A Matrix for Ethical Decision Making in a Pandemic

n recent years, there has been a great deal of interest in emergency preparedness. This is especially true in light of concerns about a pandemic of the H5N1 virus, the “bird flu.”* Ethical concerns include ensuring access to basic resources such as health care, and the duties of professionals to perform their task in the face of such events.1† Like other states, Oregon set out to establish an emergency preparedness plan to address these issues. A part of this planning included the establishment of a Medical Advisory Group (MAG), whose charge it was in part to describe the role ethics would play in decision making during a pandemic.§ In this article, I intend to describe why and how we in Oregon took an approach that differed in some ways from other plans. only six ethical principles in its recommendations, of which four are really outcomes measures. These principles are intended to achieve the primary goal of “maximizing Minnesotans’ chances of surviving,” with a secondary goal of protecting “against the loss of any single generation when reasonable measures to do so are available” [emphasis added].¥ For all these plans’ strengths, these two examples illustrate the common absence of a decisionmaking matrix in emergency preparedness plans. Stand on Guard for Thee does state that decisions should be reasonable, transparent, and inclusive—but these procedural values do not, by By FR. JOHN F. TUOHEY, PhD Fr. Tuohey is director, Providence Center for Health Care Ethics, Providence St. Vincent Medical Center, Portland, Ore.