On May 4, the World Health Organisation declared that COVID-19 is no longer considered a pandemic. This news brought a sigh of relief after three years of turmoil around the world. COVID-19 brought to the fore many issues of bioethical concern.
Perhaps the most debated remains the allocation of ventilators and other resources in hospitals. A few months into the pandemic, when a vaccine was finally made available, questions emerged concerning autonomy – “do I have the right to refuse being vaccinated?”; justice – “who gets priority over whom?”; and equity – “should developing countries have as equal access as developed countries?”
COVID-19 has also revealed how much palliative care, an indispensable chain in all healthcare systems, is underestimated, often bearing the brunt of lack of resources. Many people around the world died alone without access to palliative care and dignified end-of-life care. As a qualified nurse for the past 29 years, six of which as a hospice nurse, I often face situations that raise challenging bioethical questions.
As a nurse, I am expected to be the patient’s advocate. But how am I to understand what is best for the person in front of me without knowing what kind of nurse I want to become and without knowing what kind of person the patient aspires to be even in their suffering?
Having a sound understanding of bioethics is indispensable to make wholesome choices and to understand, debate and implement changes on a clinical, managerial and legislative level
Three years ago, I enrolled for a Master of Arts in Bioethics with the aim of broadening my understanding on how best to address different situations that I am frequently faced with both on a professional and personal level.
During the course, which is an interdisciplinary programme of studies, I had the opportunity to discuss several issues, some of which were directly related to my profession, such as suffering and palliative care.
Other subjects that were less familiar to me, but which were nonetheless interesting, included bioethics: anthropological and methodological issues; public policy and ethics at the edges of human life; law and policy; emerging European values and policies; the best interests of the child; priority setting, justice and resource allocation; research ethics; neuroethics, mental health and psychiatric ethics; and ethical issues in genetics.
Through my dissertation, I had the opportunity to study in greater depth how the practice of dying at home is being replaced by dying in a hospital setting, which in turn tends to lead to several end-of-life bioethical dilemmas.
The shift of caring for the dying at home to dying in a hospital setting is due to several factors, not least by rapid medical advances. Although the latter are good in themselves, their possible indiscriminate use in palliative and end-of-life care has been a cause of bioethical concern and debate for years.
It is argued that the emergence of hospice and later palliative care was a response to the kind of care that persons at the end of life were receiving in hospitals, which tended to focus more on cure rather than care; disease rather than the person as a whole being.
The ever-changing demographics wherein people suffering from a life-limiting disease are living longer will result in an increased demand for palliative care. This will require more support in terms of research, legislation, funding, awareness, and equitable access, which issues remain among the most debated in the public arena. Having a sound understanding of the different frameworks of bioethics is indeed indispensable to make wholesome choices and also to understand, debate and implement any required changes on a clinical, managerial and legislative level.
Unlike perhaps the general assumption, an MA in bioethics is relevant not only for those from a medical or health background. As we are faced with ethical questions in different ways on a daily basis, the study of bioethics is of interest to professionals from other disciplines and the public alike.
Alexandra Azzopardi is a nurse at Hospice Malta.
alexandra.azzopardi@hospicemalta.org
The Master of Arts in Bioethics is offered by the Professional Ethics Platform of the University of Malta’s Faculty of Theology. For details and to apply, visit this link.