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Ethics in an epidemic: ethical considerations in preparedness planning for pandemic influenza.

Article Excerpt
Introduction

In the event of an influenza pandemic, a host of difficult decisions will have to be made, including stark choices about allocation of limited resources such as antivirals, the imposition of restrictive measures such as quarantines, the level of risk that health care workers should be expected to face while caring for the sick, and the use of travel restrictions and other measures to contain the spread of disease. These decisions will affect population survival rates and impact fundamental individual rights and freedoms. (1)

The World Health Organization has recommended that every country develop and maintain an up-to-date national influenza preparedness plan. (2) Further, to assist with preparation and planning, the WHO has developed a checklist of essential and desirable elements of national preparedness plans. (3) The checklist specifically includes discussion of legal and ethical issues. (4)

The purpose of this paper is to present an overview of a more detailed report produced by the Pandemic Influenza Working Group at the University of Toronto Joint Centre for Bioethics [JCB]. The full report, Stand On Guard For Thee: Ethical Considerations in Preparedness Planning for Pandemic Influenza, is freely available on the Internet. (5) An elaboration of the methodology used for developing the report's ethical framework is presented elsewhere. (6)

Background

Government leaders and health care officials in many parts of the world are developing pandemic plans. However, there has been precious little public discussion and debate about the planning process. The values underlying pandemic plans must be made public. Decision-makers should discuss the values with people who could be affected, ranging from health care workers, who will find themselves on the front lines, to hospital administrators who will make decisions about the allocation of limited resources, to the public at large, who will be affected in many ways. This discussion should take place in advance of a health crisis, not when patients are lining up at emergency wards.

Openly discussing the choices and confirming that they are based on ethical values that are shared by members of a society brings important benefits. If ethical values are clearly built into pandemic plans in an open and transparent manner, and with buy-in from multiple sectors of society, the plans carry greater trust, authority, and legitimacy. (7) Advance discussions of such issues can help address fears of the unknown. People will be more likely to cooperate, and accept difficult decisions made by their leaders for the common good.

The need for a clearly understood and widely accepted ethics approach to dealing with serious communicable disease outbreaks was underscored during the outbreak of severe acute respiratory syndrome [SARS] in...

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