Transcript Ethical Issues in Pandemic Influenza Planning North

Confronting the Ethics of Pandemic
Planning
Indianapolis, Indiana
July 14, 2008
Janelle A. Rhyne, MD, FACP
Physician Epidemiologist
Public Health Regional Surveillance Team 2
President, North Carolina Medical Board
Process
 Panel convened by North Carolina Division of Public Health
and The North Carolina Institute of Medicine.
 Diverse membership representatives from:
 Ethicists
 Physicians
 Persons with disabilities
(physical & mental)
 Policy makers
 Private industry
 Legal
 Faith-based groups
 Hospitals
 Nursing Board
 Medical Board
 Health Directors
 American Association of
Retired Persons
 Law Enforcement
 Minority populations
 Schools
 Department of Agriculture
 Respiratory Therapy
Series of Testimonies, Scientific Presentations
Development of Recommendations
Followed with community focus
groups discussing
 Pandemic Influenza overview
 Critical Workers
 Balance Rights
 Limited Resources
Ethical Principles
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Individual liberty
Protections of the public from harm
Proportionality
Privacy
Reciprocity
Duty to provide: health care workers and other critical
infrastructure
Equity
Trust
Collaboration
Stewardship
Procedural Values
 Reasonableness
 Transparency
 Truth telling
 Inclusiveness
 Responsiveness
 Timeliness
 Accountability
http://www.epi.state.nc.us/epi/gcdc/pandemic/AppendixO1_2008.pdf
www.ncmedicaljournal.com
Hurricane Katrina Hit the Gulf Coast in 2005
6000 PHYSICIANS
LEFT THE AREA
2003 Severe Acute Respiratory
Syndrome (SARS) Outbreak in Canada
43% OF THOSE FALLING PREY TO SARS WERE
HEALTH CARE WORKERS WITH A CASE
FATALITY RATE OF ABOUT 15%
49% OF SARS HEALTH CARE
WORKERS REPORTED SOCIAL
STIGMATIZATION
31% REPORTED OSTRACISM
BY FAMILY MEMBERS
DURING THE SARS EPIDEMIC FAILURE TO
REPORT TO WORK RESULTED IN
PERMAMENT DISMISSAL OF HOSPITAL
STAFF
• Many health care professionals left the
profession for new careers rather than expose
themselves and their families to
risks associated with caring for patients
with potentially lethal infectious disease.
Professional’s Duty to Care in a
Public Health Emergency
American Medical Association Policy Statement
•National, regional and local responses
to epidemics, terrorist attacks, and other
disasters require extensive involvement
of physicians. Because of their
commitment to care for the sick and
injured, individual physicians have an
obligation to provide urgent medical
care during disasters.
…continued
•...The physician workforce, however, is
not an unlimited resource; therefore,
when participating in disaster
responses, physicians should balance
immediate benefits to individual
patients with ability to care for
patients in the future.
The American College of Physicians (ACP) Ethics
Statement
•Physicians should evaluate their risk for becoming
infected with pathogens, both in their personal lives
and in the workplace, and implement appropriate
precautions. ...Physicians can and should expect
their workplace to provide appropriate means to
limit occupational exposure through rigorous
application of infection control methods. The
denial of appropriate care to a class of patients for
any reason, including disease state is unethical.
Appeal to Professionalism
Professionalism is the basis of medicine’s contract with
Society.
It
- places the interests of patients above those of the
physician
- sets and maintains standards of competence and
integrity
- provides expert advise to society on matters of health
Professional Obligation
Licensed and nonlicensed healthcare professionals have
an ethical obligation to provide care because:
The ability of physicians and other licensed healthcare
professionals to provide care is greater than that of the public,
thus increasing their obligation to provide care.
2. The licensed professions have a social contract, resulting from
the privilege of self-regulation and self-licensure, that calls on
members to be available in times of emergency.
3. By freely choosing a profession or job devoted to caring for the
ill, healthcare personnel have assumed an ethical obligation to
act in the best interests of the ill and to assume a proportional
share of the risks to which their professions and/or
employment setting expose them.
1.
Reciprocal Obligation
Government and healthcare organizations have
reciprocal duties to healthcare personnel:
Healthcare organizations have reciprocal obligations to ensure
that the work asked of healthcare personnel does not exceed
their professional capabilities, and that the tasks assigned are
targeted to addressing the existing emergency. May involve
“Just in Time” training.
2. Government and healthcare organizations have reciprocal
duties to ensure that healthcare workers are suitably protected,
compensated, and supported.
3. Government should provide healthcare personnel and
organizations with qualified immunity from liability from
malpractice or other suits if they act in good faith to provide
needed health services during the pandemic.
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Questions????