Ethical considerations found lacking in preparedness plans for bird flu outbreaks

A report from Toronto, a city hardened by SARS, says discussing tough choices beforehand will help lessen the damage of a potential avian influenza pandemic.

By Kevin B. O'Reilly, AMNews staff. Jan. 2/9, 2006.

International planning to control a potential avian influenza pandemic should include an explicit ethics component, according to a report the University of Toronto's Joint Centre for Bioethics released in November 2005.

The Congressional Budget Office has estimated that as many as 90 million Americans could get sick, and 2 million could die within months of a potential outbreak of the H5N1 flu strain that has killed at least 69 people in Asia.

While the White House and the Dept. of Health and Human Services have issued pandemic flu plans, neither plan deals explicitly with ethical issues that would arise should a pandemic hit.

Toronto's experience with the severe acute respiratory syndrome outbreak in 2003 that infected 375 people, killed 44 and practically shut down the city made it clear that ethical issues such as prioritizing medical treatment, instituting a quarantine and helping physicians meet ethical obligations should be examined before the emergency strikes, according to the report, "Stand on Guard for Thee."

"There's about 200 countries in the world. Zero have an explicit ethics framework in their pandemic plans," said Peter A. Singer, MD, MPH, one of the report's authors and director of the Joint Centre for Bioethics. "The lesson from SARS is that the ethical values framework is the foundation of the house in those plans."

Toronto political and health officials, with no ethics plan in place, rushed to justify decisions about prioritizing access to care, implementing a quarantine and defining health care workers' duty to care for the sick even at personal risk.