In my last post, I looked at some of the ethical considerations an individual might make during a flu epidemic. My focus was squarely on the individual's decisions: whether to stay in bed or seek medical care, whether to seek aid from others, etc. This is the kind of everyday ethics that crops up for most of us as we try to get through our days.
If you're someone who is responsible for keeping health care infrastructure or other state resources in good working order, however, the ethical landscape of a major flu epidemic looks quite different.
On January 30, 2009, the Minnesota Pandemic Ethics Project issued a preliminary report, For the Good of Us All: Ethically Rationing Health Resources in Minnesota in a Severe Influenza Pandemic (PDF). As you might guess from the subtitle, a big issue the report takes on is how ethically to ration resources that are bound to be limited in the event of a flu pandemic -- things like face masks, ventilators, antiviral drugs, and doses of flu vaccine. Given that the vaccine can't be developed until the virus behind the pandemic has presented itself to medical scientists, scarcity (or at least a significant lag between when serious flu cases present themselves and when large quantities of vaccine can be prepared) is unavoidable. This means distribution of scarce resources will require state officials to work out what is most fair.
From page iii of the draft report (in the Executive Summary), here is the first part of the "Proposed Ethical Frameworks At-a-Glance":
Ethical commitments about how pandemic planning and response will be implemented
Pursue Minnesotans' common good in ways that:
- Are accountable, transparent, and worthy of trust
- Promote solidarity and mutual responsibility
- Respond to needs fairly, effectively, and efficiently
Principles for rationing resources in a severe pandemic
Steward scarce resources to promote Minnesotans' common good by balancing three equally important ethical principles:
- Protect the population's health
- Protect public safety and civil order
- Treat people fairly, recognizing the moral equality of all
Protect the population's health
- Reduce mortality and serious morbidity
Protect public safety and civil order
- Reduce disruptions to the basic health care, public health, public safety and other critical infrastructures
- Promote public understanding about and confidence in the distribution of health care resources
Treat people fairly, recognizing the moral equality of all
- Reduce significant group differences in mortality and serious morbidity
- Make reasonable efforts to remove barriers to fair access
- Reciprocate to groups accepting high risk in the service of others
- Reduce significant differences in opportunities to live a normal lifespan
- Promote equitable access through fair random processes for individuals equally prioritized
It will not surprise you that the trick is in working out how the various individuals are prioritized before turning to the random processes.
This is very interesting reading (and I'm still working my way through the 84 pages of this draft document -- I haven't even gotten to the accompanying draft document on implementing the ethical frameworks described in this report). I'm impressed that Minnesota actually has a tentative plan for dealing with pandemic flu as an ethical challenge as well as a medical one.
While swine flu is still simmering, let's hope other states -- and federal governments, too -- have a look at this report and take some serious steps toward developing pandemic response plans of their own. I'm pretty sure you don't want to be making the tough calls in the heat of a crisis if you can help it.
Diseases don't really get eradicated. When old diseases die new ones take their place. This has always been and always will be. The infectious diseases have vanished from the developed world but other frightening monsters such as AIDS, Cancer, Appendicitus, Alzheimers and Obesity have come along in their wake.
Since I always start at the end when reading and with the details when problem solving, I'd have gone for the implementation document first, and then gone back to the philosophy--but you knew that from our past history.