Introduction
While it remains difficult to predict exactly when the next influenza pandemic will take place, it is widely observed that the world has recorded an average of three pandemics in every century, noted at the interval of 10 to 50 years (World Health Organization, 2007). Morbidity and mortality rates associated with every pandemic usually differ significantly, but the consequences are devastating to human health while causing severe social and economic burdens.
Several vital ethical concerns have emerged in pandemic influenza organizing, readiness, and response, and some of these issues relate to “priority access to care, vaccine availability, and intensive care unit bed allocation is given that these resources are hardly adequate” (World Health Organization, 2007).
Healthcare workers’ obligations and risks they face raise important ethical questions. Further, surveillance, isolation, and quarantine may be done in a manner that undermines human rights. Finally, states also have obligations with regard to planning and response to an influenza pandemic. This public administration case study focuses on ethical issues that are most likely to arise during the next influenza pandemic in the US. The case study presents solutions or recommendations to the identified ethical issues.
Ethical Issues and Solutions
The first major ethical issue relates to the management of the healthcare workforce. Specifically, absenteeism and possible sanctions; control strategies, including isolation and quarantine; and the possible involvement of unqualified or non-professional healthcare providers who lack similar qualifications possessed by physicians and nurses. To overcome this ethical issue, the following solutions are preferred.
First, it is imperative for the state to pinpoint all healthcare personnel who are considered vital during the influenza pandemic. Second, high expectations without punishment should be implemented during the pandemic. Third, government agencies involved should clearly set and communicate their intentions and goals that healthcare facilities should meet. For instance, there is a need to have sufficient medical supplies for personnel who directly interact with affected persons.
Finally, it is recommended that all healthcare facilities should have common policies for reinforcing interventions, identifying compliance issues, and setting fair and responsive conditions for extraordinary cases. These solutions may assist the public health administrator in overcoming ethical issues related to the management of staff.
Another ethical concern involves triage and allocation of inadequate resources (Silva et al., 2012). In this case, triage and access to limited healthcare resources could raise difficult questions for care providers based on diverse patient-specific characteristics, such as social, medical, and demographic. These factors are bound to influence patient priority during pandemic and periods of limited resources. The main ethical issues are most likely to be influenced by age or social factors when considering the best candidate for limited medical resources. In this case, three solutions are presented. First, in the case of ventilator triage, the New York Workgroup provision insists on physiologic and prognosis (Indiana University, 2007).
In this case, social factors and age are completely not used as inclusion and exclusion criteria. Second, it is necessary for the state to urge all care facilities to develop and implement a general procedure for the allocation of constrained resources. Third, the public and civil society organizations should also support and facilitate the distribution and the use of prophylactic and therapeutic options. Lastly, there should be a standard procedure for assessing the daily progress of all triage outcomes to notice any challenges with the protocol and enhance accountability (O’Laughlin & Hick, 2008).
Improvised facilities could lead to altered care standards. The major ethical issues noted include care provision in alternative sites rather than established facilities, inadequate staffing issues, and possible changes in patient documentation during admission and discharge. On this note, the following solutions are considered practical. There should be a protocol from the state to assist all healthcare facilities in handling the pandemic influenza once declared.
It is important to involve all leaders from healthcare facilities and communities to discuss current and emerging issues based on the altered state of care. Database of available healthcare workers and volunteers should be available to understand any constraints. Healthcare workers should rely on sufficient training based on a comprehensive program to ensure that they can handle the pandemic and respond sufficiently to their expected responsibilities. It is imperative to have minimal levels of modification of documents to ensure effective documentation and data protection across various departments during the pandemic.
Ethical challenges could also emanate from information, education, and communication. Therefore, it is necessary to have expressive, active means of interactive and enlightening people regarding pandemic influenza and other related issues. In these cases, trust, transparency; timely communication; and planning are extremely important to the public. Prior adequate planning would ensure that most members of the public are engaged while racial, and language barriers are sufficiently addressed.
The following information should reach the public during the pandemic. The public must be informed of the ongoing initiatives to address the pandemic and possible areas of participation. Public health officials should present the nature and scope of the pandemic and associated risks, and its patterns of spread. In addition, communications must focus on interventions based on policies and their justifications, which should be supported by evidence-based practices.
The information must show how citizens should protect themselves against possible infections. In addition, decision-making processes should also be communicated to all stakeholders in advance. In case the information is uncertain, it is important to account for and communicate the uncertainty clearly. Moreover, information is subjected to change based on new developments during the pandemic, which requires constant updates. It is, therefore, important for the public to learn about such changes and their relevance.
Further, the process of planning and preparedness also requires openness, public involvement, and social support (World Health Organization, 2007). This process needs the engagement of important stakeholders to facilitate decision-making, policy reviews, scrutiny, and resource mobilization. Consequently, there would be enhanced public awareness and participation in the pandemic and related health issues to ensure that individuals, families, and communities can respond effectively to the pandemic.
Effective plans should be sufficient and adequate. They must enhance public confidence based on the attributes of policies such as realistic, openness, and non-discriminatory while accounting for local conditions and values. Communication should also include regular feedback. Feedback should show the effectiveness of policies, public acceptability, and specific improvements to account for local conditions. All communications should be used to reinforce public trust, enhance plan legitimacy, and promote accountability throughout the process.
Finally, ethical issues may also arise in attempts to balance human rights, interests, and values based on planning and preparedness. Generally, the influenza pandemic requires public officials to balance possibly conflicting interests of persons and communities. An influenza pandemic is also associated with emergencies. As such, personal gratification based on some rights could be restricted to protect public health. Nevertheless, ethical issues must not arise because of all efforts to ensure human rights protection will be included in the plan.
It would be noted that any restrictions on individual rights and civil liberties must be justified, equitable, not discriminating, proportional, and adhere to the state and federal laws. While striving to accommodate diverse competing interests and individual beliefs and values, public officials should apply ethical principles to guide decision-making on conflicting interests. One must, however, recognize that ethics does not dictate certain fixed sets of policies.
Instead, policymakers should consider local contexts and belief systems. While ethical principles may lead to competing theoretical concepts, they offer a framework for public health officers to evaluate and understand a wide range of interests involved. All ethical considerations and options would be based on fundamental laws that guide human rights and related policies to reflect applicable ethical standards and human rights. That is, no violation of such rights is expected during the influenza pandemic.
Conclusion
Ethical issues are bound to arise during the influenza pandemic. Hence, it is imperative for public health officers to understand potential ethical issues. In this case, equitable allocation of resources, movement restriction, healthcare workers’ obligations, state obligations, and communication are vital issues of considerations. Information sharing, transparency, and public participation are vital for addressing possible ethical challenges. Public health is vital.
However, the influenza pandemic is most likely to result in adverse effects, including morbidity and mortality. The case, therefore, shows how public health officials and other decision-makers could incorporate ethical issues into state influenza pandemic preparedness and response plan. Overall, an ethical framework is vital for enhancing and maintaining trust, promoting compliance, and lessening possible social and economic impacts on the affected population.
References
Indiana University. (2007). Pandemic Flu Preparedness in Indiana: Ethical Issues and Recommendations. Web.
O’Laughlin, D. T., & Hick, J. L. (2008). Ethical Issues in Resource Triage. Respiratory Care, 53(2), 190–197.
Silva, D. S., Gibson, J. L., Robertson, A., Bensimon, C. M., Sahni, S., Maunula, L., & Smith, M. J. (2012). Priority Setting of ICU Resources in an Influenza Pandemic: A Qualitative Study of the Canadian Public’s Perspectives. BMC Public Health, 12, 241. Web.
World Health Organization. (2007). Ethical Considerations in Developing a Public Health Response to Pandemic Influenza. Web.