Transcript Influenza Pandemic: A Model for Development of

Influenza Pandemic: A Model for Development of Administrative Policies
and Procedures to Guide Preparedness for Influenza Pandemic Actions in
Catholic Hospitals in Pennsylvania.
Author: John Mary Mooka Kamweri
Graduate Student - Center for Healthcare Ethics, Duquesne University, PA.
It is critical that Catholic hospitals in Pennsylvania develop provisional
administrative policies and procedures to guide actions in the event of an
influenza pandemic outbreak. Health officials are concerned that a highly
pathogenic influenza A pandemic (H5N1) could occur when the H5N1 strain
of bird flu manages to mutate and spread between humans (IPRP, 2005).
This could lead to ethical and legal questions about restrictive public health
interventions that could disrupt personal liberties like individual autonomy,
privacy, confidentiality, freedoms of association, and access to limited
supplies.
The Pennsylvania’s Influenza Pandemic Response Plan (IPRP), has provisions
for mandating the exercise of intrusive powers like culling, isolation and
quarantine by public health care workers. Triage and suspension of treatment
Continuation….
of non-influenza pandemic related illnesses could pose a challenge to the
ethical ‘duty to care’ and diminish physician-patient trust relationship. Patientload will overwhelm physicians and staff who will also be concerned with
personal safety. The provisional administrative policies and procedures will
seek to propose values to guide ethical decision-making in Catholic hospitals
in the event of a pandemic influenza outbreak. The values to be considered in
policy drafting include: the duty to care, social beneficence, individual
liberties, and justice in distribution of scarce resources.
Objectives:
.
Identify ethical actions, in a clinical setting, essential for effective responses to a pandemic emergency.
.
Demonstrate a balance between individual liberties and protection of the public in developing policies for a
pandemic response.
.
Describe the process of formulating policies and procedures from abstract ethical principles.
INFLUNZA PANDEMIC (H5N1) PERIOD AND INTERVENTION
1. Introduction
Pandemi
c Period
• Estimated morbidity and mortality during Influenza Pandemic within 1216 weeks, in Pennsylvania:
• Outpatient care - 1.6 million; Hospitalization – 37,800; Death – 9,100
(IPRP, 2005).
• Shortages: Vaccines, medical supplies, medical staff, facilities…
Interceptio • Possible invasive measures: Mandatory Vaccination, quarantine,
isolation.. (IPRP, 2005).
n
Ethical /
Legal
Issues
• Protection of civil liberties (autonomy, freedom, privacy,
justice).
• Preservation of the safety and health of the population –
principle of self-defense; Police Powers – substantive and
procedural; Standards (necessity, reasonable, proportionate and prevention from
harm ) ; common good ( solidarity, cooperation, membership, communication, trust).
2. MIXED-INTERESTS ETHICS MODEL (MIEM)
Balancing Individual Interests and the Population’s interests.
• Autonomy /
(bodily integrity)
• Beneficence
• Non-maleficence
• Justice
• Principles:
• Double effect
• Lesser evil
• Proportionality
• Self-defense
• Common Good
Self-defense:
Vaccination,
Quarantine,
Isolation…
autonomy,
privacy…
Public
Health:
Population
InterestsHealth
/Safety.
Catholic :
Common
good,
Dignity,
Solidarity,
stewardship..
Legal:
ConstitutionPolice
powers,
Substantive
& procedural
due process • . Standards:
Clinical:
Individual
Interests-
• Necessity
• Reasonable
• Proportionate
• Avoid harm .
3. DEVELOPMENT OF POLICY
(Duty to care, Protection from Harm, Liberty interests, and Justice)
• Stewardship (trust,
transparence,
responsibility)
• Care (compassion,
fiduciary..)
• Solidarity
(collaboration,
communication)
DUTY TO
CARE
Liberty
Interests
• Autonomy, JusticeDue process:
Reasonable,
Necessary,
Proportionate, Harm
avoidance).
Protection
(of public)
from harm
social
beneficence
• Common Good
(safety and health)
• Subsidiarity (shared
decision-making)
• Control measures
(forced diagnosis,
vaccination, ….).
Priority
Setting
(Justice)
• . Priority Setting
(Justice)
• (justice as fairness,
allocation of
resources, triage).
RECOMMENDATION
(Four Interdependent Policy Development Sub-Committees)
Standards: necessity, proportionate, reasonable, and harm avoidance.
Population
Interests Subcommittee
Individual
Liberty
Interests
SubCommittee
Influenza
Pandemic
Policy
Developmen
t Committee
Priority Setting
/ Allocation
Sub-Comm.
Providers’
Interests SubCommittee
SUMMARY
•
•
•
•
Government intervention actions in an Influenza Pandemic that are non-voluntary and
intrusive raise ethical and legal issues.
In a clinical setting administrative policy oversight is required in areas concerning: the
professional’s duty to care; the protection of the public from harm; the preservation of
individual liberties; and, justice in distribution of scarce resources. To be relevant and
effective, policy need to be a hybrid of individual interest-based ethics and common goodbased ethics. I refer to the approach as “Mixed-Interests Ethics Model (MIEM).” Upon the
legal doctrine of bodily integrity and the ethical notion of autonomy, clinical practice protects
the individual’s interests in liberty, freedom, privacy and confidentiality. Based upon the
principle of self-defense, the government safeguards the population’s interests in health and
safety. The constitutional basis for the state’s authority is police powers. The limits to the
authority is the constitutional requirement for substantive and procedural due process. The
Constitutional standards are necessity, reasonable, proportionate, and harm avoidance. The
two traditions are relevant in policy development for Influenza Pandemic intervention.
Catholic Hospitals are advantaged since Catholic moral guidance in health care provides for
respect for the person and a moral obligation to help others. In the practical application,
principles such as double effect, lesser evil, proportionality and altruism are relevant to
administrative policy development for Influenza Pandemic intervention actions.
An Influenza Pandemic policy development committee is more effective when composed of
focus sub-committees in defense of health providers interests, individual liberties,
population’s interests and distributive justice.
Sources
•
Pennsylvania Department of Health. “PA Pandemic Flu Preparedness: Pennsylvania’s Influenza Pandemic
Response Plan (IPRP).” Available at
http://www.pandemicflu.state.pa.us/pandemicflu/cwp/view.asp?a+496&q=151651&pp=12
•
Gostin, Lawrence O. ed. “Pandemic Influenza: Public Health Preparedness for the Next Global Health
Emergency.” 32 J.L. Med. & Ethics 565 (winter 2004).
•
Gostin, Lawrence O. ed. Public Health Law and Ethics: A Reader. Berkeley and Los Angeles, CA:
University of California Press, 2002.
•
Toronto Joint Center for Bioethics. “Stand on Guard for Thee: Ethical considerations in preparedness
planning for pandemic influenza”, A report of the Toronto Joint Center for Bioethics Pandemic Influenza
Working Group (November 2005).
•
United States, Department of Health and Human Services. PandemicFlu.gov: General Information, 2007.
•
United States Conference of Catholic Bishops. “Ethical and Religious Directives for Catholic Health Care
Services, 4thed.” Washington, DC: United States Conference of Catholic Bishops (2005).