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标题：Ethics in a Pandemic: A Survey of the State Pandemic Influenza Plans
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作者：James C. Thomas ; Nabarun Dasgupta ; Amanda Martinot 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2007
卷号：97
期号：Suppl 1
页码：S26-S31
DOI：10.2105/AJPH.2006.093443
语种：English
出版社：American Public Health Association
摘要：A pandemic of highly pathogenic influenza would threaten the lives of hundreds of thousands in the United States and confront governments and organizations, with ethical issues having wide-ranging implications. The Department of Health and Human Services and all states have published pandemic influenza plans. We analyzed the federal and state plans, available on the Internet, for evidence of ethical guidance as judged by the presence of ethical terms. The most striking finding was an absence of ethical language. Although some states acknowledged the need for ethical decisionmaking, very few prescribed how it should happen. If faced by a pandemic in the near future, we stand the risk of making many unjust and regrettable decisions. IN ANTICIPATION OF A devastating pandemic of human influenza, the World Health Organization published recommendations for countries to use in their own preparations. 1 ^, 2 In November of 2005, the US president’s Homeland Security Council laid out a broad national strategy, 3 followed thereafter by a more detailed pandemic influenza plan and subsequent supplements issued by the Department of Health and Human Services (DHHS). 4 ^– 6 The plan and supplements describe the role the federal government would play in a pandemic and provide guidance to state and local governments, with whom the principal responsibilities for planning and responding would lie. Hundreds of thousands of people in the United States could die in a period of months during a pandemic of highly pathogenic influenza. The allocation of resources and the application of control measures would therefore have enormous ethical implications, not only in the saving of lives but also in the preservation of human rights, maintenance of a functioning society, and the achievement of social justice. Considering the ethics of a situation entails ethical reflection and discussion, skills that require preparation and practice. When a wave of influenza deaths begins in a community, there will be little time to reflect and discuss, much less alter public health and medical and other social systems to act more ethically. The time to consider the foreseeable ethical challenges is well before the pandemic. Levels of ethical awareness and competence required for such a task are as follows: (1) recognizing that an ethical dimension exists, (2) identifying specific ethical issues, (3) identifying guidelines and tools for ethical reasoning, (4) deciding who is responsible for which ethical decisions, (5) preparing responsible parties to engage in ethical decisionmaking, (6) putting the decided plans into action, and (7) evaluating whether the action achieved the intended result. A federal or state pandemic influenza plan could be expected to address levels 1 through 4 and provide guidance for achieving level 5. To assess the amount of ethical awareness and reasoning in the DHHS plan and the state influenza pandemic preparedness plans, we conducted systematic text searches for ethical terms and examined the contexts in which they were used.