Nov

28

Ethics before the fact: Talking about Pandemic

November 28, 2005 |

Planners in the health-care arena shudder at the thought of having to decide what to do when they’ve run out of life-saving mechanical ventilators and a gravely ill 15-year-old comes through the emergency department door, Dr. Allison McGeer admitted.

Do they take the oldest person on a ventilator in the hospital off it? Do they call around to other hospitals to see if someone older still can be removed from a ventilator across town?

“I think, at least among health-care workers, to even have the discussion somehow creates a sense of playing God,” she said.

“People know if they get in the situation where the decisions will have to be made, they’ll have to be made. But to overtly have a discussion ahead of time about making them? . . . The general response up till now among health-care workers is that people really don’t think they can do that.”the toronto star

Dr. McGeer knows of what she speaks - as well as being one of Canada’s leading epidemiologists, she worked closely enough with patients in the SARS crisis that she caught the disease herself.

Creating rules for the allocation of vaccines when they are available, anti-virals until then, respirators to keep the ill alive and quarantine regimes to keep the healthy functional requires clear ethical guidelines. The rules have to be effective and they have to be seen as fair if they are going to work.

This is not something which is only the concern of healthcare professionals and public health authorities. The public at large and politicians need to be involved in the conversation and the decisions.

Just to give a few examples outside the hospital: in a pandemic what is the sanction against a person breaking quarantine. Do you arrest them? Because if you do arrest them and put them in jail you might very well be sentencing them to death because they will be exposed to the virus when they otherwise might not be. Or, from the other perspective, is it justifiable to keep individuals in prison if the flu breaks out in that prison and they are non-violent offenders? Should politicians’ families have preferential access to anti-virals. Should politicians below cabinet level. Should we allocate vaccine on the basis of job status? Age? Wealth?

These are not easy questions and they go right to the very heart of what we collectively see as a fair society.

We hope that avian flu does not make the jump to easy human transmission. But we need to prepare for it and for all of the other nasty bugs which get loose from time to time. This is about when, not if.


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