Avian influenza virus

Currently nobody knows exactly whether we will face a new human pandemic with a mutated avian influenza virus or not. So far, the pandemic is mainly an animal disease and the cases of infected human beings are linked to direct contact with infected animals. But if the H5N1-virus mutates into a strain which can easily pass between human beings resulting in a new human pandemic with dramatic effects, we are sure to be confronted with serious ethical decisions, in addition to huge other problems They can be anticipated and are not new – the coming ethical problems are well known.
First of all, a global human influenza pandemic will bind enormous capacities in the health care systems all over the world. Highly developed medical systems in wealthy countries might be able to cope with the challenges of treating an extremely high number of sick people in a more acceptable way. They might have enough human and material resources to react in a way that minimises the number of people infected and dying from the disease. But most health care systems in the world will not be able to respond adequately to the increased health care needs. They lack the necessary reserves. Their medical capacities are already insufficient to cope with their daily health problems, let alone to cope with a new human pandemic flu. Less developed health care systems face two options, both of which pose serious dilemmas; they can either concentrate on fighting the new human pandemic at the expense of other urgent health care needs, or they can neglect the new pandemic trying to maintain the level of other health care services.
In any case, the consequences will be devastating for the people involved, the avian influenza victims or those with other sicknesses. And the choice between these two options is a difficult one, with ethical implications. On the one hand the responsible health care officials have to decide under conditions of some uncertainty based on vague data about the outcome of their measures, on the other hand they have to choose the appropriate aim of their strategy: Should one follow the utilitarian goal to minimize the number of fatalities, or should other considerations govern the decisions, e.g. egalitarian considerations that give all indi-Medical Ethics and Human Rights Avian influenza: A possible new human pandemic with old ethical problems Prof. Urban Wiesing MD, PhD, Georg Marckmann MD, MPH viduals an equal chance of treatment regardless of the overall outcome? Even well-funded health care systems will be confronted with a shortage of antiviral drugs, vaccines, hospital beds and health care professionals for the treatment of avian influenza patients. Who should receive the available drugs, who be vaccinated first, or who get the needed hospital beds? Those who are able to pay the price – which will highly increase? Or the professionals who are responsible for the public health system and for the treatment of infected people? Should the drug be distributed by ability to pay in a free market or in a regulated way for the benefit of the greatest number? The answer is dearly in favour of maximising the overall benefits. Consequently, most pandemic plans give priority to health care workers and other professionals who help to maintain public order.
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Understandably, it always places a heavy burden on a physician to decide between two patients in the absence of capacitiesy to treat both. Therefore, the World Medical Association has defined a clear priority in its “Statement on Medical Ethics in the Event of Disasters” (1994) When the circumstances do not allow the treatment of every patient who under normal conditions could be treated, the “decision to ‘abandon an injured person’ on account of priorities dictated by the disaster situation cannot be considered ‘failure to come to the assistance of a person in mortal danger It is justified when it intends to save the maximum number of victims.”

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