Canadian centre calls for preparedness
A second wave of the H1N1 influenza pandemic could present a host of thorny medical ethics issues, according to discussion papers from the University of Toronto Joint Centre for Bioethics.
"Now is the time to think through the serious ethical challenges societies may confront, not in the midst of crisis with line-ups at hospital doors, " says director Ross Upshur.
Below are some of the problems the Centre foresees:
* Do healthcare workers have an obligation to treat patients despite risk of infection? What limits, if any, are there to health care workers’ duty to care? A study by the Centre found that many people feel that "like soldiers, [health care workers] should be expected to uphold their duties no matter how challenging and frightening the situation.”
* A major pandemic will demand difficult ethical choices related to ventilators, vaccines, antivirals and other resources. Who should get the last bed and ventilator in an intensive care unit — an accident victim suffering a severe but potentially reversible brain injury or a nurse who contracted the flu while caring for patients in the hospital?
Should resources be allocated to save the most lives or to give everyone a fair chance at survival? Should special consideration be given to vulnerable populations in determining access to resources? Who should make these allocation decisions?
* Some of the ethical goals of priority-setting involve legitimacy, fairness and equity. Should resources be given to the sickest or to those directly responsible for the care of others (such as elderly parents).
* Should people be forced to be vaccinated? Coercion could range from aggressive marketing campaigns, to introducing policies that exclude unvaccinated individuals, to introducing mandatory vaccination.
* How far should governments go in limiting the basic personal freedoms of mobility, freedom of assembly, and privacy to protect the public good?
* What obligations exist to support poorer countries in response to a flu pandemic? Should countries have the right to close their borders to travelers coming from affected areas? How might a collaborative focus on minimizing harms, avoiding stigmatization, and preventing unnecessary constraints on international travel and trade be fostered and maintained?
* How transparent should governments and individuals be about outbreaks and infections? ~ EurekAlert, Sept 23
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