Frequently Asked Questions
Questions about the project
1. What is the Minnesota Pandemic Ethics Project and what part of it is a research study?
2. Who is leading and funding this project?
3. What kinds of resources might be scarce during a severe pandemic, and what resources are discussed in this project?
4. For whom are the recommendations?
5. What is included in the report titled For the Good of Us All?
6. Who developed the ethical rationing recommendations?
7. What is included in the report titled Implementing Ethical Frameworks?
8. Who participated in the protocol committee that helped develop the implementation recommendations?
9. Do I need to read both reports in order to submit comments?
10. How do the project’s recommendations fit with federal guidance?
11. Are the project’s recommendations final?
12. How do I get answers to my questions about the project?
Questions about pandemic influenza
13. What is pandemic influenza?
14. What is a severe influenza pandemic?
15. What is the difference between seasonal and pandemic influenza?
16. Where can I go to learn more about pandemic influenza?
17. What else is the state of Minnesota doing to prepare for a pandemic?
Questions about rationing and ethics
18. Why is it necessary to think about rationing now?
19. Why don't hospitals and the state of Minnesota just stockpile enough resources so that rationing isn’t needed?
20. What other kinds of ethical issues are likely to be confronted in a severe flu pandemic?
Questions about submitting comments
21. Why is it important to hear from the public? How will your comments be used?
22. Must I be from Minnesota to submit comments?
23. Do I need to be an expert on health care or pandemic to submit comments?
24. How old must I be to submit comments?
25. Will my comments be publicly available?
26. What is the deadline?
27. To submit comments
Questions about the project
What is the Minnesota Pandemic Ethics Project and what part of it is a research study?
The project’s goal is to propose ethical frameworks and procedures for rationing scarce health resources in Minnesota during a severe influenza pandemic. The frameworks recommend how to decide in what order different groups of Minnesotans should be prioritized to receive resources. There are also recommendations about implementing the ethical guidance provided by the frameworks. The preliminary recommendations have been developed by a broad-based panel and work groups of more than 100 Minnesotans.
An important part of this project is to gather public input so that the final recommendations include broader perspectives. The process of gathering public input is a research study that has been reviewed and approved by three institutional review boards at the University of Minnesota, Minnesota Department of Health, and St. Olaf College. By submitting comments you are consenting to participate in this study.
Who is leading and funding this project?
The project is funded by the Minnesota Department of Health and is led by the Minnesota Center for Health Care Ethics and University of Minnesota Center for Bioethics.
Minnesota Pandemic Ethics Public Engagement Study Team:
Minnesota Center for Health Care Ethics:
J. Eline Garrett, JD
Karen Gervais, PhD
Angela Witt Prehn, PhD
Dorothy E. Vawter, PhD
University of Minnesota Center for Bioethics:
Debra A. DeBruin, PhD
Joan Liaschenko, RN, PhD, FAAN
What kinds of resources might be scarce during a severe pandemic, and what resources are discussed in this project?
Food, medicines and supplies of all types could be scarce at times during a severe pandemic. During the peaks of a severe pandemic as many as 40% of the workforce could be absent due to illness, death, caretaking duties at home or fear. Large workforce shortages could result in interrupted services, manufacturing, and distribution chains for many resources. Health care resources are likely to be in particularly short supply, because demand will be very high.
This project recommends how to ration five kinds of health-related resources as examples of those that will be scarce: antiviral medications (both for treatment and prevention), N95 respirators, surgical masks, pandemic vaccine and mechanical ventilators.
For whom are the recommendations?
The Minnesota Department of Health has asked for these recommendations to inform its pandemic planning process. To this end, the recommendations take a population health perspective on rationing. It is possible that the recommendations will also be helpful to a broader audience of government agencies, health care organizations and businesses as they plan how best to ration health-related resources. Finally the recommendations are likely to be of interest to all Minnesotans because all are likely to experience rationing and more limited access to resources.
What is included in the report titled For the Good of Us All?
This report includes background information about pandemic influenza, the project team’s process, assumptions made for this project, recommendations for ethically rationing scarce health-related resources, discussion about those recommendations, and next steps. For more information, see Preliminary Recommendations.
Who developed the ethical rationing recommendations?
Over 100 Minnesotans with diverse expertise and experience participated. Lists of the participants are included in the report. Here is a partial list of the kinds of organizations and perspectives that were represented:
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- Ethics
- Faith communities
- Health systems
- Health care
- Public health
- Special needs populations
- Community advocates
- Communication and public engagement
- Public safety
- Law
- Business
What is included in the report titled Implementing Ethical Frameworks?
The implementation report offers recommendations about the practical application of ethical frameworks for rationing in an influenza pandemic. While such ethical frameworks for rationing play a critically important role in pandemic planning and response, important questions nonetheless remain about how their moral guidance can be implemented in the enormously complex context of actual pandemic planning and response. These recommendations concern broad practical issues that span the ethical frameworks. For more information, see Preliminary Recommendations.
Who participated in the protocol committee that helped develop the implementation recommendations?
These recommendations were developed by experts in public health, public safety, infectious disease control, hospital administration, law, ethics, and other relevant areas specifically targeted to the task of analyzing issues related to the implementation of the ethical frameworks being developed in the project. In addition, representatives from the Minnesota Department of Health provided briefings on issues related to pandemic planning and response, and participated in meetings to lend their expertise on public health issues and state planning efforts.
Do I need to read both reports in order to submit comments?
No, you may read and comment on either or both reports.
How do the project’s recommendations fit with federal guidance?
Federal pandemic plans expressly call for states to develop rationing plans. The federal government has recently issued guidance for rationing vaccines and antivirals. In several important ways, these federal guidelines are consistent with this project’s preliminary recommendations, but there are some differences, too. The Minnesota Department of Health directed that the project be informed by federal guidance but not limited by it, because federal guidance is still evolving. The ways recommendations fit or differ from federal guidance are discussed in For the Good of Us All in the sections on ethical frameworks for rationing vaccines and antivirals.
Are the project’s recommendations final?
No, final recommendations will be issued only after the panel has had an opportunity to consider feedback received from the general public through this web-based process and other public engagement activities.
How do I get answers to my questions about the project?
This list of Frequently Asked Questions is designed to provide answers to some of the most common questions about the project. If you have questions that are not answered here, you may also email the study leaders at: mnpanflu@umn.edu.
Questions about pandemic influenza
What is pandemic influenza?
Influenza is a virus that changes and evolves naturally. Sometimes a new strain emerges, and humans have no natural immunity to it. When that happens, the virus can quickly spread around the world and become a pandemic. There were three influenza pandemics in the United States in the 20th century: mild or moderate pandemics in 1957 and 1968, and a severe pandemic in 1918-1919. We cannot predict when the next pandemic will occur or how severe it will be, but we do know that it will occur.
What is a severe influenza pandemic?
What makes a pandemic severe, as opposed to mild or moderate, is the rate of deaths and other serious complications from the disease. The more people die or develop serious complications, the more severe it is. Severe pandemic influenza occurs on a scale that distinguishes it from other public health disasters in terms of its global nature and duration. It is experienced over years, not days, weeks or months, and threatens core public health, social and economic infrastructures. Unlike a mild pandemic, a severe pandemic has the potential to disrupt normal health care and business operations and therefore interfere with the distribution of essential goods and services globally. Unlike other disasters, states and communities cannot count on receiving federal assistance in a severe pandemic. For purposes of this project, we assumed that a severe pandemic could resemble the one that occurred in 1918–19.
What is the difference between seasonal and pandemic influenza?
Seasonal influenza
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- Occurs every year during the winter
- Affects up to about 10% of the population
- For most people it is an unpleasant but not life-threatening infection
- The very young, the very old, and people with certain chronic illnesses are most at risk of serious illness
- Annual vaccination is available
- Antiviral drugs are available to treat those at special risk
Pandemic influenza
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- Has occurred three times in the last 90 years
- Can occur at any time of the year
- It is a more serious infection for everyone
- People of every age may be at risk of serious illness
- A vaccine probably won't be available when the pandemic starts – when it does become available the aim will be to immunize people as rapidly as possible as vaccine supplies become available
- Antiviral drugs are likely to be in limited supply and will have to be used to best effect according to how the disease develops
Vaccine against ordinary flu will not protect against pandemic flu. However, getting your annual flu shot is one of several things you can do to keep yourself healthy, and that may help you fight off the pandemic virus.
Where can I go to learn more about pandemic influenza?
There are many websites with useful information about pandemic influenza. Here are some links:
What else is the state of Minnesota doing to prepare for a pandemic?
The Minnesota Department of Public Safety, Division of Homeland Security and Emergency Management leads overall pandemic planning for the state. The Minnesota Department of Health is the lead technical agency for human health issues. Information is available at http://www.health.state.mn.us/divs/idepc/diseases/flu/pandemic/otherstate.html and
http://www.hsem.state.mn.us/readyminnesota/New_Ready_Web/stateagency.html.
Questions about rationing and ethics
Why is it necessary to think about rationing now?
Rationing decisions are difficult, and thinking about them only during a crisis will make them even harder. Good decisions depend upon good planning.
Why don't hospitals and the state of Minnesota just stockpile enough resources so that rationing isn't needed?
Not all resources can be stockpiled (like vaccines for a novel virus). Some resources (like antivirals) may expire before a pandemic occurs. How well a new virus will respond to an existing antiviral medication is not known. Some resources (like ventilators) require many trained personnel to use them, and absenteeism may be as high as 40% during the peaks of a pandemic. Money is limited in public health and health care sectors, and stockpiling resources takes funds away from other things that are also important whether or not a severe pandemic strikes.
What other kinds of ethical issues are likely to be confronted in a severe flu pandemic?
Planning for and responding to a severe pandemic poses many ethical issues. The focus of this project is rationing of health-related resources. Additional ethical issues include:
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- the possibility of rationing other kinds of resources (like food, water, gasoline or heating fuel)
- decisions about how much and what kinds of resources to stockpile
- who should be responsible for stockpiling
- whether and when to use strategies like school and business closures, isolation and quarantine in order to slow the spread of influenza
Questions about submitting comments
Why is it important to hear from the public? How will your comments be used?
A severe pandemic would affect everyone, and it is very important that rationing decisions reflect Minnesotans’ values and input. We want to hear from persons from all walks of life. We also are interested in hearing from non-Minnesotans because responding to a pandemic involves close collaboration with others, including other states and countries.
The recommendations will be reconsidered in light of the feedback received. Please tell us what you agree with and what you don't, and how the ethical guidance can be improved.
This web-based public comment process is part of a larger study to understand what Minnesotans and others think about the draft recommendations. Unless you choose to provide your name or other identifying information, your comments will be anonymous. State law requires that the study team provide copies of the comments received to anyone who requests them. If you have questions for the team, please contact us as indicated below.
Must I be from Minnesota to submit comments?
No. Anyone may submit comments about these recommendations.
Do I need to be an expert on health care or pandemic to submit comments?
No. Anyone may submit comments about these recommendations. We want to hear from individuals and organizations with many different perspectives.
How old must I be to submit comments?
You must be 18 or older to submit comments.
Will my comments be publicly available?
Yes. Your comments will be anonymous unless you choose to provide your name or other identifying information. State law requires that the study team provide copies of the comments received to anyone who requests them.
What is the deadline?
The deadline for submitting comments was April 13, 2009.
To submit comments:
Minnesota Pandemic Ethics Project
c/o Minnesota Center for Health Care Ethics
Carondelet Center
1890 Randolph Ave.
St. Paul, MN 55105
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