Preparing for an influenza pandemic: are some people more equal than others?
CONTEXT: Planning for a severe influenza pandemic entails facing many substantive public health challenges, especially in the area of the distribution of insufficient supplies of materials and personnel. It is anticipated that rationing of health care resources will be required, thus demanding that choices be made about which individuals should receive potentially life-saving care when not all who can be saved can be served. EVIDENCE ACQUISITION: Most proposed triage and allocation plans have used medical inclusion and exclusion criteria to reduce this gap, but there will still be many more patients than resources. Thus, the potential to arbitrarily exclude groups of people on non-medical grounds in order to reduce relative scarcity could offer an attractive option. Can societies make reasoned anticipatory decisions to keep certain people from receiving influenza treatment in order to maximize the availability of care for other, more favored groups? RESULTS: In this paper, we argue that taking the fundamental moral equality of people seriously requires the inclusion of vulnerable, socially marginalized groups (such as illegal immigrants and incarcerated prisoners) in planning for a pandemic. While there may be a majoritarian justification for a priori discrimination against some groups of people on non-medical grounds, there are no morally defensible reasons to do so and many reasons not to engage in such behavior. CONCLUSIONS: Pandemic planners should resist attempts to institute either unsanctioned or authorized discrimination in resource allocation. Because of their unique position in society, their ethical code and their essential role in confronting a pandemic, physicians can (and should) defend egalitarianism in the allocation of health care resources in such a public health crisis and advocate and act against such exclusion were it to occur.
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