Name

Residence

Affiliation

Title of the paper 

Cindy C. Bitter

USA

Saint Louis University

The business (ethical) case for

promoting wellbeing of medical staff     

Abstract

Introduction: Even prior to the ongoing COVID pandemic, burnout and the related 
constructs of compassion fatigue, secondary traumatic stress, and moral injury among 
healthcare staff was a major problem across many disciplines and many countries. 
The widespread nature of the problem has lead to a realization that burnout is not 
an individual failing, but is rooted in the systems in which healthcare takes place. 
The COVID pandemic has placed additional stressors on healthcare staff and, in most 
studies, has increased burnout. The impact of burnout on healthcare institutions and 
infrastructure is less explored. Methods: A series of systematic reviews was conducted 
to explore the prevalence and root causes of burnout among healthcare workers, estimate 
the effects on patient care and costs to healthcare systems, and evaluate predictors of 
resilience and proposed strategies to mitigate burnout among healthcare staff. Results: 
Burnout is prevalent in healthcare workers across nations, disciplines, and specialties. 
Root causes vary by context but include overwhelming workload, lack of control, 
inadequate perceived and received support, and disconnect between individual and 
organizational values. Healthcare staff suffering with burnout are more prone to medical 
error, practice defensive medicine, provide lower quality of care at higher cost. 
Physician burnout is estimated to cost $4.6 billion annually in the US alone, not 
including costs for nursing staff, pharmacists, and other allied health professions. 
Individual strategies to reduce burnout include mindfulness, cognitive behavioral 
therapy, development of an internal locus of control, and strengthening relationships. 
Organizational strategies include transparent and reasonable expectations for 
productivity, flexibility in performance of tasks, promotion of community, 
destigmatization of support, and alignment of values. Several of these initiatives have 
been demonstrated to be cost-effective, and there is evidence that institutions with 
better employee culture provide higher-quality patient care and have better reputations.

Name

Residence

Affiliation

Title of the paper

Francisca Stutzin Donoso

UK

Ethics of chronic disease and long-term

treatment

Abstract

Non-communicable chronic diseases are the main disease burden worldwide, accounting for 
71% of all deaths globally, 37% of which are considered premature deaths. Estimates show  
that adherence to long-term treatment for all chronic conditions is around 50% in high-
income countries and presumably comparable or lower in low-and-middle-income countries, 
contributing to the high rates of premature death and poor individual and population 
health outcomes. Adherence is strongly associated with adjustment to illness, which is 
commonly defined as the “presence or absence of diagnosed psychological disorder, 
psychological symptoms or negative mood” or the “healthy rebalancing by patients to 
their new circumstances”. It is considered a dynamic process, which unfolds over time 
and is sensitive to fluctuations and prognosis of disease among other variables, such as 
culture, gender, and socioeconomic status. Although it has been argued that most people 
adjust to illness, around 30% of people go through an extended period of adjustment that 
can sometimes be unsuccessful, meaning that some people do not adjust. 
Still, it is not yet clear which strategies and dispositions are most effective for 
adjustment of chronic disease, which makes it difficult to know in advance how to better 
support this specific group of patients to adjust and adhere to treatment. Even if 
considered dynamic, such perspectives on adjustment are prescriptive because lack of 
adjustment and poor self-management are seen as failing at something that is expected, 
considered healthy and, once achieved, must remain stable. Drawing on the original 
findings of a qualitative study involving 27 adult participants living with different 
chronic diseases in the United Kingdom, this paper introduces a novel perspective on the 
dynamic element in adherence to long-term treatment. Living with chronic disease is 
described as an on-going effort towards balancing different, often competing, demands to 
live lives people have reason to value. This balance can be more or less precarious as 
it is closely intertwined with a myriad of variables both disease and non-disease 
related, and should be thus understood in terms of dynamic equilibrium where new 
information is constantly being created and nothing is static. 

In this on-going effort, the chronically ill endure a myriad of challenges and burdens 
and display several resources and strategies. The empirical findings of this study show 
how justifiably hard and demanding long-term treatment can be, meaning that it cannot 
always be prioritised and thus adherence may be hampered. Strategic non-compliance or 
the chronically ill departing from medical advice to achieve this balance between 
disease-associated demands and the life they want to live has been described as positive 
for health outcomes, but this cannot always be the case. Sometimes deviations from 
medical recommendations may lead to unwanted health consequences, and not all 
non-adherence are strategic or voluntary, introducing the ethical problem of cumulative 
disadvantages affecting people who live with chronic diseases.