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Preparedness includes the ability to anticipate ethical dilemmas, recognize unforeseen ones as they arise, and have broadly accepted processes for addressing them.


  • Ensure that decision makers are impartial and neutral. CDC Ethics in Pandemic Flu
  • Objective decision-making procedures eliminate subjectivity and bias from the triage protocol. As a result, allocation decisions will be able to withstand public scrutiny. Indiana University
  • Avoid conflicts of interest that could interfere with the willingness to acknowledge public health threats. APHA Code of Ethics, 4.2.2.
  • Establish formal structures, such as ethics committees, to address and resolve ethical disagreements and challenges and to enhance organizational ethics and decision making. APHA Code of Ethics, 4.11.7.
  • National, provincial/state/territorial, and municipal governments, as well as the health care sector, should ensure that their pandemic plans include an ethical component. University of Toronto
  • National, provincial/state/territorial, and municipal governments, as well as the health care sector, should consider incorporating both substantive and procedural values in the ethical component of their pandemic plans. University of Toronto
  • Governments and the health care sector should ensure that pandemic influenza response plans include a comprehensive and transparent protocol for the implementation of restrictive measures. The protocol should be founded upon the principles of proportionality and least restrictive means, should balance individual liberties with protection of public from harm and should build in safeguards such as the right of appeal. University of Toronto
  • Professional colleges and associations should provide, by way of their codes of ethics, clear guidance to members in advance of a major communicable disease outbreak, such as pandemic flu. Existing mechanisms should be identified, or means should be developed, to inform college members as to expectations and obligations regarding the duty to provide care during a communicable disease outbreak. University of Toronto
  • Diverse public voices should be involved in determining the need for restrictions and in articulating the ethical justification for these restrictions. CDC Ethics in Pandemic Flu
  • Governments and the health care sector should engage stakeholders (including staff, the public and partners) in determining what criteria should be used to make resource allocation decisions (e.g., access to ventilators during the crisis, and access to health services for other illnesses), should ensure that clear rationales for allocation decisions are publicly accessible and should Provide a justification for any deviation from the predetermined criteria. University of Toronto
  • Development of workforce management protocol at the State level, the inclusion of health care professionals in the development process, and open communication will help to ensure that members of the health care field statewide will be aware of and approve of the recommended protocol, resulting in policy compliance. Indiana University
  • Communications and processes should be clear, transparent and without hidden agendas. CDC Ethics in Pandemic Flu
  • The decision-making criteria and procedures that will be used during an influenza pandemic should be communicated to the public as far in advance as possible. WHO Ethics in Pandemic Flu
  • Governments and the health care sector should publicize a clear rationale for giving priority access to health care services, including antivirals and vaccines, to particular groups, such as front line health workers and those in emergency services. The decision makers should initiate and facilitate constructive public discussion about these choices. University of Toronto
  • Include processes to revise or correct approaches to address new information, including a process for appeals and procedures that are sustainable and enforceable. CDC Ethics in Pandemic Flu
  • Governments and the health care sector should ensure that there are formal mechanisms in place for stakeholders to bring forward new information, to appeal or raise concerns about particular allocation decisions and to resolve disputes. University of Toronto
  • The inclusion of an appeals process may be considered to allow health care workers and the general public to voice concern and dissent. Evaluation of these appeals may result in more effective and acceptable triage protocol. Indiana University
  • Professional and non-professional staff should be aware of ethical obligations and professional duties during the time of an influenza pandemic. Clear expectations should be conveyed to both professional and non-professional staff. Indiana University