If a major flu pandemic were to occur:
- Who would be given priority access to today's very limited supply of medicine? How would that decision be made? Would the rationale be acceptable to most people - including those NOT on the priority list?
- What guidance would be given to health care workers facing competing obligations in the face of a disease for which there may be no absolute protection or cure? Should they fulfill their duty to care for patients (in the process, quite possibly contracting the disease) or should they protect their own health and that of their families? What can society do to help these workers cope?
- How would governments get citizens to cooperate with quarantines?
Coping effectively with a potential influenza pandemic will require more than new drugs and good infection control. It will probably require some excruciating choices. Those choices may be easier to make (though still painful) if pandemic plans have an ethical foundation that reflects shared values. By engaging the public in the planning process, the plans can reflect what most people will accept as fair and good for public health.
That's the thrust of an advisory report released yesterday from the Influenza Pandemic Working Group at the University of Toronto Joint Centre for Bioethics. The group's recommendations are based in part on experiences and study of the Severe Acute Respiratory Syndrome (SARS) crisis of 2003 which directly impacted Toronto.
"A shared set of ethical values is the glue that can hold us together during an intense crisis," says Peter Singer, M.D., Director of the Centre.
In a Financial Times article yesterday, Singer commented further on the SARS experience, "In the first week, all the discussion was on technical issues such as the size of face masks, but by the second, the ethical issues were emerging. The foundation of the decisions of political, public health and healthcare leaders is not in operational details but ethics."
The report concludes that flu pandemic plans universally need an ethical component that addresses four key issues:
- Health workers' duty to provide care during a communicable disease outbreak;
- Restricting liberty in the interest of public health by measures such as quarantine;
- Priority setting, including the allocation of scarce resources such as medicines;
- Global governance implications, such as travel advisories.
To help in your planning, download a copy of the report [148k .pdf] from the University.
Also of note: In her coverage of this study, Canadian Press medical reporter Helen Branswell writes about the difficulty healthcare personnel have even discussing such issues.
Another resource: Peter Sandman and Jody Lanard are experts in risk communication. Their Web site offers exceedingly practical advice, including the value of getting broad public involvement in the pandemic planning process.