato il 20 Maggio 2020.
20) Jeong EY. (2020). South Korea tracks virus patients’ travels and publishes them online. The Wall Street Journal. Disponibile su: https://www.wsj.com/articles/south-korea-tracks-virus-patientstravelsand-publishes-them-online-11581858000?mod=searchresults&page=1&pos=2&mod=article_inline. Visionato il 20 Maggio 2020.
21) Wang CJ, Ng CY, Brook RH. Response to COVID-19 in Taiwan: Big Data Analytics, New Technology, and Proactive Testing. JAMA. 2020; 323(14):1341–1342.
22) Ko H, Leitner JM, Kim E et al. (2017). Structure and Enforcement of Data Privacy Law in South Korea. Disponibile su: https://ssrn.com/abstract=2904896. Visionato il 20 Maggio 2020.
23) Park S, Choi GJ, Ko H. Information Technology-Based Tracing Strategy in Response to COVID-19 in South Korea – Privacy Controversies. JAMA. 2020; 10.1001/jama.2020.6602.
24) Jie S. (2020). Big data, grid management support disease control in Quzhou. Disponibile su: https://www.globaltimes.cn/content/1179731.shtml. Visionato il 20 Maggio 2020.
25) Krolik A, Satariano A. (2020). As coronavirus survillance escalates, personal privacy plummets. Disponibile su: https://www.nytimes.com/2020/03/23/technology/coronavirus-surveillance-trackingprivacy. Visionato il 20 Maggio 2020.
26) Editorial. (2017). The world’s most valuable resource is no longer oil, but data. Disponibile su: https://www.economist.com/leaders/2017/05/06/the-worlds-most-valuable-resource-is-no-longer-oil-but-data. Visionato il 20 Maggio 2020.
27) Shaffer, L. WHO wants to bring order to health data. Nat Med. 2020; 26:2–3.
28) Gostin LO, Bayer R, Fairchild AL.Ethical and legal challenges posed by severe acute respiratory syndrome: implications for the control of severe infectious disease threats. JAMA. 2003; 290(24): 3229-3237.
29) Tay Swee Kian C, Lateff F.Infectious diseases law and severe acute respiratory syndrome - Medical and legal responses and implications: The Singapore experience. Aplar Journal of Rheumatology. 2004;7: 123-129.
30) Abbas AR, Alsafi Z, Rahman A et al. Today’s actions shape tomorrow’s world: is the Coronavirus Pandemic (COVID-19) eroding our privacy? International Journal of Surgery. 2020; 79.
31) Kelion L. (2020). UK coronavirus app must respect privacy rights. Disponibile su: https://www.bbc.co.uk/news/technology-52003984. Visionato il 20 Maggio 2020.
32) Bruns DP, Kraguljac NV e Bruns TR.COVID-19: Fatti, considerazioni culturali e rischio di stigmatizzazione. Journal of Transcultural Nursing. 2020. Disponibile su: https://doi.org/10.1177/1043659620917724.Visionato il 20 Maggio 2020.
33) International Federation of Red Cross, United Nations Educational, Scientific and Cultural Organization, World Health Organization. Social Stigma associated with COVID-19. Disponibile su: https://www.unicef.org/documents/social-stigma-associated-coronavirus-disease-covid-19.
34) Brooks SK, Webster RK, Smith LE, et al.The psychological impact of quarantine and how to reduce it: Rapid review of the evidence. Lancet. 2020; 395(10227):912-920.
35) Zhai Y, Du X. Mental health care for international Chinese students affected by the COVID-19 outbreak. Lancet Psychiatry. 2020;7(4):e22
36) Anderson RM, Heesterbeek H, Klinkenberg D, et al.How will country-based mitigation measures influence the course of the COVID-19 epidemic? Lancet. 2020; 395(10228):931-934.
37) Lewnard JA, Lo NC. Scientific and ethical basis for social distancing interventions against COVID-19. Lancet Infect Dis. 2020. Disponibile su: https://doi.org/10.1016/S1473-3099(20)30190-0. Visionato il 20 Maggio 2020.
38) UNAIDS. Rights in the time of COVID-19-Lessons from HIV for an effective, community-led response. 2020. Disponibile su: https://www.unaid s.org/en/resou rces/docum ents/2020/human-rights-and-covid-19. Visionato il 20 Maggio 2020.
39) World Health Organization. Mental health and psychosocial considerations during the COVID-19 outbreak. 2020. Disponibile su: https://www.who.int/news-room/campaigns/connecting-the-world-to-combat-Coronavirus/healthyathome/healthyathome---mental-health?gclid=EAIaIQobChMI_Kj4nKPC6QIVkuvtCh0S3ghgEAAYASAAEgIdQ_D_BwE. Visionato il 20 Maggio 2020.
40) Person B, Sy F, Holton K, et al. Fear and stigma: The epidemic within the SARS outbreak. Emerging Infectious Diseases. 2004; 10(2):358-363.
41) Budhwani H, Sun R.Creating COVID-19 Stigma by Referencing the Novel Coronavirus as the “Chinese virus” on Twitter: Quantitative Analysis of Social Media Data. J Med Internet Res. 2020; 22(5):e19301.
42) Logie CH, Turan JM.How Do We Balance Tensions Between COVID-19 Public Health Responses and Stigma Mitigation? Learning from HIV Research. AIDS Behav. 2020 Apr 7:1-4.
43) Roderick BW.Epidemics, Privacy Rights and Public Concerns: The Hong Kong SARS Experience. (2006). In: European Commission - Science and Society Workshop: Globalisation and New Epidemics: Ethics, Security and Policy Making. Brussels, Belgium.
44) World Health Organization. Mental health and psychosocial considerations during the COVID-19 outbreak. 2020. Disponibile su: WHO/2019-nCoV/MentalHealth/2020.1. Visionato il 20 Maggio 2020.
45) Ho CS, Chee CY, Ho RC. Mental health strategies to combat the psychological impact of COVID-19 beyond paranoia and panic. Ann Acad Med Singap. 2020; 49(1):1-3.
46) Adams JG, Walls RM. Supporting the health care workforce during the COVID-19 global epidemic. JAMA Netw Open. 2020. Disponibile su: https://doi.org/10.1001/jama.2020.3972.
47) Lai J, Ma S, Wang Y et al.Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA Netw Open. 2020; 3(3):e203976.
48) Rajkumar RP. COVID-19 and mental health: A review of the existing literature. Asian J Psychiatr. 2020; 52:102066.
49) Sani G, Janiri D, Di Nicola M et al.Mental health during and after the COVID-19 emergency in Italy. Psychiatry Clin Neurosci. 2020. Disponibile su: 10.1111/pcn.13004. doi:10.1111/pcn.13004.
50) Pfefferbaum B, North CS. Mental Health and the Covid-19 Pandemic. N Engl J Med. 2020; 10.1056/NEJMp2008017.
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