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Ethics and Public Health Preparedness

Physicians' response to epidemics

In 1970, the United States' Surgeon General declared it time to "close the book" on infectious diseases. Now, perhaps more than ever, we must acknowledge the hastiness of that statement. Antibiotic resistance is giving rise to "super-bugs", outbreaks of which may be difficult to effectively treat and contain. Novel pathogens, such as the SARS coronavirus, continue to emerge and spread into an increasingly accessible global community. Recent terrorist activity in the US and abroad has served to legitimize the threat of bioterrorism, i.e. the potential use of biological weapons to intentionally spread infectious agents among the US population. And most recently, pandemic influenza has dominated the headlines.

Physicians, together with other health care professionals, constitute a critical first line of defense against epidemics, whether natural or bioterror-related. In considering their obligations in preparing for and responding to an outbreak of infectious disease, medical professionals are faced with a host of ethical challenges that must be understood and responsibly met, including the need to address access to care, balance the medical needs of individuals and communities, and ensure that health professionals continue to treat infectious patients in spite of the risk they present. By acknowledging these duties and meeting the challenges they present, physicians have an opportunity to strengthen medicine's professional identity and public trust.

With this in mind, the AMA's Institute for Ethics continues to explore the many complex ethical issues associated with epidemic preparedness, with the specific aim of helping physicians to better understand and act to fulfill their professional obligations in this regard.

Reports of the AMA Council on Ethical and Judicial Affairs

Guidelines to Prevent Malevolent Use of Biomedical Research (E-2.078)

Physician Obligation in Disaster Preparedness and Response (E-9.067)

Institute for Ethics Publications

Alexander GC, Larkin GL, Wynia MK. Physicians' Preparedness for Bioterrorism and Other Public Health Priorities. Acad Emerg Med. 2006 Nov;13(11):1238-41. Epub 2006 Apr 13.

Wynia MK. Risk and trust in public health: a cautionary tale. Am J Bioeth. 2006 Mar-Apr;6(2):3-6.

Wynia MK. Markets and public health: pushing and pulling vaccines into production. Am J Bioeth. 2006 May-Jun;6(3):3-6.

Wynia MK. Ethics and Public Health Emergencies: Rationing Vaccines. Am J Bioethics. 2006 Nov-Dec;6(6):4-7.

Wynia MK. Ethics and Public Health Emergencies: Restrictions on Liberty. Am J Bioethics. 2007; 7(2):1-5.

Wynia MK. Ethics and public health emergencies: Encouraging responsibility. Am J Bioethics. 2007; 7(4):1-4.

Wynia MK. Mandating vaccination: What counts as a “mandate” in public health and when should they be used? Am J Bioethics 2007; 7(12):2-6.

Wynia MK, Kurlander JE, Green SK. Physician professionalism and preparing for epidemics: challenges and opportunities. In: Ethics and Epidemics. J Balint, S Philpott, R Baker, and M Strosberg eds. Advances in Bioethics series, Vol 9. Elsevier, Amsterdam. 2006. Pp:135-161.

Allhoff F. On economic justifications of bioterrorism defense spending. Am J Bioeth. 2005 Fall;5(4):52-4.

Green, SK. Bioterrorism and health care reform: No preparedness without access. Virtual Mentor. 2005; 6(5).

Green SK. E3LSI research: an essential element of biodefense. Biosecur Bioterror. 2005;3(2):128-37.

Green SK. Using ethics to fight bioterrorism. Science. 2005 Aug 12;309(5737):1012-7; author reply 1012-7.

Schwab A. The biases of bioterror funding. Am J Bioeth. 2005 Fall;5(4):54-6.

Green SK. ELSI and bioterrorism countermeasures? Nat Biotechnol. 2004 Jun;22(6):656.

Green SK. Physician-scientists and social responsibility. Virtual Mentor. 2004; 6(9). .

Green SK, Morin K. Biodefense: spend, but spend wisely. Am J Bioeth. 2005 Fall;5(4):50-2.

Huber SJ, Wynia MK. When pestilence prevails...physician responsibilities in epidemics. Am J Bioeth. 2004 Winter;4(1):W5-11.

Wynia MK, Gostin LO. Ethical challenges in preparing for bioterrorism: barriers within the health care system. Am J Public Health. 2004 Jul;94(7):1096-102.

Alexander GC, Wynia MK. Ready and willing? Physicians' sense of preparedness for bioterrorism. Health Aff (Millwood). 2003 Sep-Oct;22(5):189-97.

Wynia MK, Gostin L. Medicine. The bioterrorist threat and access to health care. Science. 2002 May 31;296(5573):1613.