Prof. Alexander Capron (a Bellagio Group member) delivered the 2007 Johnson & Johnson Health Care lecture at the University of South Carolina School of Law, entitled Ethical Challenges in Preparing for a Pandemic (has links to audio & video). Prof. Capron, now at USC, was the WHO's first Director of Ethics, Trade, Human Right, & Health Law. He structures the talk around the broad theme of individual versus group interests. I'd highly recommend listening to the entire thing (it even made FluWiki's "Tip of the Week"), but here are some of the points I found particularly salient:
He pointed out how ethical considerations are often "buried" within other planning activities. For example, national pandemic plans that set a goal of "saving the most lives" or minimizing mortality have thereby made an implicit ethical commitment to give preference for treating certain people, i.e., those whose lives are easiest to save by means of whatever interventions are on hand (not the sickest, who will almost certainly die, and not the healthiest, who might likely recover without treatment). Given the significance of these questions, how can we bring them to the fore?
He described a case study, developed by Harvard ethicist Dan Brock, that highlights the importance of public engagement in prioritization decisions. The hypothetical case involves four community hospitals that adopt four different policies for allocating antivirals: (A) concentrate on prophylaxis of health care workers; (B) focus on treating patients who are sickest; (C) attempt to maximise survival rates by treating those mose likely to benefit; (D) adopt all 3 strategies, resulting in quicker depletion of drug supplies. The point of the case study, as I understand it, is to help generate discussion about what sort of allocation strategy to adopt, since these sorts of hard decisions may well be left to local authorities (hospitals, municipalities, etc.). By outlining different allocation strategies in pretty stark terms, it may be easier for people to voice an opinion about what policy or policies they would recommend.
Regarding international obligations, some very interesting comments about whom we (i.e., donor countries) have obligations toward. Essentially, our primary responsibility is to help people in developing countries, not to those countries' governments per se. This seems like a no-brainer, but the implications are quite substantial. If countries do not have the means or the will to deliver resources (drugs, vaccines, food, water, etc.) efficiently and equitably (by at least some minimal standard), then simply handing over money or supplies to a government might not suffice (and may, in fact, be very unwise). Think, for example, of Burma (where there were new H5N1 cases reported this week). This does not mean that obligations to people in such countries would disappear, only that it becomes harder to fulfill those obligations. Food for thought, with no obvious answers....
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