Contingency Ethics: Shifting the Conversation During Public Health Emergencies

Under the Instititue of Medicine’s report: A Systems Framework for Catastrophic Disaster Responses,” many states and cities are establishing crisis standards of care plans undergirded by strong ethical foundations. The report calls for an ethics framework for normal times, contingent times, and crisis times. In normal times, healthcare ethics guide difficult decisions about the appropriate use of medicine to achieve patient goals.  In crisis mode. public health ethics balance the needs of the society with the rights and desires of the individual.  When a catastrophic public health emergency arises, healthcare providers must shift from an emphasis on the autonomy of patient desires to a focus on the common needs and interests of the community in maximizing the use of resources.  The move from healthcare ethics to public health ethics requires a shift in focus that we describe as “contingency ethics.” 

Contingency ethics occupies the space between anticipation of a public health emergency (contingent) and the actuality of that emergency (crisis).This presentation will explore contingency ethics as a necessary intermediary step to provide proactive ethics education to healthcare providers, mobilize a statewide or regional ethics support team, activate a palliative care workgroup, organize a communications plan for elderly, disabled, and pediatric populations, and gather reserve resources. Instead of autonomy or community, we base a contingency ethics on a notion of the common good where health care will try to meet the needs of individuals, but delay wants until another time while the focus shifts to identifiable, imminent public health threats. 

The presenters will use the first 5 minutes to discuss the Institute of Medicine framework and explain how medical ethics applies in normal healthcare and a communitarian public health ethics applies in crisis. The second 5 minutes will present our ideas on contingency ethics. The remaining time will be an opportunity for discussion as well as question and answer.