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Currents in Contemporary Ethics: Should Health Care Providers Get Treatment Priority in an Influenza Pandemic?

Published online by Cambridge University Press:  01 January 2021

Mark A. Rothstein
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Extract

The 2009 pandemic of influenza A (H1N1) was relatively mild, but a subsequent outbreak of pandemic influenza could be much worse. According to projections from the Department of Health and Human Services, the potential health consequences of a severe (1918-like) influenza pandemic in the United States could be literally overwhelming: up to 1.9 million deaths; 90 million people sick; 45 million people needing outpatient care; 9.9 million people hospitalized, of whom 1.485 million would need treatment in an intensive care unit (ICU); and 742,500 patients needing mechanical ventilators. Even a less cataclysmic, moderate pandemic (like 1958 or 1968) would result in 209,000 deaths; 90 million people sick; 45 million people needing outpatient care; 865,000 people hospitalized, of whom 128,750 would need treatment in an ICU; and 64,875 patients needing mechanical ventilators.

Type
JLME Column
Information
Journal of Law, Medicine & Ethics , Volume 38 , Issue 2 , Summer 2010 , pp. 412 - 419
Copyright
Copyright © American Society of Law, Medicine and Ethics 2010

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References

Department of Health and Human Services, “Health Outcomes: Number of Episodes of Illness, Healthcare Utilization, and Death Associated with Moderate and Severe Pandemic Influenza Scenarios,” 2005, available at <http://www.hhs.gov/disasters/discussion/planners/playbook/panfu/index.html> (last visited February 4, 2010).+(last+visited+February+4,+2010).>Google Scholar
Id.Google Scholar
Hampton, T., “Pandemic Flu Planning Falls Short: Many Vulnerabilities in Health Care System,” Journal of the American Medical Association 297, no. 11 (2007): 1177–1178; Tomer, E. et al., “Hospital Preparedness for Pandemic Influenza,” Biosecurity and Bioterrorism 4, no. 2 (2006): 207–217.CrossRefGoogle Scholar
American Hospital Association, Fast Facts on US Hospitals (November 11, 2009) (on file with the author).Google Scholar
Halpern, N. and Pastores, S., “Critical Care Medicine in the United States 2000–2005: An Analysis of Bed Numbers, Occupancy Rates, Payer Mix, and Costs,” Journal of Critical Care Medicine 38, no. 1 (2010): 65–71.CrossRefGoogle Scholar
Osterholm, M. T., “Preparing for the Next Pandemic,” New England Journal of Medicine 352, no. 18 (2005): 1839–1842.CrossRefGoogle Scholar
Id.Google Scholar
Beauchamp, T. L. and Childress, J. F., Principles of Biomedical Ethics, 6th ed. (New York: Oxford University Press, 2009): 241.Google Scholar
Olsen, J. A., “Theories of Justice and Their Implications for Priority Setting in Health Care,” Journal of Health Economics 16, no. 6 (1997): 625–639.CrossRefGoogle Scholar
Beauchamp, and Childress, , supra note 8, at 243.Google Scholar
Uscher-Pines, L. et al., “Planning for an Influenza Pandemic: Social Justice and Disadvantaged Groups,” Hastings Center Report 37, no. 4 (2007): 32–39. See also Powers, M. and Faden, R., Social Justice: The Moral Foundations of Public Health and Health Policy (New York: Oxford University Press, 2006): at 81.Google Scholar
American Medical Association, Code of Ethics of the American Medical Association, 2008–2009 ed. (Chicago: American Medical Association 2008): at sec. 2.03, p. 10.Google Scholar
Beauchamp and Childress, supra note 8, at 279.Google Scholar
Rawls, J., A Theory of Justice (Cambridge, MA: The Belknap Press of Harvard University Press, 1971): at 313.Google Scholar
Arras, J. D., “Rationing Vaccine During an Avian Influenza Pandemic: Why It Won't Be Easy,” Yale Journal of Biology and Medicine 78 (2005): 287–300.Google Scholar
Centers for Disease Control and Prevention, Citizen Voices on Pandemic Flu Choices — A Report of the Public Engagement Pilot Project on Pandemic Influenza (2005), available at <http://hhs.gov/nvpo/PEPPI/PEPPICompleteFinalReport.pdf> (last visited January 2, 2010).+(last+visited+January+2,+2010).>Google Scholar
Boyd, M. et al., “Pandemic Influenza: Clinical Issues,” Medical Journal of Australia 185, no. 10 (2006): S44–S47.CrossRefGoogle Scholar
A similar argument is that providing medical malpractice immunity is necessary to ensure an adequate supply of volunteer physicians. See Rothstein, M. A., “Malpractice Immunity for Volunteer Physicians in Public Health Emergencies: Adding Insult to Injury,” Journal of Law Medicine and Ethics 38, no. 1 (2010): 149–153.CrossRefGoogle Scholar
Coleman, C. and Reis, A., “Potential Penalties for Health Care Professionals Who Refuse to Work During a Pandemic,” Journal of the American Medical Association 299, no. 12 (2008): 1471–1473.CrossRefGoogle Scholar
Alexander, G. C. and Wynia, M. K., “Ready and Willing? Physicians' Sense of Preparedness for Bioterrorism,” Health Affairs 22, no. 5 (2003): 189–197.CrossRefGoogle Scholar
Schuklenk, U. and Gartland, K. M. A., “Confronting an Influenza Pandemic: Ethical and Scientific Issues,” Biochemical Society Transactions 34, pt. 6 (2006): 1151–1154.CrossRefGoogle Scholar
Ruderman, C. et al., “On Pandemics and the Duty to Care: Whose Duty: Who Cares?” BMC Medical Ethics 7, no. E5 (2006): 5–27; Rothstein, M. A., “Are Traditional Public Health Strategies Consistent with Contemporary American Values?” Temple Law Review 77, no. 1 (2004): 175–192.CrossRefGoogle Scholar
Huber, S. J. and Wynia, M. K., “When Pestilence Prevails…Physician Responsibilities in Epidemics,” American Journal of Bioethics 4, no. 1 (2004): W5, W7.CrossRefGoogle Scholar
American Medical Association, Policy E-9.067, Physician Obligation in Disaster Preparedness and Response (Dec. 2004), available at <http://ama-assn.org> (last visited February 2, 2010).+(last+visited+February+2,+2010).>Google Scholar
Hall, T., “Bargaining with Hippocrates: Managed Care and the Doctor-Patient Relationship,” South Carolina Law Review 54, no. 3 (2003): 689–740, 697.Google Scholar
Rothstein, M. A. et al., “Quarantine and Isolation: Lessons Learned from SARS – A Report to the Centers for Disease Control and Prevention” (2003), available at <http://louisville.edu/bioethics/publichealth/SARS.pdf/view> (last visited December 31, 2009).Google Scholar
Reynolds, G., “Why Were Doctors Afraid to Treat Rebecca McLester?” New York Times Magazine, Apr. 18, 2004, at 32.Google Scholar
See Brody, H. and Avery, E. N., “Medicine's Duty to Treat Pandemic Illness: Security and Vulnerability,” Hastings Center Report 39, no. 1 (2009): 40–48; Coleman, C., “Beyond the Call of Duty: Compelling Health Care Professionals to Work During an Influenza Pandemic,” Iowa Law Review 94, no. 1 (2008): 1–47; Malm, H. et al., “Ethics, Pandemics, and the Duty to Treat,” American Journal of Bioethics 8, no. 8 (2008): 4–19; Rothstein, et al., supra note 22.CrossRefGoogle Scholar
Rawls, , supra note 14, at 312.Google Scholar
McGorty, E. K., “Ethical Guidelines for an Influenza Pandemic,” North Carolina Medical Journal 68, no. 1 (2007): 38–42.CrossRefGoogle Scholar
der Heide, Auf, “The Importance of Evidence-Based Disaster Planning,” Annals of Internal Medicine 34, no. 1 (2006): 34–49; Hoey, B. A. and Schwab, W. C., “Level I Center Triage and Mass Casualties,” Clinical Orthopaedics and Related Research 422 (2004): 23–29.Google Scholar
Beauchamp and Childress, supra note 8, at 279.Google Scholar
Battin, M. P. et al., The Patient as Victim and Vector: Ethics and Infectious Disease (New York: Oxford University Press 2009): at 396–397.CrossRefGoogle Scholar
See Blagg, C. R., “The Early History of Dialysis for Chronic Renal Failure in the United States: A View from Seattle,” American Journal of Kidney Diseases 49, no. 3 (2007): 482–496; Fox, R. C. and Swazey, J. P., The Courage to Fail: A Social View of Organ Transplants and Dialysis (Edison, NJ: Transaction Publishers 2001).Google Scholar
Caplan, A. L. and Coelho, D. H., eds., The Ethics of Organ Transplantation: The Current Debate (Amherst, N.Y.: Prometheus Books 1999); Veatch, R. M. Transplantation Ethics (Washington, D.C.: Georgetown University Press 2001).Google Scholar
Harris, J. R., The Value of Life (London: Routlege and Kegan Paul 1985); see also Callahan, D., Setting Limits, What Kind of Life? (New York: Simon and Schuster 1990).Google Scholar
Hope, T. et al., “Rationing: The Health Authority,” British Medical Journal 317, no. 7165 (1998): 1067–1069.CrossRefGoogle Scholar
Smith, G. P., “Distributive Justice and Health Care,” Journal of Contemporary Health Law and Policy 18, no. 2 (2002): 421–430.Google Scholar
Persad, G., Wertheimer, A., and Emanuel, E. J., “Principles for Allocation of Scarce Medical Interventions,” The Lancet 373, no. 9661 (2009): 423–431. For a criticism of this approach, see Kerstein, S. and Bognard, G., “Complete Lives in the Balance,” American Journal of Bioethics 10, no. 4 (2010): 37–45.CrossRefGoogle Scholar
Id., at 428.Google Scholar
White, D. B. et al., “Who Should Receive Life Support During a Public Health Emergency? Using Ethical Principles to Improve Allocation Decisions,” Annals of Internal Medicine 150, no. 2 (2009): 132–139.CrossRefGoogle Scholar
McGregor, M., “Cost-Utility Analysis: Use QALYs Only with Great Caution,” Canadian Medical Association Journal 168, no. 4 (2003): 433–434.Google Scholar
Christian, M. D. et al., “The Development of a Triage Protocol for Critical Care During an Influenza Pandemic,” Canadian Medical Association Journal 175, no. 11 (2006): 1377–1381; Ferreira, F. L. et al., “Serial Evaluation of the SOFA Score to Predict Outcome in Critically Ill Patients,” Journal of the American Medical Association 286, no. 14 (2001): 1754–1758.CrossRefGoogle Scholar
Hick, J. L. and O'Laughlin, D. T., “Concept of Operations for Triage of Mechanical Ventilation in an Epidemic,” Academic Emergency Medicine 13, no. 2 (2006): 223–229.CrossRefGoogle Scholar
Beauchamp, and Childress, , supra note 8, at 277.Google Scholar
Arcavi, L. and Benovitz, N. L., “Cigarette Smoking and Infection,” Archives of Internal Medicine 164, no. 20 (2004): 2206–2216.CrossRefGoogle Scholar
Berger, A. W. and Caporaso, N., “Cigarette Smoking,” Journal of the National Cancer Institute 91, no. 16 (1999): 1365–1375.CrossRefGoogle Scholar
Kayman, H. and Ablorh-Objidja, A., “Revisiting Public Health Preparedness: Incorporating Social Justice Principles into Pandemic Preparedness Planning for Influenza,” Journal of Public Health Management and Practice 12, no. 4 (2006): 373–380.CrossRefGoogle Scholar
See Battin, et al., supra note 33, at 397.Google Scholar
Barry, J. M., The Great Influenza: The Epic Story of the Deadliest Plague in History (New York: Viking Adult Books 2003): 346–350.Google Scholar
Daniels, N. and Sabin, J., Setting Limits Fairly (New York: Oxford University Press 2002).CrossRefGoogle Scholar
Veatch, , supra note 35, at 352–362.Google Scholar
Gostin, L. O., “Public Health Strategies for Pandemic Influenza,” Journal of the American Medical Association 295, no. 14 (2006): 1700–1704.CrossRefGoogle Scholar
See Rothstein, , supra note 22.Google Scholar