Monday, May 11, 2009

The Five People You Meet in a Pandemic…

I am a member of The Hastings Center---an independent, nonpartisan, and nonprofit bioethics research institute founded in 1969. To quote from their home page: The Center's mission is to address fundamental ethical issues in the areas of health, medicine, and the environment as they affect individuals, communities, and societies.

During the recent flu flurry I checked to see if the Center had published anything on the flu pandemic. I found this treasure written by Nancy Berlinger and Jacob Moses: The Five People You Meet in a Pandemic—And What They Need from You Today. (November 2007)

The five people (truck driver, gatekeeper, triage officer, janitor, and public health official) each represent a group of first responders. Each has needs and complex responsibilities to the community. The authors ask important questions about health care during a pandemic, for example: incentives, public education, collaboration, fairness, end-of-life care, training for triage, and rationing supplies. They urge public and private sector leaders to recognize the duty to plan, the duty to develop rules and tools for first responders, and the duty to be accountable to one another. The also urge that ethics be given a seat at the planning table. The report ends with these words:

“All of these decisions are hard decisions. To say these decisions are too hard to make today is to shirk our duty to plan, and to make the duties of first responders even more difficult.

And to say Americans won’t plan, or won’t ration, or won’t care about others---and will no longer trust the public sector to be on their side---is to allow cynicism to triumph over civic responsibility and the public interest. In considering these five people, pandemic planners must show the rest of us how we will care for one another, as communities and as a society, in perilous times.”

My question is---how do we apply this commitment to planning, to confronting hard choices to less sexy illnesses that afflict millions already---like alzheimer’s disease? The chronic, debilitating illnesses of old age?

Do only contagious diseases merit a community response? Qualify for public and private sector planning?

These questions are vital. I think we make an artificial dichotomy between contagious disease and non-contagious disease. We see the former as a community issue requiring planning/preparation and the latter as a private tragedy/responsibility confined within the home. Yet anyone who has had an illness or cared for someone through an illness process has met the truck driver and the gatekeeper; has confronted the ethical challenges of collaboration, fairness, end-of-life care, triage, and rationing supplies.

All illness is a community issue. All illness mandates planning by both the public and private sector.

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