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Kongress Medizin und Gesellschaft 2007

17. bis 21.09.2007, Augsburg

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Ethical issues in SARS control – a framework for decision making in public health

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  • Sabine Schipf - Ernst Moritz Arndt Universität Greifswald, Institut für Epidemiologie und Sozialmedizin, Greifswald
  • Karl Wehkamp - Hamburg University of Applied Sciences, Faculty of Life Sciences, Department of Public Health, Hamburg
  • Ralf Krumkamp - Hamburg University of Applied Sciences, Faculty of Life Sciences, Department of Public Health, Hamburg
  • Ralf Reintjes - Hamburg University of Applied Sciences, Faculty of Life Sciences, Department of Public Health, University of Tampere/Finland, Tampere School of Public Health, Hamburg/Tampere

Kongress Medizin und Gesellschaft 2007. Augsburg, 17.-21.09.2007. Düsseldorf: German Medical Science GMS Publishing House; 2007. Doc07gmds678

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/gmds2007/07gmds678.shtml

Published: September 6, 2007

© 2007 Schipf et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Background: The political response in containing the spread of severe acute respiratory syndrome (SARS) as a new emerged infectious disease was associated with a high potential for ethical conflicts. So far, there is no agreed framework for public health ethics. The aim of this analysis was to identify ethical issues in SARS control and providing an ethical framework for decision making in public health.

Subjects and methods: A literature review was undertaken with articles published between 11/2002 and 3/2006 in PubMed with ‘SARS and ethics’ as search terms. The identified ethical issues were categorized in clinical ethics; public health ethics, and global health ethics. A framework for public health policies was developed.

Results: 46 articles were retrieved, of which 30 met the including criteria. The frequency of identified ethical issues related 48% to clinical ethics; 35% to public health ethics; and 17% to global health ethics. Eleven main ethical issues were identified. The framework for public health policies is based on the four principles of biomedical ethics, and transformed and matched to collective level as followed: Autonomy of the patient – Autonomy of citizens; Beneficence for the individual – Beneficence for populations; Nonmaleficence towards individuals – Protecting societies; Justice – Equity.

Discussion: The experience with SARS highlighted ethical issues such as duty to care; civil liberties; collateral damage; privacy of information or global interdependence, and why adequate decisions in the control of SARS-like diseases needs ethical fundaments. To strike a balance between protection of the public good and protection of individual rights, the principles of biomedical ethics (Beauchamp and Childress) can be used as pragmatical tools for application in any situation where competing interests are at play for identifying and analysing ethical dilemmas. Because epidemics need quick responses, these aspects should be a starting point for guiding decision making in public health.