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Ethical Issues in Influenza Pandemics Essay

Throughout history, there have been significant pandemics that have left a great impact on humankind. The first influenza pandemic to occur took place in 1918-1919. This pandemic was later classified as the Spanish influenza A H1N1. Successive outbreaks of influenza had occurred almost simultaneously throughout North America, Europe and Africa with not much being know about the virulence of the virus. It has been estimated that this pandemic caused around fifty million deaths in only twelve months. Half of the deaths that occurred were among those twenty to forty years of age.

To this date there is still much controversy over where the virus originated, with suggestions being either from China or US military camps in the mid-west. Several years later, another pandemic spread across the world. This next pandemic was known as the Asian Influenza A N2H2 of 1958. This time is was certain that the virus originated in China. Since this new virus had completely different antigens than the first virus that spread in 1918, mortality rates were still considerably high. Again, the virus spread worldwide and many people became infected and fell ill.

The death rate for this pandemic was estimated at 69 800 deaths, with more than fifty percent of the deceased were aged five to nineteen. Another pandemic that occurred throughout history was the Hong Kong influenza H3N2. This virus shared some of the properties of the virus that was isolated in the Asian influenza pandemic, but also carried some different properties with it. Mortality rate of this pandemic was estimated at 33 800, which is almost half of the mortality rate of the previous pandemic.

Experts believed that the severity of this new virus was reduced because many people around the world had already been exposed to the Asian influenza in which their bodies produced antibodies towards. In the past, following the trends of these pandemic outbreaks led experts to believe that they had to occur every ten to fourteen years. With recent research on pandemics and their occurrences, it is now clear the influenza pandemics occur at unpredictable intervals throughout time.

Not being able to judge when the next influenza pandemic will hit, many countries across this globe have developed pandemic plans of action to help them prepare for whatever new strain of influenza has in store for humankind. Ethical Issues Gaining an understanding about influenza pandemics that occurred in the past and the ethical issues that co-inside, will help international and government officials devise pandemic plans that are ethically appropriate and effective.

Although some of the ethical issues that surround influenza pandemic outbreaks have been addressed by government officials and implemented into their plans of action, there are still many issues that need to be addressed. Many of the ethical issues discussed around the topic of influenza pandemic outbreaks violate human rights. One issue discussed by the World Health Organization, stated that in the event of an influenza pandemic, quarantine, isolation and international travel and boarder control would be implemented.

But, the document also discusses “Social separation can infringe individual rights and disrupt social and economic life… Freedom of movement is a basic right protected by national laws and international treaties. ” This shows one of the many ethical dilemmas with influenza pandemic outbreaks. In the article by Pahlman, Tohmo and Gylling, it states “It can be argued all human beings have a moral duty to help other people in great need. ” If this is the case, and every human shared this same moral duty, should only health care professionals put their lives at risk to save others?

Should there be advanced training implemented into the national plans for members of society to take part in order to prepare more citizens to aid health care professionals at the time of a pandemic? These ethical issues are only a few issues pointed out by these various authors. There is a great magnitude of ethical concerns that arise when an influenza pandemic outbreak occurs. Philosophers and Bioethicists Opinions In the article Preparing for an Influenza Pandemic: Ethical Issues, Kotalik discusses a majority of ethical issues that can be grouped into categories.

These categories include: scarcity, vaccines and anti-virals, healthcare workers and communication. If an influenza pandemic were affect many countries around the world, there would be a great number of sick people requiring care all at the same time. Since many people around the world live with other greater health conditions on a daily basis, would they have to give up their ventilators that have been breathing for them for the past year to someone who has been hit with the influenza virus?

The ethical question then is “Who will take priority when supplies become scarce during the pandemic? Since many countries have learned from past influenza pandemics, plans have been devised to ensure preventative as well as what should be done immediately if an outbreak were to occur. Kotalik wrote: “An effective vaccine is the best way to decrease the impact of the new virus, but production cannot be started until the new virus strain is isolated. ” Since production of a vaccine cannot take place until the new virus strain is evident, vaccines will be produced and shipped out a gradual rate and again the question of who takes priority for these new vaccines is posed.

On the topic of vaccine administration, health care workers in most job settings are mandated to receive the influenza vaccination on a seasonal basis. If they do not do so, it could result in a loss of their job or weeks without pay. During a pandemic, since health care workers are working on the front lines, they are expected to receive this new vaccine that has only been briefly tested. Is this ethical to make a person take something that has not been tested thoroughly with unknown adverse effects?

Another issue Kotalik analyzes in his article address communication among nations. He explains how he believes that the content of pandemic plans devised by various countries should be communicated throughout in order to level the playing field of all nations if a pandemic outbreak were to occur. If there are nations who are unable to develop such plans due to lack of resources, then this communication technique will aid these countries and pandemic plans will be made available to all nations to implement at the time of another influenza outbreak.

Kotalik also touches on the use of media during an influenza outbreak and expresses that “A concern that public discussion of a probable flu pandemic will cause alarm among the public is not sufficient justification for non-communication. ” What Kotalik was trying to get across with this statement is that yes, at times the media can over exaggerate things like an influenza pandemic outbreak, but is that fair to society to be kept out of the loop about the important issues going on around them?

Is it ethical to keep information from people when there is a chance they may be exposed to something that could be detrimental to their ealth? Bioethicists Kotalik brings to light some important ethical issues to consider if a influenza pandemic were to occur sometime during this century. Most articles presented by philosophers and bioethicists look at the moral obligation of health care professionals when a pandemic outbreak occurs. But what about everyone else in society, do they not hold the same moral principles to care for those in need? What if the first line of vaccinations was ineffective and most of the health care professionals fell ill to the influenza virus?

Would there be anyone in society to care for the healthcare professionals? In the article Non-Professional Healthcare Workers and Ethical Obligations to Work during Pandemic Influenza, the authors look at other staff members that work within hospital settings and provide services that assist healthcare professionals to complete their jobs and care for clients effectively. The authors consider “ whether non-professional healthcare workers-porters, domestic service workers, catering staff, clerks, IT support workers, ect. -have an obligation to work during and influenza pandemic. These bioethicists used interviewing techniques to analyze the factors that made healthcare professionals decide not to attend work if an influenza pandemic were to occur. Many of these reasons included: obligations to care for their own sick children or family at home, lack of child care availability, lack of transportation methods and fears about vaccination. If pandemic plans were able to implement strategies to overcome these obstacles to working, then more healthcare professionals would be able to take part in caring for others during a pandemic outbreak. It was also pointed out in this article:

Healthcare professionals have abilities others lack, abilities that are particularly likely to do good, and so healthcare professionals have strong obligations to exercise these skills when they are needed. But the ability of these professionals to exercise their skills effectively depends partly on the support of those working in nonclinical and/or non-professional roles. Here it is indicated by the bioethicists of this study, that in a state of emergency, if an influenza pandemic were to occur, it is the obligation of everyone in society to continue to work and help one nother out in order to maintain the obligations each individual withholds. In looking at another point of view from international bioethicist, Tzeng and Chang, they analyzed the feelings of nursing staff and the fears they express about future pandemic outbreaks: People’s level of fear is high and lasting when faced with the possibility of an H5N1 influenza pandemic. Because nurses usually work in the front line of care and have the most contact with patients, more attention should be paid to their concerns about the possibility of an avian influenza pandemic before such an outbreak occurs.

These bioethicist continue to elaborate on the importance of listening to the fears healthcare professionals are expressing and to implement strategies to decrease these fears before an influenza pandemic occurs. The discussed how fears that healthcare professionals express can turn into phobias if not enough attention is given to the situation. If the front line workers develop phobias about an upcoming pandemic, they will not be able to carry out their obligations and care for those who have fallen ill from this new virus.

From interviewing nursing staff, “42% of the nurses did not think that, if there were an outbreak of avian flu, their working hospitals would have sufficient infection control measures and equipment to prevent nosocomial infection in their working environment. ” Sp by recognizing these fears, organizations can implement strategies to ensure the proper measures are being met to reduce these fears before the occurrence of a pandemic. Religious Views It was difficult to locate information about influenza pandemics or vaccinations from various religious denominations in Canada.

In the article Pandemic Influenza Preparedness and Response Among Immigrants and Refugees, it discussed the feeling of non-catholic members of an African tribe to catholic members. Those who were non-catholic members saw the influenza virus as a plague sent from their ancestors for breaching traditional ways or the work of witchcraft. Whereas catholic members held the belief that with faith and medical intervention this disease would rid their tribe. No ethical considerations from religious denominations were found using an academic search base. Case Study #1:

During an evening shift, a patient with a potential diagnosis of avian flu is admitted to an acute medical unit in a large urban hospital. The emergency department nurse who facilitates this transfer indicates that they have been alerted to expect other suspected cases. The man is admitted and placed in isolation. Little information is available concerning his diagnosis, and the staff is concerned for their own safety and the safety of other patients. The unit manager has been involved in planning for such an event, but none of the staff on duty have received any education or information related to a suspected flu outbreak.

The evening supervisor is called in to assist. Ellie, a registered nurse (RN), is assigned to care for the patient. Ellie works part-time on the unit. She is a single parent of two school-aged children. Ellie also works as a casual employee in home care, which provides her with more flexible working hours and extra income. Currently, she does not work weekends, as child care is not available. Ellie is concerned about her health, the health of her children, and the implications that an outbreak will have on her work schedule.

This evening, the unit is short-staffed and morale is low: one full-time RN called in sick, and again no replacement casual RNs were available. The unit manager has indicated that the unit is over budget for staff hours, and that staff must minimize their use of supplies to balance the budget, which includes using caution with how many gloves and masks are used daily. Moreover, overall reductions in the healthcare budget have resulted in bed closures throughout the hospital, and a consistent backlog of patients awaits placement in the Emergency Department.

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