Skip to main content

Form policies and plans

Government agencies and the health care sector should develop policies to implement in preparation for, and during a pandemic.

 

  • Countries will have to make difficult decisions about the relative weight to be given to pandemic preparedness com­pared to other important public health priorities, such as HIV and malaria. WHO Ethics in Pandemic Flu
  • Public health officials have a responsibility to maximize preparedness in order to minimize the need to make allocation decisions later. CDC Ethics in Pandemic Flu
  • Policies should be established by government authorities authorized to enforce public health laws. APHA Code of Ethics, 4.6.1.
  • Encourage policy development to protect the public’s health. APHA Code of Ethics, 4.12.4.
  • 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
  • Include impartial mechanisms for assessing the ethical appropriateness of public health policies and plans after they have been implemented, as well as mechanisms for adjusting such policies and plans to ensure continued adherence to ethical standards. APHA Code of Ethics, 4.5.10.
  • 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.
  • Incorporate ethics into quality improvement and performance management policies and activities. APHA Code of Ethics, 4.11.8.
  • The group that specifies the decision makers and the criteria should be seen by all types of stakeholders as representative or otherwise acceptable. CDC Ethics in Pandemic Flu
  • The group that is involved in implementing the policies, educating the public and hearing objections should also be seen as representative or otherwise acceptable. CDC Ethics in Pandemic Flu
  • Measures that limit individual rights and civil liberties must be necessary, reasonable, proportional, equitable, non-discriminatory, and in full compliance with national and international laws. WHO Ethics in Pandemic Flu
  • Adopt the least restrictive practices that will allow the common good to be protected. CDC Ethics in Pandemic Flu
  • Ensure that restrictions are necessary and proportional to the need for protection CDC Ethics in Pandemic Flu
  • Requirements for mandatory liberty-limiting and social distancing interventions should be imposed only in cases in which voluntary actions seem unlikely to be effective. CDC Ethics in Pandemic Flu
  • 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
  • Governments and the health care sector should include measures in their pandemic influenza preparedness plans to protect against stigmatization and to safeguard the privacy of individuals and/or communities affected by quarantine or other restrictive measures. University of Toronto
  • Promote policies that enhance community health and well-being and collaboratively respect the privacy, dignity, and civil liberties of individuals and communities affected by the policies and plans. APHA Code of Ethics, 4.5.4.
  • Avoid infringing on individual liberties and privacy to the extent possible. APHA Code of Ethics, 4.6.3.
  • Ensure that resulting interventions have the least restrictions necessary to protect the public. APHA Code of Ethics, 4.2.8.
  • Ensure that reasonable alternative options are considered and evaluated and that final public health policies and plans are designed to most effectively accomplish stated goals while minimizing the potential for harm. APHA Code of Ethics, 4.5.9.
  • Ensure that resulting interventions do not have a disproportionately negative impact on minority or otherwise vulnerable populations (including children and elders) and that there is an effort to enhance the resilience of populations and ecosystems to prevent future harm. APHA Code of Ethics, 4.2.9.
  • Avoid unintentional stigmatization of specific groups within the community. APHA Code of Ethics, 4.5.5.
  • Aim to improve the health of – and health care for – all vulnerable populations impacted by existing disparities and inequities. APHA Code of Ethics, 4.5.6.
  • Consider and, where possible, address determinants of health that reside outside a person’s genetic endowment and personal behaviors, including the circumstances in which people grow, live, work, and age. These determinants might include individual resources, community resources, hazardous exposures, and opportunity structures. APHA Code of Ethics, 4.5.7.
  • Reduce or eliminate negative impacts on communities and the environment, particularly as these negative impacts tend to be disproportionately experienced by individuals already faced with health inequities. APHA Code of Ethics, 4.5.8.
  • Ensure that public health policies and plans are sensitive to race, ethnicity, sex, sexual orientation, gender identity, and other unique characteristics of individuals affected by the policies or plans. APHA Code of Ethics, 4.5.11.
  • Base health promotion efforts on respect for the dignity and capability of individuals, not on strategies of stigmatization or on appeals to motivations of fear, disgust, and shame. APHA Code of Ethics, 4.7.3.
  • Improve access to community-based public health services and outreach to underserved populations and those most affected by health disparities. APHA Code of Ethics, 4.7.5.
  • Public health measures that involve significant costs and/or burdens should be reserved for situations where they can be reasonably expected to make a difference to the consequences of a pandemic. WHO Ethics in Pandemic Flu
  • Attempt to ensure that those impacted by restrictions receive support from the community. CDC Ethics in Pandemic Flu
  • Governments and the health care sector should institute measures and processes to guarantee provisions and support services to individuals and/or communities affected by restrictive measures, such as quarantine orders, implemented during a pandemic influenza emergency. Plans should state in advance what backup support will be available to help those who are quarantined (e.g., who will do their shopping, pay the bills and provide financial support in lieu of lost income). Governments should have public discussions of appropriate levels of compensation in advance, including who is responsible for compensation. University of Toronto
  • International and national monitoring should pay particular attention to the needs of all popula­tions, regardless of their legal status, especially with respect to access to health care. WHO Ethics in Pandemic Flu
  • Recognize and act upon the fact that the ethical obligation to provide access to health care is not limited to persons with citizen status only. APHA Code of Ethics, 4.7.6.
  • A balance between centralized, federal control and state and local community implementation of central guidelines must be effectively struck. CDC Ethics in Pandemic Flu
  • Vaccine priority groups are established by federal agencies. Federal and state stockpiles of antivirals may only be used for treatment and there is no priority list for their use. If there is an abundance of antivirals, then health care facilities should be aware of other prioritization guidelines in their community. Indiana University (see also Allocation of scarce resources)
  • Promote constructive communication among the public, nongovernmental entities, individuals, and groups that draft and enact public health legislation and individuals and groups within the government that develop and implement public health activities. APHA Code of Ethics, 4.12.1.
  • Empower nongovernmental entities to engage in open dialogue with the government. APHA Code of Ethics, 4.12.2.
  • Governments and the health care sector should ensure that: a. care providers’ safety is protected at all times, and providers are able to discharge duties and receive sufficient support throughout a period of extraordinary demands; and disability insurance and death benefits are available to staff and their families adversely affected while performing their duties. University of Toronto
  • Governments, hospitals and health regions should develop human resource strategies for communicable disease outbreaks that cover the diverse occupational roles, that are transparent in how individuals are assigned to roles in the management of an outbreak, and that are equitable with respect to the distribution of risk among individuals and occupational categories. University of Toronto
  • Through partnerships with owners/administrators of potential alternate care sites, planners may develop procedures that will ensure the public’s health needs are met, while assuring owners their facilities will be properly insured and protected. Indiana University
  • Institutions should consider how to anticipate and address staffing shortages because the alteration of staff members’ regular responsibilities may result in increased stress for the affected staff or a decreased quality of the usual care. Indiana University
  • Planning for altered standards of care is controversial; however, it is imperative. It is strongly advised that each institution have a triage plan in place for altered standards of care. Indiana University
  • Every hospital should have a triage protocol, which includes ethically sensitive tie-breaking criterion. Indiana University
  • Health care organizations should identify and designate health care workers, clinical and nonclinical, deemed to be critically necessary during a pandemic. Indiana University
  • It should be exceedingly clear why particular individuals or communities are being restricted and that the criteria that justify a restriction would be equally applied to any and all individuals meeting these same criteria. CDC Ethic in Pandemic Flu
  • Consistency in the implementation and application of the policy helps to ensure that similar cases will be treated equally. This will aid in limiting unnecessary discrimination and may assist in conveying the policy’s fairness to the public and to the affected parties. Institutions may determine what, if any, exceptions may be made to the policy. Indiana University
  • Policies must be implemented consistently to ensure fairness and equal opportunity for care. Indiana University
  • Policy decisions and their justifications should be publicized and open to public scrutiny. WHO Ethics in Pandemic Flu
  • Both the decision makers and the criteria that will be used to determine when restrictions will be implemented should be specified. CDC Ethics in Pandemic Flu
  • Promote openness among the government, nongovernmental entities, and the public regarding resource allocation and performance improvement. APHA Code of Ethics, 4.12.3.
  • Preparedness plans should be flexible enough to allow timely adaptation as new evidence about the nature of the disease arises. WHO 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


What is Pandemic Ethics?

A pandemic is pervasive in scope and touches virtually every human-made system. In this dashboard, we focus on ethics in a government’s or an employer’s actions in a pandemic.

Public health ethics addresses the relationship between those governing or administrating and the population or employees they serve. They are best summarized by the Public Health Code of Ethics of the American Public Health Association.

Contact Jim Thomas