1. Ethics in Public Health Andrew Bates 12 - 15 October, 2009 Phnom Penh, Cambodia

2. Objectives You should be able to: Know principles and concepts of Public Health Ethics. Describe the elements of a National Disaster System they has incorporated ethics. Write disaster plans with that include ethical considerations processes.

3. Foundation of ethical considerations There must be a clear and visible health threat to the community to justify interventions that disrupt social activity Government interventions must be; Measured Reasonable Effective Transparent Benefits and burdens should distributed fairly

4. Concepts and Principles Trust and accountability is required to maintain public trust. Trust and accountability is required to maintain public trust. Honest and direct communications enhances trust Honest and direct communications enhances trust Governments and institutions have reciprocal obligations to individuals and countries that contribute to public health activities; (Treaties, agreements, Mutual Aid) Governments and institutions have reciprocal obligations to individuals and countries that contribute to public health activities; (Treaties, agreements, Mutual Aid) Personal information should be kept confidential and secure to the extent possible Personal information should be kept confidential and secure to the extent possible

5. Concepts and Principles Human Rights documents, particularly the WHO Ethical guidelines provide a legal framework for public health activities Antiviral and vaccine distribution plan Medical care triage for flu patients and non flu patients; For foreigners and Host Nation Nationals Before receiving antiviral or vaccines people must informed of the risks and potential benefits

6. Concepts and Principles Healthcare workers (Dr. Nurse, Techs’) have a special obligation to work in dangerous areas during a pandemic and are deserving of care as a result Healthcare workers (Dr. Nurse, Techs’) have a special obligation to work in dangerous areas during a pandemic and are deserving of care as a result Morally correct Morally correct Practically prudent and wise Practically prudent and wise Essential services workers; Examples Essential services workers; Examples Military forces Military forces Transportation workers Transportation workers Make a National priority list before the event Make a National priority list before the event

7. Ask the Question: What would it mean for me and my family to comply with any official guidance/directive to change my behavior? Ask the Question: What would it mean for me and my family to comply with any official guidance/directive to change my behavior? Under what conditions would I not comply with a directive from the government? Under what conditions would I not comply with a directive from the government? What incentives can be used to encourage compliance? What incentives can be used to encourage compliance? What pressure(s) can the International community bring to bear on a country for perceived unethical behavior towards its population? What pressure(s) can the International community bring to bear on a country for perceived unethical behavior towards its population? What role can religious leaders play? What role can religious leaders play? What role can the media play? What role can the media play? Questions to consider

8. Summary Determine the primary ethical decisions in advance (when possible) of a disaster and communicate them Determine the primary ethical decisions in advance (when possible) of a disaster and communicate them Review ethical questions as they arise in a transparent and honest fashion Review ethical questions as they arise in a transparent and honest fashion Actions must measure up to the level of threat Actions must measure up to the level of threat Benefits and burdens must be equally and fairly distributed to maintain order Benefits and burdens must be equally and fairly distributed to maintain order Always remember to place yourself in the “other persons” shoes before making an ethical choice or decision Always remember to place yourself in the “other persons” shoes before making an ethical choice or decision

9. QUESTIONS?