Ethical Solutions to Implementing QuarantineCase Study

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¶ … ethical principles that should be applied to situations regarding pandemic influenza response. The situations are based on the following expected issues where ethical considerations may need to be considered. The major issues are mandatory vaccinations and quarantining, with consideration of controlling media representations in order to prevent panic, fear and hysteria from spreading also being a significant issue. The ethical approaches utilized seek a balance between utilitarian and libertarian principles, with one or the other or sometimes both being applied. The proper approach is dependent upon the situation and the proposed solutions to each issue.

Influenza Pandemic: Ethical Solutions to Practical Problems

Introduction

One of the most important ethical questions regarding preparation for a pandemic influenza outbreak is whether or not to incorporate mandatory vaccinations as a precautionary measure. Vaccinations are a controversial subject and elicit extremely different responses, often at odds with one another, across the public spectrum. Self-identity issues (such as personal, religious or work-related beliefs) have been cited as reasons for procuring exemptions from influenza vaccinations among health care personnel (Trafimow, 2013, p. 44). Trafimow (2013) argues that even though personnel may feel strongly or "sincerely" about their reasons for refusing vaccinations, the sake of the greater good is more important than the individual personal beliefs: what is at risk, Trafimow asserts, is the public health and safety of others, especially patients -- "My opinion is that patients' interest should be the overriding concern" (Trafimow, 2013, p. 44). At issue, however, are two points: first, what ethical approach should one take in this matter of to issue mandatory vaccinations or not; and, second, what do researchers say about the efficacy vs. risk of vaccinations (i.e., are they effective in stymieing the spread of outbreaks or are they participants in such outbreaks?). This latter point (born of suspicion) is one of the main causes for personal reasons against receiving vaccinations. Education or direct legal action can be possible factors in overcoming such resistance. The other point, however -- the ethical approach -- is essentially the main determining factor in how to proceed.

The Right Approach

Ethical approaches vary in today's modern world. There is the utilitarian approach (which is the pragmatic or practical approach that puts the "common good" above all else). The utilitarian approach is a consequence-based method of addressing such sensitive issues. A second approach is the categorical imperative approach, which places a universalist perspective on the issue -- as in what is right for one is what is right for all others. A justice as fairness approach would place the legitimate right of individuals as the ultimate factor in discerning what is just. A Confucian approach (or Golden Rule approach) would assert that one should treat others as he or she would like to be treated -- which in this case is perhaps too impractical to consider. Then there is the altruistic approach, which is rooted in helping others by placing their needs first (but this approach, too, may be impractical as it is unclear exactly how we are to help primarily because the problem of how to approach the ethical framework for this issue has yet to be resolved; thus, this approach may also be too impractical). Essentially, what is at stake here is whether it is justified to act authoritatively in this matter (assuming vaccinations are the safest course and making them mandatory for the public), or whether a libertarian type of approach (rights-based, in which the will of individuals is given priority over government wishes) is more ethical.

As Sandel (2009) notes, "The idea that justice means respecting freedom and individual rights is at least as familiar in contemporary politics as the utilitarian idea of maximizing welfare" (p. 20). But here the utilitarian concept is complicated by two conflicting ideologies: on the one hand, there is the appeal to freedom as the way towards the "common good" or happiness for the greatest number of people (Halbert, Ingulli, 1999, p. 15). And on the other hand there is the appeal to social welfare as the way. The two are exclusive: one cannot have absolute freedom and yet still be dependent upon the state. Either one is cut loose or one is chained (by dependency). A utilitarian or pragmatic happiness is only as endurable as the society's ability to control the environment which produces that pragmatic happiness. Thus, before proceeding to arrive at an approach, it is necessary to know that the environment can be controlled via vaccination. Many researchers support vaccination as helpful in deterring the spread of diseases and outbreaks (Ota, Idoko, Ogundare, Afolabi, 2013; Adams, Suresh, Lahey, 2016). Theodoridou (2014) goes so far as to argue that "voluntary vaccination programs have not achieved acceptable rates" and that "legally mandated vaccination is required" (p. 4866). In short, the majority of the medical community supports mass vaccination for the sake of "herd immunity" (Amin, Parra, Kim-Farley, Fielding, 2012) and some, such as Theodoridou, support mandatory vaccination as a preventative measure.

To Vaccinate or Not to Vaccinate

While a small number of dissenters disagree with vaccination policies, if one is to hold that the safest course of action is in following the majority, the utilitarian approach suggests that the common good lies in adopting a policy of mandatory vaccination in order to prepare for and help to prevent any pandemic influenza outbreak. The main solution to addressing the ethical issues related to this policy is already made when the appropriate ethical approach is discerned. The secondary solution consists of educating the public as to the reason this approach and policy is most efficacious and most effective in protecting the common good.

On the other hand, the voice of researchers who provide evidence that vaccinations may actually cause flu strains to become more resistant over time could pose a legitimate pause for concern. The study by Ohmit, Thompson, Petrie et al. (2014) shows that while "vaccine effectiveness in the 2011-2012 season was modest overall, with lower effectiveness against the predominant A (H3N2) virus," the main cause for this lower effectiveness "may be related to antigenic drift" as well as "past history of vaccination" (p. 319). In short, there is no easy ethical solution to this problem as, first, it is unclear (unanimously speaking) whether vaccinations are harmful or helpful in the long run in terms of preventing flu outbreaks, and, two, without knowing the effect of vaccination it is impossible to identify the best approach to serving the common good. Thus, the most ethical approach to this issue is the libertarian approach, which upholds the individual right to reject vaccination. For this reason, other issues must be addressed and assessed from an ethical standpoint.

Controlling Media Reporting, Quarantining, and Other Issues

These issues concern effecting quarantines, emergency response, the banning of public outings in response to an outbreak of pandemic influenza, controlling mass media hysteria, and providing the order for employees to stay at home and not report to work. Each of these issues has its own ethical problems. This paper will now proceed to examine ethical approaches to controlling media hysteria and the issue of implementing a quarantine.

Controlling the mass media can be particularly problematic, as the ethical issue related to this situation is the right of free speech. However, in the SARS outbreak in Toronto, the mass media played a critical part in spreading panic, which made emergency response teams' jobs that much more difficult.

In Toronto, mass media portrayed the outbreak of SARS in near-apocalyptic terms, meaning that ICS had to perform educational tasks in order to calm rapidly escalating public fear, paranoia, etc. As a result of fear of spreading SARS, staff workers were isolated from communities and their morale had to be lifted via conference calls, where they were encouraged and congratulated for their hard work and perseverance on the "front lines" (Hawryluck, Lapinsky, Stewart, 2005). The ICS was responsible for managing the routines of the hospital emergency staff. Only for this reason, the scope of the crisis management was much more focused than that, for example, in New Orleans in the wake of Hurricane Katrina. It was also much more manageable as different sectors were prepped and trained on how to implement ICS beforehand.

In the case of pandemic influenza, however, managing a hysterical media can be essential as media relies upon ratings to procure revenue from advertisers and nothing spells ratings like impending disaster. Nonetheless, networks should be advised that responsible reporting can be just as effective at generating ratings as sensational reporting and can actually be more helpful from a public good perspective (and thereby give networks the possibility of being publicly honored later on). On top of this, management response teams should be made aware of the way in which irresponsible reporting on the part of mass media can lead to immense public fears and they should be prepared to combat tidal waves of paranoia, fear, low morale. Educative forces should also be dispatched so as to better facilitate public understanding. The best… [END OF PREVIEW]

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