The Unavoidable Ethical Dilemmas of Pandemic Flu

By Kirk O. Hansonexecutive director, Markkula Center for Applied Ethics Pandemics and disasters breed unavoidable — but predictable — ethical … Continued

By Kirk O. Hanson
executive director, Markkula Center for Applied Ethics

Pandemics and disasters breed unavoidable — but predictable — ethical choices. Coping with the H1N1 epidemic demands that we address a set of difficult ethical dilemmas – where our self interest and the common good of the community collide – where our ethical and religious commitments ought to drive our choices. If the current pandemic gets worse through mutation of the virus, as it may in the next two years, ethical choices will save hundreds, and likely thousands, of lives.

Fortunately, the H1N1 flu is not yet broadly lethal. It is estimated that to date over 1 million Americans have contracted the moderate H1N1 flu and over 1,000 have died. If a significant mutation occurs, these numbers would quickly explode.

We have time now to examine the H1N1’s ethical dilemmas and to resolve them thoughtfully. It is our belief that anticipating these ethical dilemmas will enable us to make better ethical choices – and save lives in the process.

Who should get the H1N1 vaccine first? Now, and particularly if a mutation occurs, available doses of an effective vaccine should go first to medical staffs and first responders, the police and fire departments. These individuals will help multiple others and maintain order in society. Secondly, we believe doses should go to those essential to the functioning of society – civic officials, and surprisingly, trash collectors and truck drivers. The trash collectors will keep disease down; the truck drivers will transport our food to us. We personally would hope ethicists would get priority treatment, but they probably should NOT unless they are teachers or deal daily with large numbers of people.

Can I pass up the H1N1 vaccine if I am afraid of the side effects? As with any epidemic, effective control depends on almost all citizens being vaccinated. The H1N1 vaccine, just now becoming available, has been tested on thousands of people and is as safe as any vaccine can be. If I pass it up, I am showing a lack of care for my fellow citizens and the common good. I am increasing the chance I will get H1N1 and so infect others.

Should I buy hand sanitizer dispensers for my home or office? At minimum, we are ethically responsible for keeping our own hands from transmitting the disease – whether from an infection we have ourselves or from the virus we encounter on a door handle, table top, or dollar bill. Frequent hand washing by individuals and use of hand sanitizers wherever they are available is an ethical obligation. Businesses and other institutions have the obligation to provide the sanitizers.

Should my Church end the common cup for communion and the kiss of peace (handshake) in the service? Some congregations have already moved to do this. Though some may feel it weakens the symbolism or the effect of religious services, prudence requires limiting the possibility of virus transmission. In most Christian denominations, receiving either the bread or the common cup are considered equivalent to receiving both.

Should I wear a facemask? Should I stay at home if I am sick?
If you have any symptoms at all, you owe it to others to stay home. Facemasks are of very limited effectiveness. Facemasks may provide limited protection for others if YOU are infected but do a poor job of protecting you from others who are sick.

Should my church, school or institution limit public meetings? This step is probably not required yet, but may be if a more lethal virus strain develops. If care has been taken to limit common cups and random transmission, meetings can continue. Leaders of organizations and meetings can, however, legitimize not shaking hands by suggesting this social custom be suspended for now.

Should I stockpile Tamiflu? Tamiflu is a medicine which can increase your chances of recovery if you contract the virus. There is a limited amount of Tamiflu available. If individuals or our large institutions scoop up all available supply, there may be too little for use in hospitals and by doctors. It is preferable and serves the common good if you don’t stockpile Tamiflu but get it from your physician immediately if you contract the virus.

Who should get use of scarce medical equipment? If a serious and lethal mutation occurs, respirators and other medical equipment will be completely inadequate to treat everyone infected. We believe public health officials and individual hospitals and doctors should follow a protocol such as the one outlined above for the distribution of scarce vaccine. The first priority should be the functioning of the medical system, of civil society, and the maintenance of order.

Kirk O. Hanson is executive director of the Markkula Center for Applied Ethics at Santa Clara University in California. Margaret R. McLean, who contributed to this essay, is Associate Director and the Center’s Director of Bioethics.

Kirk O. Hanson
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  • ccnl1

    And please do not bless yourself with “holy water” from fonts in or out of flu season. These cesspools of disease should be removed permanently from all churches.Christians also should consider, staying at home and getting their hour of weekly worship on their big screen TVs. “Bloody” communion can always be delivered to your home by FedEx.

  • edbyronadams

    Facemasks…”do a poor job of protecting you from others who are sick.”Interesting. I thought that infective agents born on aerosols were a main transmitter of influenza. Are facemasks ineffective in intercepting these or is it another factor?

  • edbyronadams

    While searching out the straight scoop on facemasks, I happened on the CDC’s recommendations for avoiding the swine flu. The data for the effectiveness of facemasks in suppressing the virus is mostly unknown but, in their recommendations there is a bigger ethical dilemna.In the home, avoid taking care of the afflicted. Yeah, right.

  • crashprevention

    Excuse me, but you say that we all have an ethical duty to our fellow citizens to get vaccinated against the swine flu, in order to achieve that ever-elusive but always promoted (by the pharmaceutical industry) “herd immunity” — that is, the idea that immunization only works if almost everybody gets vaccinated. The problem here (one of many problems here) is that the gov’t already acknowledges it will only have, at best, enough vaccines to immunize 50 percent of the population. So, so much for your “herd immunity.” Guess you can scratch that one off your list of ways to bully the public into buying yet another pharmaceutical product that’s been hastily developed, poorly tested, and then very heavily promoted.

  • LKM1

    I waffled for a bit about getting the H1N1 vaccination, but I decided, on balance, to get it. And then, about two weeks ago, I got what seems to have been the flu: fever, aches, shakes, headache, cough lasting a full week and still lingering. So . . . do I get the vaccine now, or do I assume that I have had what the CDC says is the only flu circulating? Do I vaccinate my children, or assume they were well-exposed to me? (We have all had the seasonal flu vaccination already.)

  • Judy-in-TX

    Recently, Dr. Nancy Snyderman reported some statistics which mystified me.

  • FredinVicksburg

    People should also get a pneumonia innoculation if they have not had one, and should still get the seasonal flu shot.From the standpoint of vectoring (passing of the virus from one person to another), it is essential for school children to get innoculated as they have a high degree of contact that can pass a virus from family to family.