H1N1, fear, and maternal bioethics

The H1N1 pandemic raises awareness of the ethical challenges of emergency planning for diverse members of the population. Pregnant patients are one such group as they present policymakers with the task of protecting the health and wellbeing of the individual woman, the developing fetus, and the greater public.

Antiviral medications are at the core of a pandemic planning scheme. Formulations currently approved for the H1N1 virus are Category C, indicating potential fetal effects from in utero exposure to the drug. It is regarded that the benefits of oseltamivir and zanamivir for mother and fetus outweigh the potential risks of exposure. However the influenza virus carries the potential for drug resistance, raising concerns about the need for development and use of experimental drugs in the midst of pandemic.

Policymakers must develop pandemic plans that consider the unique state of the maternal-fetal dyad, including an ethical framework protecting pregnant women's ability to participate in clinical trials. Practices that exclude pregnant women from the initial phases of clinical trials prioritize fears of fetal harm over the interests of the woman. Although potential for harm to fetuses is a concern, there may be more harm done than good by such an approach. Exclusion from clinical trials results in drugs with inadequate safety information and fosters ethically problematic practices. Carefully crafted health policy will ensure that a woman's autonomy, in addition to her health and the health of the fetus, is preserved during the time of a pandemic.