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Ethical and Legal Issues in Influenza Pandemic

Explore the ethical and legal dilemmas in managing an influenza pandemic, including resource allocation, privacy concerns, and public health strategies. Learn about vaccination prioritization, isolation policies, and the balance between public good and individual rights.

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Ethical and Legal Issues in Influenza Pandemic

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  1. Ethical and Legal Issues in Influenza Pandemic Alicia Ouellette Albany Law School

  2. Five (of many more) issues • Hazardous duty by health care providers • Resource allocation: vaccinations • Identification: naming of names • Civil confinement: isolation and quarantine • Travel and border controls

  3. Competing values PUBLIC GOOD -versus- INDIVIDUAL RIGHTS Utility Justice Professionalism Nonmaleficence Efficiency Beneficence

  4. Public good • Heath and safety • Individual patients • Public at large • Health care providers • Vulnerable populations • Integrity of process

  5. Individual rights • Privacy • Autonomy • Bodily integrity • Liberty interests • Equity • Travel

  6. Allocation of vaccines: criteria for prioritization • Historically, priority is individuals at high risk • of hospitalization • Risk of death • Beneficence-based commitment (promote good and remove harm) – likelihood of medical benefit • Utility-based commitment

  7. Triage and vaccine prioritization • Are we vaccinating those most at risk of severe illness or life lost • OR • Preventing harm, maintaining “fighting strength” by vaccinating those most likely to spread disease?

  8. Objectives for pandemic vaccination Will Primary Goal be: • to prevent overall # of deaths? • to prevent deaths in high risk pts? • To decrease gross attack rates? • To decrease severe morbidity? • To decrease disruptions of essential services? See Meltzer, Cox, Fukuda 1999

  9. Prioritization of limited vaccine • Varying Strategies • Those at High Risk for influenza-related complications, including death • determining who is at highest risk as dependent on epidemiology of pandemic • Those in essential community services • Those most likely to disseminate virus

  10. Identification: Surveillance and Contact Tracing • Reporting cases essential public health strategy • Tension with claims of privacy • Economic impact of reporting for geographic and ethnic communities

  11. Identification: Surveillance and Contact Tracing • Appropriate policy depends on scale of epidemic

  12. Name-based identification • Acceptable limit on privacy when: • State demonstrates an important need to know and intervene; • Transparency regarding uses, disclosure and harm; • Consultation with relevant communities; • Data is used for legitimate health purposes only.

  13. Isolation and Quarantine • Legal and ethical to avert significant risks of transmission • Significant issues: • Loss of liberty • Social and economic harm • Potential for discrimination

  14. Isolation and Quarantine Policies • Scientific assessment of risk • Target restrictive measures where possible • Must provide safe and habitable environment • Social justice paramount • Procedural due process • Least restrictive alternative

  15. Bounding Precaution • Safeguarding individual rights • Least intrusive alternative • Fairness and justice • Transparency

  16. Balancing Precaution, Rights, Justice, and Transparency • Use voluntary means where possible. • Mandatory measures only where necessary. • Elicit voluntary cooperation through information, solicitation, and collaboration.

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