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Ethics and Emergency Preparedness

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Ethics and Emergency Preparedness Harvey Kayman, MD, MPH, PHMO III Pandemic Influenza Planning and Preparedness Section, Immunization Branch, Department of Health ... – PowerPoint PPT presentation

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Title: Ethics and Emergency Preparedness


1
Ethics and Emergency Preparedness
  • Harvey Kayman, MD, MPH, PHMO III
  • Pandemic Influenza Planning and Preparedness
    Section, Immunization Branch, Department of
    Health Services

2
Learning Objectives
  • Review a Public Health ethical framework that may
    help officials make decisions, in the midst of
    crises.
  • Recognize key Public Health ethical issues.
  • Review potential triggers that raise ethical
    concerns.

3
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4
Foundational Principles-Toolbox for Medical
Ethics Discourse
  • Autonomy
  • Beneficence
  • Non Maleficence
  • Justice

5
Summary of Public Health Ethical Problems in
Catastrophe
  • Fair Distribution of Benefits and Burdens
  • Obligation versus Responsibilities
  • Authority and Decision Making
  • Personal Autonomy and the Common Good

6
Four Crucial Ethical Concerns Ross Upshur, Peter
Singer, etalJoint Center for Bioethics,
University of Toronto Pandemic Influenza Working
Group
  • Healthcare workers duty to provide care during a
    communicable disease outbreak.
  • Restricting liberty in the interest of Public
    Health by measures such as quarantine.

7
Four Crucial Ethical Concerns
  • Priority setting, including allocation of scarce
    resources.
  • Global governance implications such as travel
    advisories and limits on commerce.

8
Situations and Events that might Trigger Ethical
Concerns
  • Before, during or after the crisis, staff become
    uneasy with aspects of the emergency operations
  • Manifestations troubled/disturbed/
    uncooperative/crying/angry/ despondent/inefficient
    / ineffective, etc.

9
Situations and Events that might Trigger Ethical
Concerns
  • Change in situation that requires a change in
    direction, use of resources, personnel confusion
    about proper course of action, need for
    prioritization process.
  • Jurisdictional conflicts with decision makers,
    administration, public health, law enforcement,
    political leaders,etc.

10
Situations and Events that might Trigger Ethical
Concerns
  • Imminent surge leading to anxiety and unclear
    direction, need for criteria for decision making.
  • Perceived injustice with tiered prioritization
    for distribution of limited resources vaccines,
    medications, etc.
  • Rationing Triage of patients, including ones
    family, community equipment.

11
Situations and Events that might Trigger Ethical
Concerns
  • Imposition of enforced social distancing
    (quarantine)with potential closure of business,
    schools, churches, recreation, social events, and
    travel restrictions that affect the person or
    their families at home.
  • Need for action despite incomplete information.

12
Situations and Events that might Trigger Ethical
Concerns
  • Rioting or panic in the community, just outside
    ones workplace
  • Perceived needs of certain stakeholders ignored.
  • Need to set Brown out in motion, reduce quality
    or quantity of operations.
  • Need to stand down.

13
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14
Allocating resources during periods of mild,
moderate and extreme scarcity (Bryant John, 1977).
  • Postulate Ordinary people, especially those who
    have been disenfranchised for generations, should
    be included in the decision-making process for
    resource allocation, prior to and during
    emergencies which are likely to involve very
    scarce and shrinking resources, because inclusion
    in the decision making process works.

15
Allocating resources process should
  • be fair.
  • promote human dignity.
  • be part of our democracy.
  • be a just way to proceed.
  • help gain the support of suspicious populations.

16
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17
Ethical Discourse from different moral
perspectives
  • Rights (Locke)
  • Distributive Justice (Rahls)
  • Consequences (Mills)
  • Universal ideals/Intentions (Kant-Categorical
    Imperatives)

18
Ethical Decision-making from different
perspectives
  • Virtue, based on high moral character (Aristotle)
  • Caring relationships (Gilligan)
  • Community (Hume)
  • Blended, the best of all the approaches, mixed to
    achieve coherence. (Beauchamp, Childress)

19
The Precautionary Principle
  • Transparency
  • Inclusion in the decision making process
  • Accountability.

20
The Precautionary Principle
  • Action, even coercive action, must be taken when
    there is a serious threat to the publics
    welfare, often in the face of uncertainty.

21
Coercive public health action must be shown to be
  • Effective
  • necessary
  • the least restrictive means
  • proportional
  • impartial.

22
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23
In Public Health, there is a tension between
  • Individual rights and freedoms, on the one hand,
  • and the publics health and the common good, on
    the other.

24
Public Health Ethical Concerns
  • Liberty, freedom of movement.
  • Freedom of association.
  • Bodily integrity.

25
Public Health Ethical Concerns
  • Right to privacy.
  • Justice, fair distribution of benefits and
    burdens.
  • Procedural justice, due process.

26
Public Health Ethical Concerns
  • Right to control ones own property and destiny.
  • Obligation/Duty (personal vs. familial vs.
    societal)
  • Responsibility

27
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28
A Framework for Ethical Decision Making
  • Recognize that you are faced with a moral issue.
  • Gather a multidisciplinary team trained in
    ethical deliberation, if available.
  • Gather the facts.

29
A Framework for Ethical Decision Making
  • Evaluate alternative actions from various moral
    perspectives.
  • Make a decision about how to proceed.
  • Act and reflect on the decision and alter course,
    if necessary

30
Problems of Pandemic Influenza
  • In the midst of pandemic influenza, our ordinary
    assumptions may crash against realities of very
    limited resources, despite the current effort.

31
Problems of Pandemic Influenza
  • Actions, to mitigate the spread of the pandemic,
    are not yet proved.
  • The decisions Public Officials will make may be
    effective or may be of little value
  • Vaccines and anti-viral medications are likely to
    be either unavailable or in limited supply.

32
Areas that need to be addressed during a DISASTER
  • Detection,
  • Incident Command,
  • Scene Safety and Security,
  • Assess Hazards,
  • Support,
  • Triage and Treatment,
  • Evacuation and
  • Recovery.

33
Ethical Issues
  • Resource Allocation Planning and in crisis.
  • Decision making and prioritization.
  • Obligations and Responsibilities.
  • Fair Distribution of Benefits and Burdens
  • Negative Rights and Entitlements
  • Population, sub-group and Individual rights
  • Citizen Expectations and Trust
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