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APHA Scientific Session and Event Listing

Marian H. Adly, BA, BS, MSc and Ross Upshur, MA, MD, MSc. Joint Centre for Bioethics, University of Toronto, 88 College Street, Toronto, ON M5G 1L4, Canada, 630-677-2718, marian.adly@gmail.com

The Severe Acute Respiratory Syndrome (SARS) outbreak of 2003 in Canada highlights the ethical dilemmas in setting priorities during a public health crisis. Presently, the leading theory in priority setting is Daniels' and Sabin's (1997) Accountability for Reasonableness (A4R), which enhances ethically-guided decisions in typical health care settings. Whether this framework may be applied to crises has yet to be examined. A4R is an innovative framework that attempts to mitigate conflicting interests, to ensure a greater degree of fairness and accountability, and to facilitate deliberations over priorities in health care settings. The purpose of this study tests this framework's applicability within existing frameworks of the emergency health services during an atypical or emergent circumstance and to descriptively evaluate SARS in Canada through A4R.

Conducting qualitative analyses to the SARS case study highlights how priorities were set and how resources were competed for, shared, or allocated by health authorities in a publicly funded health care system during an outbreak. Responses from Canadian health authorities at the macro (federal), meso (provincial), and micro (municipal) levels of governance were conducted with a total to-date of 40 interviews completed through snowball sampling. Qualitative analytical approaches will be applied to the data with interim-analysis meetings, and subsequently implemented into and tested against the A4R framework.

Preliminary findings suggest that refinements to A4R as well as other emergency health frameworks may be required to minimize collateral damage and harms during and after the response either within Canada, within the United States, or at the border. These key lessons are germane to pandemic influenza planning.

Learning Objectives: