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Ethical Decision Making in a Crisis: A Case Study of Ethics in Public Health Emergencies

Thomas, James C. PhD, MPH; MacDonald, Pia D.M. PhD, MPH; Wenink, Emily MSPH

Journal of Public Health Management & Practice: March/April 2009 - Volume 15 - Issue 2 - p E16–E21
doi: 10.1097/01.PHH.0000346021.06803.76
Article

Public health emergencies, such as hurricanes and the constant threat of an influenza pandemic, present public health responders with many ethical issues and little time to think them through. We interviewed 13 responders in the Epidemiology Section of the North Carolina Division of Public Health to learn how they have identified and addressed ethical issues in public health emergencies affecting the state and to identify potential means of improving those processes for North Carolina and other states. The Epidemiology Section staff demonstrated an awareness of several ethical issues in public health emergencies and an ability to identify and address issues through group interactions. However, few study participants in the section had received any training in public health ethics. Perhaps for this reason, the range of ethical issues they identified excluded several mentioned in the Public Health Code of Ethics. Moreover, their ethical decision making could be enhanced by a more detailed understanding of the ethical issues they named. We recommend seven practical steps that the Epidemiology Section can take to improve their ability to identify and address ethical issues in a public health emergency. The recommendations are likely relevant to many state, city, and county public health departments throughout the United States.

This study offers some recommendations applicable to the vast majority of state, city, and county health departments in order to identify and address ethical issues in public health emergencies.

James C. Thomas, PhD, MPH, is an Associate Professor of Epidemiology and Director of the Program in Public Health Ethics at the University of North Carolina, Chapel Hill.

Pia D.M. MacDonald, PhD, MPH, is a Research Assistant Professor of Epidemiology and Director of the North Carolina Center for Public Health Preparedness at the University of North Carolina, Chapel Hill.

Emily Wenink, MSPH, is a Doctoral Student in the Department of Epidemiology at the University of North Carolina, Chapel Hill.

Corresponding Author: James C. Thomas, PhD, MPH, Department of Epidemiology, University of North Carolina, Chapel Hill, NC 27599 (jim.thomas@unc.edu).

This study was funded by a grant from the Greenwall Foundation.

© 2009 Lippincott Williams & Wilkins, Inc.