Education And Debate
Ethics and SARS: lessons from TorontoBMJ 2003; 327 doi: https://doi.org/10.1136/bmj.327.7427.1342 (Published 04 December 2003) Cite this as: BMJ 2003;327:1342
Decision tool for policy makers in addressing future epidemics
Civil liberties and quarantine Naming names and the right to privacy Duty to care Collateral damage Global concerns Individual liberty Individual rights can be over-ridden for common good. Must be ethical, even handed so no one is unfairly harmed. Public protection Authorities have duty to restrict certain rights to safeguard public health. Citizens must comply for common good. Protection of public health may limit individual right to privacy and confidentiality of health information. Proportionality Restrictions of liberty must be legitimate and necessary, exercised by people with authority using least restrictive methods available. Health officials releasing confidential information must be able to argue that protection of the public health could not be achieved by less intrusive measures. Reciprocity Those quarantined receive adequate care, should not be kept in quarantine for excessively long periods, abandoned or psychosocially isolated. Economic barriers, such as loss of income, may have to be eliminated. Society and institutions have a reciprocal duty to assist health care professionals, providing information so staff can understand risks, and having policies that support safety practices. Transparency All stakeholders to be properly informed about issues, including risks and benefits of various options, and have input on issues that affect them. Honest reporting about an emerging epidemic and the numbers of people affected should not violate an individual’s right to privacy of medical information. Privacy Individuals have a right to privacy but this is not absolute. Harms of releasing information must be balanced against benefits of reducing health risk. Protection against stigmatisation Caution should be taken not to unduly stigmatise communities through the release of information. Duty to provide care Health professionals
have a duty to care based on several ethical considerations, such as "virtue ethics" which means being of good character.
Equity In an emergency, authorities face hard choices about which services to maintain and which to place on hold. People want these decisions to be made in a fair manner, including appropriate access to limited resources. There needs to be equity between SARS and non-SARS patients. Solidarity A new global health ethic based on solidarity could help make a more stable world. Solidarity means feeling one has common cause with others who are less powerful, wealthy, or healthy.
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