Overview of Ethical Issues for Health Care During a Pandemic

1
Overview of Ethical Issues for Health Care During
a Pandemic

• David T. Ozar, Ph.D.Loyola University Chicago

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Four Sets of Issues

• A. Social Priority Issues
• B. Institutional Priority Issues
• C. Health Professionals Individual Issues
• D. Issues of Jurisdiction (about A.
• and B, and in response to Health Professionals
  decisions about C.)

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A. Social Priority Issues

• Weighing Risks to HC Providers
• vs care for known Infected Patients,
• vs care for Unknown Patients
• Weighing priority of care of Infected Patients
  vs preventive measures for the public,
• vs responding to other health needs of the
  public
• Rationing health care resources
• Rationing of health care expertise
• Triage issues (i.e. presenting patients)

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Non-Crisis Health Care Differentiated by
Outcome/Functional Benefit (9 items)

• 1. Emergency life-saving care (to prevent people
  from dying by accident).
• 2. Pain relief or limitation (and control of
  other symptoms that interfere with normal forms
  of human functioning), including treatment of
  chronic pain and related symptoms.
• 3. Primary care, i.e. initial diagnosis,
  referral to other subsystems for care,
  self-contained on-site treatment, and explanation
  for understanding.
• 4. Preventive care (both individual and in the
  form of public health measures) and education for
  self-care.
• 5. Curing a life-threatening condition (e.g.
  ending an infection) or on-going treatment of a
  life-threatening chronic deficit (e.g. insulin
  therapy), with the aim of return to or
  maintenance of (more or less) normal forms of
  human functioning and (more or less) normal
  homeostasis to sustain them.

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Non-Crisis Health Care Differentiated by
Outcome/Functional Benefit cont.

• 6. Function-maintaining/function-restoring care
  (regarding non-life-threatening conditions), with
  the aim of restoring/maintaining (more or less)
  normal forms of human functioning and (within
  limits) the special functional capacities of
  individual persons, and including chronic
  deficits of function.
• 7. Support in time of dying (psycho-social
  support in addition to pain relief and symptom
  control).
• 8. Life-extending care without cure of a
  life-threatening condition, with restoration or
  maintenance of (more or less) normal forms of
  human functioning.
• 9. Maintaining biological life without
  maintaining or likelihood of restoring normal
  forms of human functioning.

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Institutional Priority Issues

• Internal Triage Issues
• When to close the doors
• Whether to follow the socially established
  policies (previous slide), or to choose
  (organizationally) to conscientiously act
  otherwise

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Health Professionals Individual Issues

• Determining how much risk is required by
  professional ethics in this situation (a social
  professional-ethical issue) ?
• Determining the proper ethical weight of ones
  other commitments vs ones professional
  obligations
• Whether to conscientiously decline to act as
  required by the social or institutional standards
  (to serve at all or regarding specific policies)

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Issues of Jurisdiction (about A. and B, and in
response to Health Professionals Decisions about
C.)
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Special Ethics Issues Regarding Proper Care of
End-of-Life Patients in Extreme Settings

• What is the proper priority, among medical goals,
  of pain relief and other palliative interventions
  for dying patients unlikely to receive
  life-extending treatment in time ?
• Should socially accepted Macro-Rationing
  Standards to be applied in the Micro-Rationing
  setting in exactly the same way ?

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THANK YOU

• Questions