225107 Public engagement on pandemic ethics in Minnesota: A focus on vulnerable populations

Monday, November 8, 2010 : 2:45 PM - 3:00 PM

J. Eline Garrett, JD , Health Policy and Public Engagement Consultant, Minneapolis, MN
Dorothy E. Vawter, PhD , Minnesota Center for Health Care Ethics, St Paul, MN
Karen G. Gervais, PhD , Minnesota Center for Health Care Ethics, St Paul, MN
Debra A. DeBruin, PhD , Center for Bioethics, University of Minnesota, Minneapolis, MN
Angela Witt Prehn, PhD , School of Health Sciences, College of Health Sciences, Walden University, Minneapolis, MN
Groups suffering health disparities are likely to suffer disproportionately during a severe influenza pandemic. Heightened vulnerability may stem from poor underlying health, poor access to health care, inability to stockpile, and increased exposure due to crowded living conditions. In 2009 we conducted extensive public engagements to identify the overarching ethical objectives that should guide the state's health department in rationing scarce resources during a severe pandemic, including perspectives about protecting public health, preserving critical infrastructures and being fair. We led large community forums and small group engagements. Participants were diverse with respect to race, ethnicity, gender, age, employment, disability/ability, geography and income. This presentation will report findings concerning vulnerable groups, highlighting engagements conducted in vulnerable communities. It will also illustrate how public engagement findings influenced 2009 H1N1 response in Minnesota. Participants were asked specifically to identify and reflect on access barriers to rationed resources. The definition of “critical infrastructures” was fraught with tension. Participants identified systems vulnerable populations depend on that could be imperiled, and, they fear, likely to be forgotten during pandemic planning; yet they were concerned about defining infrastructures so broadly that resources would not be left for vulnerable groups and the general population. Some participants expressed fear of stigmatization if vulnerable groups were prioritized; others thought that those traditionally at the back of the health care line should have first access in a pandemic. Participants generally agreed that while rationing during a crisis cannot redress existing disparities, above all rationing should not exacerbate disparities.

Learning Areas:
Diversity and culture
Ethics, professional and legal requirements
Protection of the public in relation to communicable diseases including prevention or control

Learning Objectives:
Describe a robust public engagement process to glean perspectives about how best to ration a state’s health-related resources ethically during a severe pandemic. Discuss the ethical tensions that are present when deciding how best to ration public resources among critical infrastructures, the general population, and particularly vulnerable groups. Identify systems on which vulnerable populations particularly rely that may be threatened in a severe pandemic.

Keywords: Disasters, Underserved Populations

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a leader of the Minnesota Pandemic Ethics Project and the public engagement processes integral to the project.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.