Development of an Ethical Framework for Influenza Pandemic

The Minnesota Department of Health (MDH) is preparing to address some critical ethical issues that are likely to arise during a severe influenza pandemic. MDH has contracted with the Minnesota Center for Health Care Ethics (MCHCE) and the University of Minnesota Center for Bioethics to produce a set of ethical procedures for allocating medications, vaccines, protective equipment, and other health care and medical items that may be in short supply in a pandemic. Jeffrey Kahn, PhD, MPH and Debra DeBruin, PhD will lead the Center for Bioethics’ work on this project. Other Center faculty participants include Joan Liaschenko, RN, PhD, FAAN, Mary Faith Marshall, PhD, Steven Miles, MD, Carol Tauer, PhD, and Susan Wolf, JD.

Recommendations will also be developed for sharing the proposed ethical framework with the public, to ensure that the plan is widely understood and accepted. MDH will be seeking public input on the proposed allocation framework once the group has completed its work. "There is no question that we will experience another flu pandemic in the future," said Minnesota Health Commissioner Dianne Mandernach. "If we find ourselves in a major pandemic, like the one that occurred in 1918, we will need to make some very difficult decisions about how to allocate available resources. We will need to have a sound basis for making those decisions, and this project is intended to provide us with that framework." Tasks to be completed by the two groups include:

• A comprehensive review of available professional literature, plans and policies dealing with allocation of scarce resources during a pandemic.
• Recruitment of a broadly-based panel of experts and stakeholders to complete key project activities, including development of the actual recommendations for allocating resources.
• Providing leadership for the panel in developing the framework for resource allocation, and recommendations for implementing the framework. The panel is expected to address resource allocation in four areas ­ preventive measures, like vaccination; personal protective equipment, (i.e.masks); resources for intensive medical treatment (i.e. mechanical ventilators); and resources that can be used either for treatment or for prevention, i.e. antiviral drugs.
• Developing recommendations for (1) ensuring transparency and broad public participation in reviewing the initial draft of the allocation framework, and (2) conducting a public information campaign designed to build public awareness, understanding, and acceptance of the framework. In developing these recommendations, the consultants will enlist the help of experts in soliciting public participation and engagement, public health professionals, health journalists, and leaders from the faith community.

Recommendations to be produced by the two groups will also include expedited procedures for consulting about unanticipated ethical issues that may arise during a pandemic, and adjusting the final allocation framework to account for changes in current recommendations from the federal government or other sources. They will also review the allocation framework for possible application to other types of health-related emergencies. They propose to test the framework by applying it to a number of potential scenarios, including a hurricane event comparable to Katrina in 2005, a bioterrorism attack at the Metrodome, and a nuclear accident in St. Cloud. The two organizations were selected through a competitive application process. Total cost of the ethics project is $71,500, to be funded through a pandemic influenza planning grant from the U.S. Centers for Disease Control and Prevention (CDC).