Ethical Challenges and Coping Strategies about Issues Related to The Healthcare System and Social Issues During the COVID-19 Pandemic: A Narrative Review

Background and Objective : Since December 2019, the widespread outbreak of COVID-19 has led to a major public health issue worldwide. With the spread of the COVID-19 pandemic, a series of ethically challenging issues arose that put pressure on healthcare systems around the world. This narrative review aims to comprehensively review the literature focusing on ethical challenges and coping strategies about issues related to the healthcare system and social issues during the COVID-19 pandemic. Material and Methods: This narrative review was conducted via international databases including PubMed/MEDLINE, Web of Science, and Scopus using keywords extracted from medical subject headings such as "COVID-19", "2019-nCoV disease", "2019 novel coronavirus infection", "Ethics", "Bioethical Issues", "Morals", "Coping Skills", "Coping Skill", "Coping Strategies", and "Coping Strategy" from December 2019 to January 2022. Results: In general, ethical issues during the COVID-19 pandemic can be divided into two categories: 1) issues related to the healthcare system and 2) social issues. Issues related to the healthcare system can be divided into two categories: 1) lack of resources, equipment and facilities, and manpower, and 2) problems in patient care such as triage and informed consent. Social issues can be divided into four categories: 1) community engagement, 2) crisis management capacity in remote rural communities, 3) discrimination and health equity, and 4) vaccination. Coping with ethical challenges in crises such as COVID-19 requires changing health empowerment policies and strategies based on evidence-based research. On the other hand, overcome on these challenges requires interdisciplinary collaboration and fast efficient decisions. Conclusion: Overall, the present study introduced ethical challenges and coping strategies during the COVID 19 pandemic. The experience gained from this pandemic can be considered by managers and policymakers of health care systems for coping with ethical challenges.