Swine Flu: A Test of Ethical Planning

John Lantos, MD
April 28, 2009

Swine flu is coming!! Swine flu is coming!! What will we do? Will there be enough face masks? Enough ventilators? Enough vaccine? Enough antiviral medication? Who will be quarantined? How many schools will close? Will this squelch the economic recovery? Obliterate civil liberties?

The questions are already swirling, even though, to date, there are fewer cases of swine flu in the United States than there are of tularemia or of people struck and killed by lightning. (In 2007, 47 people in the United States were killed by lightning strikes.)

We don’t yet know whether or not this outbreak will be The Big One that public health experts have been predicting or not. Epidemics are notoriously difficult to predict. Let us hope it will not be.

If it is The Big One, it will be a good test of prospective ethical planning. Over the last five years, bioethicists around the world have been proposing moral frameworks for responding to a pandemic. (Check out the links below.)

Most of these documents are non-specific in their recommendations, identifying “values frameworks” or “necessary tradeoffs,” but not confronting the hard questions of politics and emotions that would take over in a real epidemic.

If and when the long-predicted pandemic arrives, it will be a test not only of our public health system but also of the value of prospective ethical analysis. We will see whether responses follow previously agreed upon moral frameworks or, instead, follow previously enshrined political power structures.

I hope it will be the former. I suspect it will be the latter.

Links:

http://www.phen.ab.ca/pandemicplanning/index.asp
http://www.who.int/ethics/influenza_project/en/index.html
http://www.ehman.org/pandemic.html
http://www.pandemicflu.gov/
Obligatory Topical Swine Flu Post, Journal of Medical Ethics Blog
April 28, 2009