Ethical reasoning in pandemic preparednes plans - southeast asia and the western pacific

Bioethics

Volumn 25, Issue 8, 2011, Pages 445-450

  Derpmann, Simon ^a  

^a UNIVERSITY OF MÜNSTER   (Germany)

Author keywords

Accountability; Equity; Ethical reasoning; Influenza; Pandemic preparedness; Personal rights

Indexed keywords

ARTICLE; ASIA; AUSTRALIA AND NEW ZEALAND; DISASTER PLANNING; ETHICS; HEALTH CARE PLANNING; HUMAN; HUMAN RIGHTS; INFLUENZA; INFLUENZA VIRUS A H1N1; NOMENCLATURE; PANDEMIC; SOCIAL BEHAVIOR; SOUTHEAST ASIA;

ASIA; ASIA, SOUTHEASTERN; AUSTRALASIA; DISASTER PLANNING; ETHICAL ANALYSIS; HEALTH PLANNING; HUMAN RIGHTS; HUMANS; INFLUENZA A VIRUS, H1N1 SUBTYPE; INFLUENZA, HUMAN; PANDEMICS; SOCIAL RESPONSIBILITY; TERMINOLOGY AS TOPIC;

EID: 80052997371     PISSN: 02699702     EISSN: 14678519     Source Type: Journal    
DOI: 10.1111/j.1467-8519.2011.01922.x     Document Type: Article

References (20)

1. It is assumed that in the case of a pandemic some ethical considerations might be lost sight of, if '[h]ealth care professionals who see their work as saving lives may view anything they do as inherently good'. See J. Thomas, N. Dasgupta & A. Martinot. Ethics in a Pandemic: A Survey of the State Pandemic Influenza Plans. Am J Public Health 2007; 97(Suppl. 1): 29.
2. Kotalik remarks that the demand for ethical reasoning should be understood as a measure to refine and not criticize pandemic planning. See J. Kotalik. Preparing for an Influenza Pandemic: Ethical Issues. Bioeth 2005; 19: 431.
3. For instance, this problem appears in the development of triage protocols, which according to Morris is a complex process is impossible to carry out during a pandemic. See J. Morris. Rethinking Risk and the Precautionary Principle. Oxford. Butterworth-Heinemann.2000
4. A. Torda. Ethical Issues in Pandemic Planning. Medical Journal of Australia 2006; 185.
5. E. Emanuel & A. Wertheimer. Who Should Get Influenza Vaccine When not All Can? Science 2006; 312: 854-855.
6. One could say that this ethical consideration concerns the ethics of pandemic planning, as opposed to ethical considerations that appear in pandemic planning. See A. Thompson et al. Pandemic Influenza Preparedness: An Ethical Framework to Guide Decision-Making. BMC Med Ethics 2006.
7. This requirement is what Daniels calls the 'publicity condition' which is part of a general requirement which Daniels refers to as 'accountability for reasonableness'. This framework is based on the condition that it is not only the outcomes of fair distributions that have to meet ethical standards, but the processes of decision-making themselves. See N. Daniels. 2008. Just Health. New York. Cambridge University Press: One could argue that it is the process itself that makes an outcome morally acceptable. However, I am not concerned with this stronger thesis here.117-119.
8. Thomas et al. offer a more extensive list of conceivable tasks including the identification and preparation responsible parties, and the implementation and evaluation of ethical measures. My list is shorter than theirs, because I focus mainly on those terms that are not only ethically relevant but also indicative of the inclusion of an explicit ethical perspective.26
9. This basically amounts to the objective '[..] to decrease cases, hospitalizations and deaths [..] and to reduce the economic and social impact of the pandemic.' See World Health Organization. 2005. WHO checklist for influenza pandemic preparedness planning: vii. Available at: [Accessed 19 Jul 2011].
10. Although WHO declares the inclusion of ethical reasoning to 'assess the acceptability of measures' not 'essential' but 'desirable'.
11. World Health Organization. 2008. Addressing ethical issues in pandemic influenza planning: 5. Available at: [Accessed 19 Jul 2011].
12. World Health Organization. 2007. Ethical considerations in developing a public health response to pandemic influenza: 2. Available at: [Accessed 19 Jul 2011].
13. This separation has no specific aim. It reflects the division of regions by WHO into a South East Asian Regional Office (SEARO) and a Western Pacific Regional Office (WPRO). The plans or drafts from South East Asia available in April 2010 were those of Bangladesh (2006), Bhutan (2006), East Timor (2005), India (2005), Indonesia (2006), Maldives (2005), Myanmar (2006), Nepal (2006), Democratic People's Republic of Korea (2006), Sri Lanka (2005), and Thailand (2007). From the Western Pacific, the plans or drafts of Australia (2008), Cambodia (2006), China, Cook Islands (2007), Fiji (2005), Hong Kong (2005), Japan (2005), Republic of Korea (2006), Laos (2006), Malaysia (2006), Mongolia (2008), Nauru (2005), New Zealand (2006), Palau (2005), Papua (2009), Philippines (2005), Singapore (2005), Tonga (2006), and Viet Nam (2006) were analyzed. The plans are constantly subject to changes. For example, there are recent updates of the plans of the plans of Bangladesh, Japan, India, Maldives and Singapore that were taken into account. Most plans and drafts can be accessed from UN websites or the local ministries of health. See. [Accessed 19 Jul 2011].
14. Thomas et al., Monier-Jack et al. offer an analysis of ethical terms in pandemic preparedness plans in Europe. They come to the conclusion that there is a '[..] lack of ethical reasoning, especially regarding resource allocation [which] might cause confusion when policies and practices need to be justified [..].' See S. Monier-Jack, R. Jas & R. Cocker. Progress and Shortcomings in European National Strategic Plans for Pandemic Influenza. Bull World Health Organ 2007; 85: 926.
15. For instance, the plan of New Zealand makes reference to 'whanaungatanga' for neighbourliness and to 'kotahitanga' for unity. These terms are not included in the list of ethical terms that guided this analysis, but nonetheless they clearly refer to ethical values.
16. This problem is specific to the analysis of large and heterogeneous regions. Thomas et al., do not have this problem because they analyse the US state preparedness plans.
17. For a more comprehensive discussion of principles for allocation that might have to be applied in combination. See G. Persad, A. Wertheimer & E. Emanuel. Principles for Allocation of Scarce Medical Interventions. Lancet 2009; 373: 424.
18. Selgelid mentions the difference between the reasons for prioritizing pandemic responders (i.e. not only health care workers, but also scientists, grave-diggers etc.) in general and healthcare workers particular. See M. Selgelid. Pandethics. Public Health 2009123257.
19. Comparable observations can be made concerning different uses of 'fairness' as a framework requirement of pandemic action. The Indian plan states that it '[..] is unrealistic to expect the poultry farmers to cooperate with the culling programme unless they can hope to get fair compensation immediately.' In the plan of Nepal there is no such emphasis on cooperation as a positive effect of fairness. Instead fairness is measured by what poultry farmers actually lose, which is why '[..] the backyard poultry farmers are paid a fair compensation to cover the value of the birds destroyed.'
20. Both my italics.