The Greenwall Foundation will fund five new research projects from the Fall 2020 cycle of its Making a Difference in Real-World Bioethics Dilemmas grant program.
The Making a Difference program funds bioethics research projects that seek to resolve current challenges in health care, policy, and research. Grants are awarded twice yearly. Since 2013, the Foundation has funded more than 80 Making a Difference grants supporting bioethics research on a wide array of issues including aid-in-dying, deception in medical contexts, discrimination towards minority clinicians, and responses to the opioid epidemic.
Three of the Fall 2020 grants address ethical and policy issues raised by the COVID-19 pandemic.
Rationing Behind Bars: Resource Allocation in Jails and Prisons During COVID-19
Brendan Saloner, PhD (Johns Hopkins Univerisity)
Abstract: COVID-19 is an unprecedented challenge in jails and prisons, raising stark health care rationing decisions. This project will address the bioethical challenges related to allocation of medical resources during the pandemic. The project will develop an ethical framework to decision-making processes. This will be informed by interviews with correctional clinicians and administrators and people who were incarcerated during the COVID-19 pandemic. Ultimately, the project will help decision-makers integrate ethical analysis into their long-term planning related to public health emergencies.
Physicians’ Moral Stress During COVID-19: A Qualitative Analysis of Systems Factors
Mara Buchbinder, PhD (UNC Chapel Hill)
Abstract: The COVID-19 pandemic has intensified stress among healthcare workers, leading to crises of moral integrity. This project investigates moral stress among physicians providing frontline care for COVID-19 patients in New York City and Seattle. Using interviews with 40 physicians in each city, the team will: (1) describe physicians’ experiences of moral stress during the pandemic; (2) assemble a conceptual framework mapping sources of moral stress in crisis and non-crisis conditions; and (3) develop and disseminate evidence-based recommendations to mitigate moral stress during the pandemic and beyond.
Evidence and Uncertainty in COVID-19 Vaccination Policy-making
Jason Schwartz, PhD (Yale University)
Abstract: In this project, the research team will identify and analyze the explicit and implicit ethical deliberations and assessments that occur during scientific review and policy-making regarding COVID-19 vaccines and vaccination programs. They will evaluate the processes by which those ethical deliberations are included in decision-making and their implications for the structure and function of vaccination policies, and will offer recommendations for strengthening those activities. Through their research, the team will inform and enhance public and expert discourse around the ethics of mass vaccination programs.
The other Fall 2020 grants will study pressing ethical and policy issues related to the conduct of clinical trials and decision-making in pregnancy.
Preventing the Initiation, and Deprioritizing the Continuation of, Uninformative Clinical Trials
Barbara Bierer, MD (Brigham and Women’s Hospital)
Abstract: Clinical trials depend upon the participation of individuals who volunteer sometimes to access medicines but often to help science advance for the benefit of future patients; each trial, therefore, should be valuable and important. But how can one know if a trial will be important or even informative before results are published? In this proposal, the team will investigate the ethical and practical implications of including an assessment of scientific value and informativeness in decisions regarding the initiation or continuation of clinical trials.
Periviable Decision-making Dynamics: Who Should Decide and What Happens When Parental Parties Disagree?
Brownsyne Tucker Edmonds, MD (Indiana University)
Abstract: Families facing the birth of an extremely premature infant must make difficult life or death choices. These decisions affect both parents, but the health care system tends to view the pregnant person as the decision-maker, neglecting partner input. There is also minimal ethical or legal guidance to help providers meet the decisional needs of families with non-traditional structures. This research will inform models of shared decision-making to engage the needs of both parents, including diverse family structures, and will provide guidance to providers on how to handle parental disagreement.