Siraj Md Sanwar, Dewey Rebecca Susan, Hassan A S M Firoz Ul
Department of Government and Politics, Jahangirnagar University, Savar, Dhaka, Bangladesh.
Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, UK.
Asian Bioeth Rev. 2020 Oct 17;12(4):491-502. doi: 10.1007/s41649-020-00149-9. eCollection 2020 Dec.
The Infectious Diseases (Prevention, Control and Eradication) Act entered into force officially on 14 November 2018 in Bangladesh. The Act is designed to raise awareness of, prevent, control, and eradicate infectious or communicable diseases to address public health emergencies and reduce health risks. A novel coronavirus disease (COVID-19) was first identified in Bangladesh on 8 March 2020, and the Ministry of Health and Family Welfare issued a gazette on 23 March, listing COVID-19 as an infectious disease and addressing COVID-19 as a public health emergency. The gazette empowers the government to monitor the spread of infection. Despite there being an infrastructure of research ethics committees in almost all hospitals in Bangladesh, a lack of such committees in the clinical setting often forces healthcare professionals to allocate scarce healthcare resources to the task. These personnel are often either influenced by materialistic matters or guided by the emergency policies, without reaching a consensus on how to allocate scarce resources in times of need, especially in the time of the COVID-19 pandemic. Ethical dilemmas often arise when a number of patients with COVID-19, especially in poor and middle-class areas, are denied care while elites are prioritized to receive such scarce resources. Resource allocation in healthcare during the COVID-19 pandemic in Bangladesh appears to be unethical and in direct conflict with the biomedical principles of non-maleficence and procedural justice. The findings of this study suggest that the Act needs substantive changes in the stipulation of policy directing hospitals in the provision of resource allocation framework. Furthermore, parliament should produce guidance outlining how to successfully implement the law with the aim of protecting public health in times of emergency, especially the COVID-19 pandemic.
《传染病（预防、控制与根除）法案》于2018年11月14日在孟加拉国正式生效。该法案旨在提高对传染病或可传播疾病的认识，预防、控制和根除这些疾病，以应对突发公共卫生事件并降低健康风险。2020年3月8日，孟加拉国首次发现新型冠状病毒病（COVID-19），卫生和家庭福利部于3月23日发布公告，将COVID-19列为传染病，并将其作为突发公共卫生事件处理。该公告授权政府监测感染传播情况。尽管孟加拉国几乎所有医院都设有研究伦理委员会，但临床环境中缺乏此类委员会往往迫使医护人员将稀缺的医疗资源用于此项任务。这些人员往往要么受物质因素影响，要么遵循应急政策，在如何在需要时，特别是在COVID-19大流行期间分配稀缺资源方面未能达成共识。当许多COVID-19患者，尤其是贫困和中产阶级地区的患者被拒绝治疗，而精英阶层却被优先分配这些稀缺资源时，伦理困境就经常出现。孟加拉国在COVID-19大流行期间的医疗资源分配似乎不道德，且与不伤害和程序公正的生物医学原则直接冲突。本研究结果表明，该法案在指导医院提供资源分配框架的政策规定方面需要进行实质性修改。此外，议会应制定指导方针，概述如何成功实施该法律，以在紧急情况下，特别是在COVID-19大流行期间保护公众健康。
