By Kirk O. Hanson
executive director, Markkula Center for Applied Ethics
Pandemics and disasters breed unavoidable — but predictable — ethical choices. Coping with the H1N1 epidemic demands that we address a set of difficult ethical dilemmas – where our self interest and the common good of the community collide – where our ethical and religious commitments ought to drive our choices. If the current pandemic gets worse through mutation of the virus, as it may in the next two years, ethical choices will save hundreds, and likely thousands, of lives.
Fortunately, the H1N1 flu is not yet broadly lethal. It is estimated that to date over 1 million Americans have contracted the moderate H1N1 flu and over 1,000 have died. If a significant mutation occurs, these numbers would quickly explode.
We have time now to examine the H1N1′s ethical dilemmas and to resolve them thoughtfully. It is our belief that anticipating these ethical dilemmas will enable us to make better ethical choices – and save lives in the process.
Who should get the H1N1 vaccine first? Now, and particularly if a mutation occurs, available doses of an effective vaccine should go first to medical staffs and first responders, the police and fire departments. These individuals will help multiple others and maintain order in society. Secondly, we believe doses should go to those essential to the functioning of society – civic officials, and surprisingly, trash collectors and truck drivers. The trash collectors will keep disease down; the truck drivers will transport our food to us. We personally would hope ethicists would get priority treatment, but they probably should NOT unless they are teachers or deal daily with large numbers of people.
Can I pass up the H1N1 vaccine if I am afraid of the side effects? As with any epidemic, effective control depends on almost all citizens being vaccinated. The H1N1 vaccine, just now becoming available, has been tested on thousands of people and is as safe as any vaccine can be. If I pass it up, I am showing a lack of care for my fellow citizens and the common good. I am increasing the chance I will get H1N1 and so infect others.
Should I buy hand sanitizer dispensers for my home or office? At minimum, we are ethically responsible for keeping our own hands from transmitting the disease – whether from an infection we have ourselves or from the virus we encounter on a door handle, table top, or dollar bill. Frequent hand washing by individuals and use of hand sanitizers wherever they are available is an ethical obligation. Businesses and other institutions have the obligation to provide the sanitizers.
Should my Church end the common cup for communion and the kiss of peace (handshake) in the service? Some congregations have already moved to do this. Though some may feel it weakens the symbolism or the effect of religious services, prudence requires limiting the possibility of virus transmission. In most Christian denominations, receiving either the bread or the common cup are considered equivalent to receiving both.
Should I wear a facemask? Should I stay at home if I am sick? If you have any symptoms at all, you owe it to others to stay home. Facemasks are of very limited effectiveness. Facemasks may provide limited protection for others if YOU are infected but do a poor job of protecting you from others who are sick.
Should my church, school or institution limit public meetings? This step is probably not required yet, but may be if a more lethal virus strain develops. If care has been taken to limit common cups and random transmission, meetings can continue. Leaders of organizations and meetings can, however, legitimize not shaking hands by suggesting this social custom be suspended for now.
Should I stockpile Tamiflu? Tamiflu is a medicine which can increase your chances of recovery if you contract the virus. There is a limited amount of Tamiflu available. If individuals or our large institutions scoop up all available supply, there may be too little for use in hospitals and by doctors. It is preferable and serves the common good if you don’t stockpile Tamiflu but get it from your physician immediately if you contract the virus.
Who should get use of scarce medical equipment? If a serious and lethal mutation occurs, respirators and other medical equipment will be completely inadequate to treat everyone infected. We believe public health officials and individual hospitals and doctors should follow a protocol such as the one outlined above for the distribution of scarce vaccine. The first priority should be the functioning of the medical system, of civil society, and the maintenance of order.
Kirk O. Hanson is executive director of the Markkula Center for Applied Ethics at Santa Clara University in California. Margaret R. McLean, who contributed to this essay, is Associate Director and the Center’s Director of Bioethics.