RESUMO
Pandemic plans are increasingly attending to groups experiencing health disparities and other social vulnerabilities. Although some pandemic guidance is silent on the issue, guidance that attends to socially vulnerable groups ranges widely, some procedural (often calling for public engagement), and some substantive. Public engagement objectives vary from merely educational to seeking reflective input into the ethical commitments that should guide pandemic planning and response. Some plans that concern rationing during a severe pandemic recommend ways to protect socially vulnerable groups without prioritizing access to scarce resources based on social vulnerability per se. The Minnesota Pandemic Ethics Project (MPEP), a public engagement project on rationing scarce health resources during a severe influenza pandemic, agrees and recommends an integrated set of ways to attend to the needs of socially vulnerable people and avoid exacerbation of health disparities during a severe influenza pandemic. Among other things, MPEP recommends: 1. Engaging socially vulnerable populations to clarify unique needs and effective strategies; 2. Engaging socially vulnerable populations to elicit ethical values and perspectives on rationing; 3. Rejecting rationing based on race, socioeconomic class, citizenship, quality of life, length of life-extension and first-come, first-served; 4. Prioritizing those in the general population for access to resources based on combinations of risk (of death or severe complications from influenza, exposure to influenza, transmitting influenza to vulnerable groups) and the likelihood of responding well to the resource in question. 5. Protecting critical infrastructures on which vulnerable populations and the general public rely; 6. Identifying and removing access barriers during pandemic planning and response; and 7. Collecting and promptly analyzing data during the pandemic to identify groups at disproportionate risk of influenza-related mortality and serious morbidity and to optimize the distribution of resources.
Assuntos
Desastres , Alocação de Recursos para a Atenção à Saúde/ética , Influenza Humana/epidemiologia , Pandemias/ética , Justiça Social , Populações Vulneráveis , Necessidades e Demandas de Serviços de Saúde , Disparidades em Assistência à Saúde/ética , Humanos , Influenza Humana/mortalidade , Minnesota , Preconceito , Avaliação de Programas e Projetos de SaúdeAssuntos
Envelhecimento , Tomada de Decisões/ética , Teoria Ética , Alocação de Recursos para a Atenção à Saúde/ética , Princípios Morais , Seleção de Pacientes/ética , Justiça Social , Adolescente , Adulto , Fatores Etários , Comportamento de Escolha/ética , Surtos de Doenças/ética , Humanos , Lactente , Expectativa de Vida , Minnesota , Prognóstico , Qualidade de Vida , Alocação de Recursos/ética , Valores Sociais , Estados Unidos , Adulto JovemAssuntos
Planejamento em Saúde Comunitária , Surtos de Doenças , Política de Saúde , Formulação de Políticas , Saúde Pública , Opinião Pública , Quarentena , Planejamento em Saúde Comunitária/ética , Planejamento em Saúde Comunitária/métodos , Planejamento em Saúde Comunitária/organização & administração , Planejamento em Saúde Comunitária/tendências , Tomada de Decisões , Política de Saúde/tendências , Humanos , Michigan , Minnesota , Quarentena/ética , Estados UnidosAssuntos
Comportamento de Escolha/ética , Surtos de Doenças , Pessoal de Saúde/ética , Mão de Obra em Saúde , Obrigações Morais , Mão de Obra em Saúde/ética , Mão de Obra em Saúde/organização & administração , Mão de Obra em Saúde/tendências , Humanos , Responsabilidade Social , Estados Unidos , Carga de TrabalhoRESUMO
Although the timing and severity of the next influenza pandemic is impossible to predict, there is broad agreement that one will occur. Preparation is vital to mitigating its effects. A severe influenza pandemic like that which began in 1918 would be unlike other disasters in nature, scale, and duration. It could cripple normal business operations and disrupt global distribution of essential goods and services. It could force ethical decisions that many in a country accustomed to relative abundance are poorly prepared to make. Although sound evidence and clinical and public health expertise are needed to make informed decisions, so is an understanding of our common and diverse values. This article outlines some of the challenges the state would face during a pandemic, especially concerning the rationing of resources and care. It also describes a process currently underway to develop guidelines for how the state should approach the ethical questions that would arise.
Assuntos
Planejamento em Desastres , Surtos de Doenças/ética , Ética Médica , Planejamento em Saúde/ética , Recursos em Saúde/ética , Influenza Humana/epidemiologia , Humanos , Influenza Humana/transmissão , Minnesota , Estados UnidosRESUMO
A public-private, multidisciplinary work group developed recommendations for rationing vaccines in Minnesota during a worst-case influenza pandemic. The recommendations encompass an ethical framework of principles, goals, and strategies. The primary goal is to maximize Minnesotans' chances of surviving both the pandemic and the years immediately thereafter and to limit two major causes of death: (a) influenza and complications of influenza, and (b) disruption of basic health care, public health, and public safety infrastructures. The work group also developed a sample rationing plan, but stressed that any final plan must reflect the best available evidence during an actual pandemic.