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Influenza Pandemics:
Ethical Issues During An Influenza Pandemic
Justice
by Luca Giordano
At each stage of a pandemic, ethical issues arise. For example, who should
receive anti-viral drugs if there are only supplies for say 20% of the
population?
National policies will vary but here is an outline of the general
principles:
(short version - legal issues and specifics for health-care workers and
for hospitals and clinics are not included in this version)
1 The Ethical Base is that of Preserving Life
Since influenza, and particularly pandemic influenza, is a potentially fatal illness that can affect large portions of the population, the resources for treating and preventing it may not be available to all. HOWEVER, since preserving life is the top priority, all people should have access to life-saving service.
2 Ethical values
A range of values is based on preserving life and upon solidarity (cohesion,
standing as one and supporting those in need). Values include:
− individual freedom (as long as freedom does not jeopardize other life).
− proportionality (the extent of the measures must be directly related to
the risk to public health and the expected benefit).
− privacy (unless publication is essential for the health of the broader
population).
− fairness (the resources for prevention and treatment must be
distributed fairly).
− trust (includes trust in the goodwill and competence of those in
positions of responsibility).
3 Solidarity in the community through good communication
In the event of a life-threatening crisis, there is a risk of a decline in solidarity as a result of fear and traumatization or as a consequence of the instinct for self-preservation. During a crisis, the authorities must make every effort to maintain solidarity between individuals and groups, since it is the task of the state to preserve the life of all its members.
4 Approaching a fair distribution
When applied to life and health, the principle of fairness and impartiality means that every individual is of equal value. If the resources required to treat all patients properly are not available, then a truly "fair" decision is not possible, because fair would mean treating all according to their needs. The least unfair solution must therefore be sought. Decisions are based on a) containing the infection and b) saving the maximum number of patients possible.
5 Principles for the distribution of scarce resources for prevention and treatment
a) Allocation does not involve an evaluation of the value of people's lives but
is based on seeing as few people as possible fall ill during the flu pandemic.
b) If there are insufficient resources for everyone, the first to be excluded
should be those who are not in need
c) Rationing must be based reasonable decisions based on the following criteria:
− Transparency, Health Benefit, Practical Feasibility and Adaptability
Other Ethical Considerations:
Prevention through antiviral drugs: Since it is unlikely that a vaccine will be available in sufficient quantities from the moment the first pandemic cases are identified, it may prove necessary to use antiviral drugs as a preventive measure in certain cases. In this case the drugs would have to be given to individuals who look after infected patients or who come into contact with infected patients.
The interpretation and implementation of the principles for allocation must be specified for each phase of the pandemic and adapted to the specific circumstances.
Those working in the healthcare professions (particularly doctors, nurses and those with responsibility for the technical and logistical functions of healthcare provision) who are in contact with influenza patients have a duty, as part of their professional ethos, to continue working during the pandemic. They therefore have the right to priority vaccination.
Sources:
The Swiss National Ethics Commission (NEC). World Health Organization
(WHO) Special Commission
Poll Results: Our
Quick Poll for June asked, "Would you allow yourself to be a human trial
of a bird flu vaccine?"
Yes : 13.3%
No : 86.7%
Some 1400 votes from various countries.
Next: » Scenario - how the next influenza pandemic is likely to start
All Articles
in this series:
» The Influenza Pandemics of the 20th Century.
» Defending ourselves against the next influenza
pandemic.
» Outcomes and Social Reshaping following a 21st Century Pandemic.
» The six phases and three periods defined by WHO for Pandemics.
» The Ethics of Pandemics - who gets the medicine and who decides.
» Scenario - how the next influenza pandemic is likely to start.
Video Presentation:
(Requires free Google video software) (3 min)
Bird Flu Report 11 - 1 (Opens in a new window
on the Google Video site.)