Preparing for a swine flu pandemic

Margaret R. McLean, director of bioethics at the Markkula Center for Applied Ethics at Santa Clara University, says preparing for a swine flu pandemic must be about far more than stockpiling vaccines or freeing up hospital beds.

It must also go hand-in-hand with ethics, she says.

In a video posted to YouTube, McLean discusses the issue, drawing on research she did two years ago looking into response to a possible bird flu pandemic.

In pandemic planning, as in medicine in general, the allocation of these scarce medical resources is the most difficult ethical issue confronting the current health care system. No one wants to speak of rationing, but it occurs daily and necessarily escalates during a disaster. In a time of pandemic, rationing is inevitable and must be done in a manner that is transparent, respectful of persons, inclusive, accountable, proportional, fair, and minimizes harm.

Drawing on the Canadian experience with the 2003 SARS outbreak, the authors of “SARS and Hospital Priority Setting” (Jennifer AH Bell, et al) argue that a public health crisis demands heightened attention to fairness: “In the midst of a crisis such as SARS where guidance is incomplete, consequences uncertain, and information constantly changing, where hour-by-hour decisions involve life and death, fairness is more important rather than less.

The World Health Organization, meanwhile, has a 33-page document outlining the ethics of pandemic planning, looking at such issues as access to treatment, quarantine, the role of health care workers, the importance of international co-operation, etc.