Who should be treated first in case of pandemic outbreak?

Published 17 July 2008

Representatives from 35 states participate in an Indiana University-hosted discussion about how should limited, potentially life-saving resources like vaccines or ventilators be allocated during a pandemic

A disease pandemic does not have to exist to have a discussion about ethical dilemmas that could come with it, including: How should limited, potentially life-saving resources like vaccines or ventilators be allocated? Do those who are sickest or those who are hardiest have first dibs when such resources are limited? What recourses do employees have if they want to stay home on the advice of the local health department but against employers’ wishes? How should hospitals handle employees who refuse to come to work? These and myriad other questions were on the agenda this week at the first-ever summit on ethical questions a pandemic might pose. Held on the campus of Indiana University-Purdue University Indianapolis, it brought together public health officials from thirty-five states and territories. It “was to be a summit of the United States who could speak to and with each other about the common challenges they face and in particular the common ethical challenges,” said Eric Meslin, director of the Indiana University Center for Bioethics, which co-hosted the event.

For many participants, the two-day conference, which concluded Tuesday, offered an opportunity to share what works best and grapple with thorny issues with others in the field. “We’ve all been wrestling with ethical issues in our own jurisdictions,” said Dr. David Sundwall, president of the Association of State and Territorial Health Officials, another host. While no clear set of mandates came out of the conference, the group identified nine key ethical challenges in drawing up pandemic influenza plans. These include meeting the needs of at-risk populations, balancing the rights and duties of health-care and critical infrastructure workers, and not exacerbating existing health disparities. Even deciding whether to order a quarantine can pose ethical dilemmas, the experts concluded. “The public health power of the state is a very unique power,” Meslin said. “It’s both a police power … and a health promotion and disease prevention power.”

In Indiana, declaring a quarantine would fall to the governor’s office, said state Health Commissioner Dr. Judith Monroe. She has the power to close schools. If a pandemic were to hit the state, Monroe said, state and local entities already have decided to close schools across the state, rather than in selected counties. Now state and local health departments are trying to decide how they would respond to public gatherings, such as funerals and football games. The other day the state hosted its own local session on the ethics of pandemic planning. In many regards, people in Indiana and across the nation share similar attitudes about the prospect of a pandemic, said James Wolf, director of IUPUI’s Survey Research Center, which conducted national and local surveys of public opinion on the ethics of pandemic planning. “The good news as far as I can tell, there does seem to be a general understanding among the public of how serious this situation would be,” he said. Wolf also found that the source most people said they would trust was their family doctor, a fact that might signal public health officials to keep local primary-care providers in the loop in the event of an emergency.