Public Health Ethics - Selected Resources: Ethics in a Pandemic

Public health ethics (PHE) is a relatively new field of study that encourages interdisciplinary discussion of moral issues related to the theory and practice of public health and preventive medicine. Emerging over the last 15 years out of dissatisfaction with the traditional orientations of biomedical ethics, PHE involves the explicit use of concepts from ethical, social and political theory to discuss and evaluate collective interventions that aim to protect and promote the health of groups and populations rather than of individuals.

This document has two aims. The first is to serve as a timely introduction to the field of PHE as applied to policy and practice responses to what was perhaps the most visible recent global public health threat, the global influenza AH1N1 pandemic. It is based on a review of the literature on this subject carried out by the National Collaborating Centre for Healthy Public Policy (NCCHPP) between May and August of 2009. The review does not claim to be exhaustive of the full range of information and resources available at the time it was carried out. Rather, it seeks to select from among that range a collection of relevant, representative, and accessible works that together provide a foundation for exploring the ethical implications of infectious disease control and pandemic response. The focus is thus to provide a type of primer for further reflection and discussion, and possibly for subsequent dispatches or briefing notes, of the variety of moral dilemmas likely to arise during an influenza pandemic. These include but are not limited to health care professionals' duty to care, resource allocation and priority setting during emergencies, imposing restrictive measures, social distancing, and quarantine in practice, international public health obligations, risk perception and communication, and public health research ethics.

The second aim of this document is to serve as a precursor to the development of a pan-Canadian Public Health Ethics Portal and an inventory (of resources, researchers, educators, projects and literature) to be hosted by the NCCHPP. There is currently no centralized and up-to-date repository of such information, despite an ever-increasing interest in the ethics of public health. The Centre's aim is therefore to build and reinforce links among public health practitioners, researchers, policy makers and educators, and to create an online library of resources and space for dialogue, information-exchange, and collaboration. Given recent events involving influenza outbreaks (both H5N1 and AH1N1), a focus on ethical decision-making during a pandemic seems a timely and useful starting point. However, the long-term objective remains to create a platform for ongoing discussion of core values and concepts and ethical issues related to all aspects of public health policy and practice. This may include infectious disease control more broadly and other “traditional” topics (such as epidemiological research, health promotion, screening, population genetics, vaccination, environmental health, and lifestyle risk factors), as well as those that derive from a broader vision of the determinants of health and the scope of public health practice (like advocacy for social equity and justice, resource allocation, health in all policies and other interdisciplinary and intersectoral initiatives, and global health).

Included here is a selection of tools intended to facilitate access to resources, stimulate reflection, encourage discussion, and build connections and encourage knowledge sharing among people — from the social science fields of philosophy, law, economics, and policy studies in addition to the field of epidemiology and the medical sciences — engaged in the practical and theoretical work of protecting and promoting the health of populations. These are:

• Short summaries of a selection of seminal papers, frameworks and guidelines;
• Links to additional resources on ethics and pandemics, including articles, presentations, case studies and other learning tools, and pertinent websites, blogs, and news sources;
• Hyperlinks leading directly to the resources listed (priority has been given to open source or publicly available documents).