The Veterans Health Administration's National Center for Ethics (Internet: http://www.ethics.va.gov/) (Intranet: http://vaww.ethics.va.gov/) has a number of resources available as part of its Pandemic Influenza Ethics Initiative. The goal of the Initiative is to provide resources to support VHA leaders, clinicians, and staff for meeting the ethical challenges of hospital-based pandemic influenza planning and response.
The following resources are available and may be accessed through the links provided:
Pandemic Influenza Ethics Initiative Resources
Staff Discussion Forums On Ethics Issues In Pandemic Influenza Preparedness
In a pandemic flu VHA, like other health care organizations, will face a surge in demand to provide care for large numbers of very sick people with high rates of complications and need for supportive care -- in the context of a highly transmissible disease. The likely demand for resources in excess of those ordinarily used on a daily basis -- i.e., the demand on a health care facility's surge capacity -- means health care standards may need to be altered to respond to the public health threat and the imbalance between care that is needed and the resources available. Tough decisions may need to be made about reporting for duty, mandatory vaccination of health care workers, quarantine, diminished patient privacy, and triage and rationing care.
Through staff discussion forums VA health care providers can share information and concerns, build mutual understanding about the difficult ethical decisions they may have to make, and better prepare to respond to the ethical and professional challenges of a pandemic.
To raise awareness and understanding about allocation of scarce resources and other difficult clinical and ethical decisions that will need to be made in a pandemic, the Ethics Center and VA's Office of Public Health and Environmental Hazards have prepared material to support staff discussion forums on ethics issues in pandemic flu preparedness.
The packet contains information for forum planners and participants:
For planners:
For participants:
- Scenarios and questions as a basis for discussing ethical values in influenza pandemic preparedness
Pre-decisional Draft Guidance: Meeting the Challenge of Pandemic Influenza: Ethical Guidance for VHA Leaders and Clinicians
The Guidance offers recommendations for workforce, communications, and patient care planning. It frames these recommendations in terms of the following ethical challenges:
- Rationing - Allocation of scarce critical care resources. The criteria & processes for decision making regarding the fair & efficient use of scarce critical care resources.
- Responsibilities - The “duty to provide care.” The obligation of health care workers to accept reasonable risk in the service of patients & the obligation of health care institutions to minimize risk to health care workers.
- Restrictions - Fair procedures for implementing limits on individual liberty to protect the health of the public and prevent the spread of infection.
Draft Protocol for Allocation of Scarce Life-Saving Resources in VHA During an Influenza Pandemic
The protocol, drawn from section 3 (Rationing) of the larger Guidance document, should be used in affected VISNs and VA Medical Centers throughout VHA to ensure that veterans have fair access to life-saving resources in circumstances when the demand is greater than the supply and use of those resources must be optimized.
