Leadership and Ethical Decision-Making in Public Health Crises: Balancing Public Safety and Individual Rights
DOI:
https://doi.org/10.31580/pjmls.v7isp2.3165Keywords:
Adaptive strategies, Crisis management, Ethical decision making, Health emergencies, Individual rights, Policy response, Public health leadership, Public safetyAbstract
Leadership teams are crucial during public health crises, as they are responsible for balancing public safety with individual rights. Effective decision-making and ethical considerations are essential in addressing health emergencies and minimizing societal impacts. While various strategies exist in public health leadership, their wide variation often poses challenges in maintaining consistency in achieving both immediate and long-term goals. This study evaluates public health leadership during crises, focusing on administrative actions, ethical decision-making, and strategies to balance public welfare and individual liberty in health emergencies. A systematic review of articles published since 2010 in PubMed, Scopus, and Google Scholar was conducted per PRISMA guidelines. From 200 papers reviewed, 120 met inclusion criteria, with 13 highly relevant articles selected for qualitative analysis of leadership effectiveness and ethical frameworks. The results reveal that adaptive leadership promotes crisis response by facilitating effective communication, coordination, and timely decision-making. Proactive risk assessment of key issues, instigating stakeholder communication and prioritizing resources are some of the key strategies identified. However, organizational hierarchies and dilemmas over the ethical enforcement of related policies are main challenges. Crisis leadership requires evidence-based ethical decision-making balancing public safety with individual rights. Improving crisis preparedness and resilience requires enhanced collaboration and adaptive leadership across sectors. Future research should also explore how certain leadership models affect crisis response outcomes.
References
Kooli C. COVID-19: Public health issues and ethical dilemmas. Ethics, Medicine and Public Health. 2021 ;17:100635
Dirani KM, Abadi M, Alizadeh A, Barhate B, Garza RC, Gunasekara N, Ibrahim G, Majzun Z. Leadership competencies and the essential role of human resource development in times of crisis: a response to Covid-19 pandemic. Human resource development international. 2020 ;23(4):380-94.
Yip JY. Healthcare resource allocation in the COVID-19 pandemic: Ethical considerations from the perspective of distributive justice within public health. Public Health in Practice. 2021;2:100111.
Glenn J, Chaumont C, Villalobos Dintrans P. Public health leadership in the times of COVID-19: a comparative case study of three countries. International Journal of Public Leadership. 2021;17(1):81-94.
Zweig SA, Zapf AJ, Beyrer C, Guha-Sapir D, Haar RJ. Ensuring rights while protecting health: the importance of using a human rights approach in implementing public health responses to COVID-19. Health and Human Rights. 2021;23(2):173.
Unruh L, Allin S, Marchildon G, Burke S, Barry S, Siersbaek R, Thomas S, Rajan S, Koval A, Alexander M, Merkur S. A comparison of 2020 health policy responses to the COVID-19 pandemic in Canada, Ireland, the United Kingdom and the United States of America. Health Policy. 2022 ;126(5):427-37.
Nicola M, Sohrabi C, Mathew G, Kerwan A, Al-Jabir A, Griffin M, Agha M, Agha R. Health policy and leadership models during the COVID-19 pandemic: A review. International journal of surgery. 2020 ;81:122-9.
Molavi-Taleghani Y, Ebrahimpour H, Sheikhbardsiri H. A proactive risk assessment through healthcare failure mode and effect analysis in pediatric surgery department. Journal of Comprehensive Pediatrics. 2020;11(3).
Martin L. Leadership challenge: lateral systems integration for healthcare. Journal of Integrated Care. 2022 ;30(1):77-86.
Martinez N, Kilag OK, Macario R. The Impact of Organizational Culture on Leadership Strategies in Crisis Management. Excellencia: International Multi-disciplinary Journal of Education (2994-9521). 2023 ;1(5):454-66.
Scholl JA, Mederer HJ, Scholl RW. Leadership, ethics, and decision-making. InGlobal encyclopedia of public administration, public policy, and governance 2023 (pp. 7495-7504).
Akinsanmi T, Salami A. Evaluating the trade-off between privacy, public health safety, and digital security in a pandemic. Data & Policy. 2021 ;3:e27.
Abdeen FN, Fernando T, Kulatunga U, Hettige S, Ranasinghe KA. Challenges in multi-agency collaboration in disaster management: A Sri Lankan perspective. International Journal of Disaster Risk Reduction. 2021;62:102399.
Gostin LO, Hodge JG. US emergency legal responses to novel coronavirus: balancing public health and civil liberties. Jama. 2020 ;323(12):1131-2.
Henderson J, Ward PR, Tonkin E, Meyer SB, Pillen H, McCullum D, Toson B, Webb T, Coveney J, Wilson A. Developing and maintaining public trust during and post-COVID-19: can we apply a model developed for responding to food scares?. Frontiers in public health. 2020 ;8:369.
Joniaková Z, Jankelová N, Blštáková J, Némethová I. Cognitive diversity as the quality of leadership in crisis: Team performance in health service during the COVID-19 pandemic. InHealthcare 2021 (Vol. 9, No. 3, p. 313). MDPI.
Ehmann MR, Zink EK, Levin AB, Suarez JI, Belcher HM, Biddison EL, Doberman DJ, D’Souza K, Fine DM, Garibaldi BT, Gehrie EA. Operational recommendations for scarce resource allocation in a public health crisis. Chest. 2021;159(3):1076-83.
Phillips W, Roehrich JK, Kapletia D. Responding to information asymmetry in crisis situations: innovation in the time of the COVID-19 pandemic. Public Management Review. 2023 ;25(1):175-98.
Bardosh K, De Figueiredo A, Gur-Arie R, Jamrozik E, Doidge J, Lemmens T, Keshavjee S, Graham JE, Baral S. The unintended consequences of COVID-19 vaccine policy: why mandates, passports and restrictions may cause more harm than good. BMJ Global Health. 2022 ;7(5):e008684.
Rubio O, Estella A, Cabre L, Saralegui-Reta I, Martin MC, Zapata L, Esquerda M, Ferrer R, Castellanos A, Trenado J, Amblas J. Ethical recommendations for a difficult decision-making in intensive care units due to the exceptional situation of crisis by the COVID-19 pandemic: A rapid review & consensus of experts. Medicina Intensiva (English Edition). 2020 ;44(7):439-45.
Galiatsatos P, Kachalia A, Belcher HM, Hughes MT, Kahn J, Rushton CH, Suarez JI, Biddison LD, Golden SH. Health equity and distributive justice considerations in critical care resource allocation. The Lancet Respiratory Medicine. 2020 ;8(8):758-60.
El-Jardali F, Fadlallah R, Daher N. Multi-sectoral collaborations in selected countries of the Eastern Mediterranean region: assessment, enablers and missed opportunities from the COVID-19 pandemic response. Health Research Policy and Systems. 2024 ;22(1):14.
Hick JL, Hanfling D, Wynia MK, Pavia AT. Duty to plan: health care, crisis standards of care, and novel coronavirus SARS-CoV-2. Nam Perspectives. 2020;2020.
Angeli F, Camporesi S, Dal Fabbro G. The COVID-19 wicked problem in public health ethics: conflicting evidence, or incommensurable values?. Humanities and Social Sciences Communications. 2021 ;8(1).
Everett JA, Colombatto C, Awad E, Boggio P, Bos B, Brady WJ, Chawla M, Chituc V, Chung D, Drupp MA, Goel S. Moral dilemmas and trust in leaders during a global health crisis. Nature human behaviour. 2021 ;5(8):1074-88.
Spalluto LB, Planz VB, Stokes LS, Pierce R, Aronoff DM, McPheeters ML, Omary RA. Transparency and trust during the coronavirus disease 2019 (COVID-19) pandemic. Journal of the American College of Radiology. 2020 ;17(7):909-12.
McGuire AL, Aulisio MP, Davis FD, Erwin C, Harter TD, Jagsi R, Klitzman R, Macauley R, Racine E, Wolf SM, Wynia M. Ethical challenges arising in the COVID-19 pandemic: an overview from the Association of Bioethics Program Directors (ABPD) task force. The American Journal of Bioethics. 2020 ;20(7):15-27.
Wang Y, Hao H, Platt LS. Examining risk and crisis communications of government agencies and stakeholders during early-stages of COVID-19 on Twitter. Computers in human behavior. 2021;114:106568.
Laventhal N, Basak R, Dell ML, Diekema D, Elster N, Geis G, Mercurio M, Opel D, Shalowitz D, Statter M, Macauley R. The ethics of creating a resource allocation strategy during the COVID-19 pandemic. Pediatrics. 2020 ;146(1).
Uy F, Kilag OK, Abendan CF, Macapobre K, Cañizares MC, Yray F. Application of Adaptive Crisis Management Theory: The Dynamics of Leadership in Times of Crisis. Excellencia: International Multi-disciplinary Journal of Education (2994-9521). 2023 ;1(5):159-70.
McMullin C, Raggo P. Leadership and governance in times of crisis: A balancing act for nonprofit boards. Nonprofit and Voluntary Sector Quarterly. 2020 Dec;49(6):1182-90.
Smith M, Miller S. The ethical application of biometric facial recognition technology. Ai & Society. 2022 ;37(1):167-75.
Chen Q, Min C, Zhang W, Wang G, Ma X, Evans R. Unpacking the black box: How to promote citizen engagement through government social media during the COVID-19 crisis. Computers in human behavior. 2020 ;110:106380.
Cleveland Manchanda EC, Sanky C, Appel JM. Crisis standards of care in the USA: a systematic review and implications for equity amidst COVID-19. Journal of Racial and Ethnic Health Disparities. 2021 ;8:824-36.
Hegele Y, Schnabel J. Federalism and the management of the COVID-19 crisis: centralisation, decentralisation and (non-) coordination. West European Politics. 2021 ;44(5-6):1052-76.
Capolongo S, Rebecchi A, Buffoli M, Appolloni L, Signorelli C, Fara GM, D’Alessandro D. COVID-19 and cities: From urban health strategies to the pandemic challenge. A decalogue of public health opportunities. Acta Bio Medica: Atenei Parmensis. 2020;91(2):13.
Beilstein CM, Lehmann LE, Braun M, Urman RD, Luedi MM, Stüber F. Leadership in a time of crisis: Lessons learned from a pandemic. Best Practice & Research Clinical Anaesthesiology. 2021;35(3):405-14.
Sriharan A, Hertelendy AJ, Banaszak-Holl J, Fleig-Palmer MM, Mitchell C, Nigam A, Gutberg J, Rapp DJ, Singer SJ. Public health and health sector crisis leadership during pandemics: a review of the medical and business literature. Medical Care Research and Review. 2022 ;79(4):475-86.
McGuire AL, Aulisio MP, Davis FD, Erwin C, Harter TD, Jagsi R, Klitzman R, Macauley R, Racine E, Wolf SM, Wynia M. Ethical challenges arising in the COVID-19 pandemic: an overview from the Association of Bioethics Program Directors (ABPD) task force. The American Journal of Bioethics. 2020 ;20(7):15-27.
Chin T, Meng J, Wang S, Shi Y, Zhang J. Cross-cultural metacognition as a prior for humanitarian knowledge: when cultures collide in global health emergencies. Journal of Knowledge Management. 2022 ;26(1):88-101.
Downloads
Published
Issue
Section
License
Copyright (c) 2024 Pak-Euro Journal of Medical and Life Sciences
This work is licensed under a Creative Commons Attribution 4.0 International License.
