Abstract

The recent appearance of an extremely widespread avian influenza virus (H5N1) that has crossed to humans in highly pathogenic form has lead to speculation that another outbreak of pandemic influenza could be imminent. However, neither the timing of the pandemic, nor the nature and epidemiology of the virus, can be predicted. This uncertainty presents major difficulties in identifying relevant ethical issues in decision-making. If the next pandemic is relatively mild, decisions may be restricted to prioritizing access to essential health services during the peak of the pandemic. If the virus is more pathogenic, social stability may be threatened. It is clear that, irrespective of the nature of the next pandemic, health professionals will have a key role in decisions about allocating scarce health resources during its acute stages. It is essential that they are not forced to make decisions without the support of established guidance or protocols. Any such guidance must be practical (decisions will often have to be made rapidly on the basis of imperfect information), reasoned, based upon sound moral principles, and must enjoy as far as possible the confidence of the wider population. This paper looks in brief at some of the ethical issues that need to be considered when planning a response to pandemic flu