Hostname: page-component-8448b6f56d-mp689 Total loading time: 0 Render date: 2024-04-20T04:00:39.051Z Has data issue: false hasContentIssue false
  • English
  • Français

Ethical Considerations for Emergency Care Providers during Pandemic Influenza–Ready or Not…

Published online by Cambridge University Press:  28 June 2012

Margarita E. Pena ,
Charlene B. Irvin  and
Robert B. Takla
Margarita E. Pena*
Affiliation:
St. John Hospital and Medical Center, Department of Emergency Medicine, Detroit, Michigan, USA Wayne State University School of Medicine, Department of Emergency Medicine, Detroit, Michigan, USA
Charlene B. Irvin
Affiliation:
St. John Hospital and Medical Center, Department of Emergency Medicine, Detroit, Michigan, USA Wayne State University School of Medicine, Department of Emergency Medicine, Detroit, Michigan, USA
Robert B. Takla
Affiliation:
St. John Hospital and Medical Center, Department of Emergency Medicine, Detroit, Michigan, USA Wayne State University School of Medicine, Department of Emergency Medicine, Detroit, Michigan, USA
*
Department of Emergency Medicine22101 Moross RoadDetroit, Michigan 48236USA E-mail: margarita.pena@stjohn.org
Get access Rights & Permissions [Opens in a new window]

Abstract

When an infectious pandemic occurs in the United States, emergency care providers (ECPs) will be on the frontlines caring for infected, potentially infected, and non-infected patients. Logistically, the current emergency care system is not ready for a pandemic, but are the providers ethically ready? Some of the most difficult and challenging issues that will be raised during a pandemic will be ethical in nature. An ECP likely will be confronted with ethical values and value conflicts underlying restriction of liberty, duty to care, and resource allocation.

This report summarizes the ethical concerns and challenges that ECPs face during an infectious pandemic, and raises ethical questions that may arise related to the role of an ECP as a healthcare provider and stakeholder.

Keywords

avian influenzaduty to careemergency care provider, ethicshealthcare providerinfectious pandemicresource allocationrestriction of liberty
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 24 , Issue 2 , April 2009 , pp. 115 - 119
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Johnson, NPAS, Mueller, J: Updating the accounts: Global mortality of the 1918–1920 “Spanish” influenza pandemic. Bull Hist Med 2002;76:105–115.CrossRefGoogle ScholarPubMed
2. Taubenberger, JK, Morens, DM: 1918: the mother of all pandemics. Emerg Infec Dis 2006;12(1):15–22.Google Scholar
3. Patterson, KD; Pyle, GF: The geography and mortality of the 1918 influenza pandemic. Bull Hist Med 1991;65(1):4–21.Google ScholarPubMed
4. Homeland Security: Flu pandemic morbidity/mortality. Available at http://www.globalsecurity.org/security/ops/hsc-scen-3_flu-pandemic-deaths.html. Accessed 04 April 2008.Google Scholar
5. de Jong, JC, Claas, EC, Osterhaus, AD, et al. : A pandemic warning? Nature 1997;389(6651):554.CrossRefGoogle ScholarPubMed
6. World Health Organization: Cumulative number of confirmed human cases of Avian Influenza A/(H5N1) reported to World Health Organisation. Available at http://www.who.int/csr/disease/avian_influenza/country/cases_table_2008_04_30/en/index.html. Accessed 16 May 2008.Google Scholar
7. World Health Organization: The world health report 2007—A safer future: Global public health security in the 21st century. Available at http://www.who.int/whr/2007/en/index.html. Accessed 05 April 2008.Google Scholar
8. Bartlett, JG, Borio, L: The current status of planning for pandemic influenza and implications for health care planning in the United States. Clin Infec Dis 2008;46:919–925.Google Scholar
9. Committee on the Future of Emergency Care in the United States Health System, Hospital-Based Emergency Care: At the breaking point, 2007. Available at http://www.nap.edu/catalog.php?record_id=11621. Accessed 22 May 2008.Google Scholar
10. Cherry, RA, Trainer, M: The current crisis in emergency care and the impact on disaster preparedness. BMC Emerg Med 2008;8:7.CrossRefGoogle ScholarPubMed
11. Marer, S, Sutjita, M, Rajagopalan, S: Bioterrorism, bioethics, and the emergency physician. Top Emerg Med 2004;26(1):44–48.Google Scholar
12. Selgelid, MJ: Ethics and infectious disease. Bioethics 2005;19(3):272–289Google Scholar
13. Bernstein, M, Hawryluck, L: Challenging beliefs and ethical concepts: The collateral damage of Service Acute Respiratory Syndrome. Critical Care 2003;7(4):269–271.CrossRefGoogle Scholar
14. Singer, PA, Benatar, SR, Bernstein, M, et al. : Ethics and Service Acute Respiratory Syndrome: Lessons from Toronto. BMJ 2003;327:1342–1344.Google Scholar
15. Upshur, R, Faith, K, Gibson, JL, et al. : University of Toronto Joint Centre for Bioethics Pandemic Influenza Working Group.Stand on guard for thee: Ethical considerations in preparedness planning for pandemic influenza. Available at http://www.jointcentreforbioethics.ca/people/documents/upshur_stand_guard.pdf#search="stand on guard for thee". Accessed 16 April 2007.Google Scholar
16. Kinlaw, K, Levine, R: Ethical guidelines in pandemic influenza –Recommendations of the ethics subcommittee of the advisory committee to the director, Centers for Disease Control and Prevention. Available at http://www.cdc.gov/od/science/phec/panFlu_Ethic_Guidelines.pdf. Accessed 16 April 2007.Google Scholar
17. World Health Organization: Ethical considerations in developing a public health response to pandemic influenza.2007 Available at http://www.who.int/csr/resources/publications/WorldHealthOrganisation_CDS_EPR_GIP_2007_2c.pdf. Accessed 16 April 2008.Google Scholar
18. Middaugh, JP: Pandemic influenza preparedness and community resiliency. JAmerican Medical Association 2008;299(5):566–568.CrossRefGoogle ScholarPubMed
19. Gostin, L, Berkman, B: Project on addressing ethical issues in pandemic influenza planning.World Health Organisation dra ft papers for working group two: Ethics of public health measures in response to pandemic influenza. Available at http://www.who.int/eth/ethics/PI_Ethics_draft_paper_WG2_6_Oct_06.pdf. Accessed 17 Jan 2007.Google Scholar
20. Lo, B, Katz, MH: Clinical decision making during public health emergencies: Ethical considerations. Ann Intern Med 2005;143(7):493–498.Google Scholar
21. Gostin, LO: Ethical and legal challenges posed by severe acute respiratory syndrome. JAmerican Medical Association 2003;290(24):3229–3237.CrossRefGoogle ScholarPubMed
22. World Health Organization Writing Group: Nonpharmaceutical interventions for pandemic influenza, national and community measures. Emerg Infect Dis 2006;12(1):88–94.Google Scholar
23. Gostin, LO: Pandemic influenza: public health preparedness for the next global health emergency. J Law Med Ethics 2004;32(4):565–573.Google Scholar
24. Ruderman, C, Tracy, CS, Bensimon, CM, et al. : On pandemics and the duty to care:Whose duty? Who cares? BMC Med Ethics 2006;7:E5.CrossRefGoogle Scholar
25. Iserson, KV: The ethics of emergency medicine. Emerg Med Clin N Am 2006;24:513–545.Google Scholar
26. Clark, CC: In harm's way: American Medical Association physicians and the duty to treat. J Med Philos 2005;30:65–87.Google Scholar
27. American Nurses Association: Code of ethics for nurses. 2001 Available at http://www.nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/EthicsStandards/CodeofEthics.aspx. Accessed 15 May 2008.Google Scholar
28. Emergen cyNurses Association: Vision/mission statements and code of ethics. Available at http://www.ena.org/about/mission/#code. Accessed 15 May 2008.Google Scholar
29. National Association of Emergency Medical Technicians: EMT code of ethics. Available at http://www.naemt.org/aboutNAEMT/EMTCodeOfEthics.htm. Accessed 15 May 2008.Google Scholar
30. American Medical Association: E-9.067 Physician obligation in disaster prepa redness and response. Available at http://www.ama-assn.org/apps/pf_new/pf_online?f_n=browse/HnE/E-9.067.HTM. Accessed 15 May 2008.Google Scholar
31. Emanuel, EJ: The lesson of Service Acute Respiratory Syndrome. Ann Int Med 2003;139(7):589–591.CrossRefGoogle Scholar
32. Sepkowitz, KA, Eisenberg, L: Occupational deaths among healthcare workers. Available at http://www.cdc.gov/ncidod/EID/vol11no07/04-1038.htm. Accessed 15 May 2008.Google Scholar
33. Maunder, R, Hunter, J, Vincent, L, et al. : The immediate psychological and occupational impact of the 2003 Service Acute Respiratory Syndrome outb reak in a teaching hospital. CMAJ 2003;168(10):1245–1251.Google Scholar
34. Bai, Y, Lin, CC, Lin, CY, et al. : Survey of stressre actions among health care workers involved with the Service Acute Respiratory Syndrome outb reak. Psychiatr Serv 2004;55:1055–1057.CrossRefGoogle Scholar
35. Grace, SL, Hershenfield, K, Roberson, E, et al. : The occupational and psychosocial impact of Service Acute Respiratory Syndrome on academic physicians in three affected hospitals. Psychosomatics 2005;46:385–391.CrossRefGoogle ScholarPubMed
36. Sokol, DK: Virulent epidemics and scope of healthcare workers' duty of care. Emerg Infect Dis 2006;12(8):1238–1241.Google Scholar
37. Thompson, AK, Faith, K, Gibson, JL, et al. : Pandemic influenza preparedness: an ethical framework to guide decision-making. Available at http://www.biomedcentral.com/1472-6939/7/12. Accessed 17 Nov 2007.Google Scholar
38. World Health Organization Department of Epidemic and Pandemic Alert and Response and Department of Ethics, Trade, Human Rights and Health Law: The role and obligations of health-care workers during an outbreak of pandemic influenza. Available at http://www.who.int/trade/Ethics_PI_consultation_report_WorldHealthOrganisation_2006.pdf. Accessed 17 Nov 2007.Google Scholar
39. Osterholm, MT: Preparing for the next pandemic. N Engl J Med 2005;352(18):1839–1842.Google Scholar
40. Hick, JL, O'Laughlin, DT: Concept of operations for triage of mechanical ventilation in an epidemic. Acad Emerg Med 2006;13(2):223–229.CrossRefGoogle Scholar
41. Christian, MD, Laura, H, Wax, RS, et al. : Development of a triage protocol for critical care during an influenza pandemic. CMAJ 2006;175(11):1377–1381.Google Scholar
42. NYS work group on ventilator allocationinan influenza pandemic and NYS DOH/NYS task force on life & the law: Allocation of ventilators in an influenza pandemic: Planning document. Available at http://www.health.state.ny.us/diseases/communicable/influenza/pandemic/ventilators/docs/ventilator_guidance.pdf. Accessed 15 May 2008.Google Scholar
43. Powell, T, Christ, KC, Birkhead, GS: Allocation of ventilators in a public health disaster. Dis Med Pub Health Prep 2008;2(1):20–26.Google Scholar
44. Devereaux, AV, Dichter, JR, Christian, MD, et al. : Definitive care for the criticallyill during a disaster: A framework for allocation of scarce resources in mass critical care: From a task force for mass critical care summit meeting, Jan 26–27, 2007, Chicago, Il. Chest 2008;133(5):51S–66S.Google Scholar
45. U.S. Department of Health and Human Services: HHS Pandemic Influenza Plan. http://www.hhs.gov/pandemicflu/plan/appendixd.html. Accessed 15 May 2008.Google Scholar
46. US Department of Health and Human Services: Draft Guidance on Allocating and Targeting Pandemic Influenza Vaccine. Available at http://www.pandemicflu.gov/vaccine/prioritization.html. Accessed 15 May 2008.Google Scholar
47. Brett, AS, Zugar, A: Avian influenza and the failure of public rationing discussions. J Law Med Ethics 2005;34:620–623.Google Scholar
48. Department of Health and Human Services and Centers for Disease Control and Prevention: CDC Influenza Pandemic Operation Plan (OPLAN). Available at http://www.cdc.gov/flu/pandemic/OPLAN/BaseOPLAN.pdf. Accessed 22 May 2008.Google Scholar