Ethical questions during a pandemic

This collection of 11 case studies extracted from existing documents or research proposals is part of a larger project on ethics during a pandemic currently being undertaken by the National Collaborating Centre for Healthy Public Policy (NCCHPP), and is intended to contribute to one of our larger core objectives, which is to provoke reflection on the use of ethical analysis in public health practice and for the development of healthy public policy.

The general aim of this series of cases is to illustrate a wide range of pandemic and infectious disease control scenarios in which professional roles and responsibilities generate ethically complex situations. Covering issues related to the powers and duties of public health officials and health care providers, and designed to place ethical issues related to preparing and responding to outbreaks in practical contexts, the cases aim to assist in the development and application of moral reasoning through concrete examples. Such an overview of some of the most pressing moral issues and debates likely to arise during a pandemic is not meant to establish normative, definitive or absolute prescriptions by identifying a single good course of action.

These cases are instead meant to stimulate deliberation, or the in-depth discussion within a group of free and equal individuals (perhaps from multiple disciplines and potentially with dissimilar points of view) in order to gain a deeper understanding of the issues from different perspectives and in general and specific contexts. Deliberation may lead to consensus on a preferable or acceptable course of action, notably through the identification, evaluation and comparison of alternatives. A commitment to mutual respect in the transparent search for shared interests is particularly encouraged, especially since clashes between different beliefs, interpretations, or justifications, each of which may be defensible from certain specific perspectives, are to be expected in light of the risks and uncertainties portrayed in the case scenarios.

Although values and ethical principles cannot be applied in mechanistic or linear ways to provide clear-cut answers to complicated questions such as those raised in this series of cases, they can stimulate thinking and provide guideposts to help both individuals and institutions make good decisions in difficult times. It is important to keep in mind that not all principles important in public health (which include at least the common good, solidarity, equity, reciprocity, necessity, protection from harm, proportionality, individual liberty and dignity, privacy, and effectiveness) or in good decision making (which generally requires that processes be reasonable, transparent, inclusive, responsive, and accountable) will always be relevant in every case.

It is also crucial to note that there is no widely accepted hierarchy of principles or goals for public health, which means that no single principle will always or even generally take priority when it comes to public health interventions or policies, which often involve balancing multiple objectives and values. Thus, each of the cases, like every situation or decision, is best approached as a unique constellation of circumstances that merit individual consideration. While there may thus be no objectively right answer to many of the moral challenges raised in these scenarios, there are justifiable answers for persons seeking to act in the face of any particular dilemma. Searching for and arriving at justifiable solutions, even if they are tied to specific contexts, is a key goal of ethical analysis, one that is central to the development of shared understandings of practical ethics. Ultimately, it is hoped that these cases will firmly demonstrate that to “do ethics” in a public health context is necessarily messy rather than formulaic, and that it requires work, time, and deliberation within and across communities.

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