Ethical Issues in Pandemic Influenza Planning - PowerPoint Presentation

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Ethical Issues in Pandemic Influenza PlanningNorth Carolina – Healthcare Workers Obligations to Work

Confronting the Ethics of Pandemic PlanningIndianapolis, IndianaJuly 14, 2008

Janelle A. Rhyne, MD, FACP

Physician Epidemiologist

Public Health Regional Surveillance Team 2

President, North Carolina Medical Board

Process

Panel convened by North Carolina Division of Public Health and The North Carolina Institute of Medicine.Diverse membership representatives from:

Ethicists

Physicians

Persons with disabilities (physical & mental)

Policy makers

Private industry

Legal

Faith-based groups

Hospitals

Nursing Board

Medical Board

Health Directors

American Association of Retired Persons

Law Enforcement

Minority populations

Schools

Department of Agriculture

Respiratory Therapy

Series of Testimonies, Scientific Presentations

Development of Recommendations

Followed with community focus groups discussing

Pandemic Influenza overviewCritical WorkersBalance RightsLimited Resources

Ethical PrinciplesIndividual liberty

Protections of the public from harmProportionality

Privacy

Reciprocity

Duty to provide: health care workers and other critical infrastructure

Equity

Trust

Collaboration

Stewardship

Procedural ValuesReasonablenessTransparencyTruth telling

InclusivenessResponsivenessTimelinessAccountability

http://www.epi.state.nc.us/epi/gcdc/pandemic/AppendixO1_2008.pdf

www.ncmedicaljournal.com

Hurricane Katrina

Hit

the Gulf Coast in 2005

6000 PHYSICIANS

LEFT THE AREA

43% OF THOSE FALLING PREY TO SARS WERE HEALTH CARE WORKERS WITH A CASE FATALITY RATE OF ABOUT 15%

2003 Severe Acute Respiratory Syndrome (SARS) Outbreak in Canada

49% OF SARS HEALTH CARE WORKERS REPORTED SOCIAL STIGMATIZATION

31% REPORTED OSTRACISM BY FAMILY MEMBERS

Many health care professionals left the profession for new careers rather than expose themselves and their families to

risks associated with caring for patients

with potentially lethal infectious disease.

DURING THE SARS EPIDEMIC FAILURE TO REPORT TO WORK RESULTED IN PERMAMENT DISMISSAL OF HOSPITAL STAFF

National, regional and local responses to epidemics, terrorist attacks, and other disasters require extensive involvement of physicians. Because of their commitment to care for the sick and injured, individual physicians have an obligation to provide urgent medical care during disasters.

American Medical Association Policy Statement

Professional’s Duty to Care in a Public Health Emergency

...The physician workforce, however, is not an unlimited resource; therefore, when participating in disaster responses, physicians should balance immediate benefits to individual patients with ability to care for patients in the future.

…continued

Physicians should evaluate their risk for becoming infected with pathogens, both in their personal lives and in the workplace, and implement appropriate precautions. ...Physicians can and should expect their workplace to provide appropriate means to limit occupational exposure through rigorous application of infection control methods. The denial of appropriate care to a class of patients for any reason, including disease state is unethical.

The American College of Physicians (ACP) Ethics Statement

Appeal to Professionalism

Professionalism is the basis of medicine’s contract withSociety.Itplaces the interests of patients above those of the

physician

sets and maintains standards of competence and integrity

provides expert advise to society on matters of health

Professional Obligation Licensed and nonlicensed healthcare professionals have an ethical obligation to provide care because:

The ability of physicians and other licensed healthcare professionals to provide care is greater than that of the public, thus increasing their obligation to provide care.

The licensed professions have a social contract, resulting from the privilege of self-regulation and self-licensure, that calls on members to be available in times of emergency.

By freely choosing a profession or job devoted to caring for the ill, healthcare personnel have assumed an ethical obligation to act in the best interests of the ill and to assume a proportional share of the risks to which their professions and/or employment setting expose them.

Reciprocal Obligation Government and healthcare organizations have reciprocal duties to healthcare personnel:

Healthcare organizations have reciprocal obligations to ensure that the work asked of healthcare personnel does not exceed their professional capabilities, and that the tasks assigned are targeted to addressing the existing emergency. May involve “Just in Time” training.

Government and healthcare organizations have reciprocal duties to ensure that healthcare workers are suitably protected, compensated, and supported.

Government should provide healthcare personnel and organizations with qualified immunity from liability from malpractice or other suits if they act in good faith to provide needed health services during the pandemic.

Questions????