Pandemic influenza and ethics

Many critical ethical questions arise in pandemic influenza planning, preparedness and response. These include: who will get priority access to medications, vaccines and intensive care unit beds, given the potential shortage of these essential resources? In the face of a pandemic, what obligations do health-care workers have to work notwithstanding risks to their own health and the health of their families? How can surveillance, isolation, quarantine and social-distancing measures be undertaken in a way that respects ethical norms? What obligations do countries have to one another with respect to pandemic influenza planning and response efforts? Governments and health care leaders have been working on pandemic plans in many parts of the world. However, most of their communication to the public has focussed on technical issues, such how to obtain, stockpile and distribute medicines, and the assignment of duties. Planners have not generally communicated the ethical underpinnings of their choices in a clear manner. But ethical issues have surfaced in public debates, often in the news media. Should people purchase their own stockpiles of antiviral drugs such as oseltamavir, or should they accept governments’ decisions on how to allocate such medications? When medications are distributed, should children come before or after health care and emergency services workers, or decision makers such politicians? Government and health care leaders need to make the values behind their decisions public. They should discuss the values with people who could be affected, ranging from health care workers, who will find themselves on the front lines, to government officials, who are making decisions about the allocation of limited resources, to the public at large, because people will be affected in many ways. They need to do this in advance of a health crisis, not when people are lining up at emergency ward doors. 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 ethics 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. Advance discussions of such issues can help to address fears of the unknown. People will be more likely to cooperate, and accept difficult decisions made by their leaders for the common good.