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Pandemic influenza preparedness: an ethical framework to guide decision-making

Alison K Thompson1*, Karen Faith2, Jennifer L Gibson3 and Ross EG Upshur4

Author Affiliations

1 Centre for Research on Inner City Health, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario, M5B 1W8, Canada

2 Clinical Ethics Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario M4N 3M5, Canada

3 Joint Centre for Bioethics, University of Toronto, Toronto, Ontario, M5G 1L4, Canada

4 Primary Care Research Unit, Sunnybrook Health Sciences Centre, and Joint Centre for Bioethics, Toronto, Ontario M5G 1L4, Canada

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BMC Medical Ethics 2006, 7:12  doi:10.1186/1472-6939-7-12

Published: 4 December 2006



Planning for the next pandemic influenza outbreak is underway in hospitals across the world. The global SARS experience has taught us that ethical frameworks to guide decision-making may help to reduce collateral damage and increase trust and solidarity within and between health care organisations. Good pandemic planning requires reflection on values because science alone cannot tell us how to prepare for a public health crisis.


In this paper, we present an ethical framework for pandemic influenza planning. The ethical framework was developed with expertise from clinical, organisational and public health ethics and validated through a stakeholder engagement process. The ethical framework includes both substantive and procedural elements for ethical pandemic influenza planning. The incorporation of ethics into pandemic planning can be helped by senior hospital administrators sponsoring its use, by having stakeholders vet the framework, and by designing or identifying decision review processes. We discuss the merits and limits of an applied ethical framework for hospital decision-making, as well as the robustness of the framework.


The need for reflection on the ethical issues raised by the spectre of a pandemic influenza outbreak is great. Our efforts to address the normative aspects of pandemic planning in hospitals have generated interest from other hospitals and from the governmental sector. The framework will require re-evaluation and refinement and we hope that this paper will generate feedback on how to make it even more robust.