Abstract

This paper explores the use of an ethics framework based on the Public Health Code of Ethics to guide rationing decisions during a pandemic flu crisis involving a shortage of ventilators. While the law provides public health officials with authority to act, public health officials, as community leaders and health department managers, must address complex questions about how they should use their legal authority, how they can ethically justify a particular action, how they should engage community stakeholders in decision making, and how the process of public justification should take place. Recognising the need for a tool that could help public health officials manage ethical tensions in practice, such as allocation of scarce resources, the Public Health Leadership Society led efforts to develop a Public Health Code of Ethics. The 12 Principles in the Code were written to express the general norms implicit in the practice of public health professionals. The Code offers no hierarchical weighting of the different principles and anticipates that weights and specification of the principles would take place in the context of each community through a process of engagement between public health officials and community stakeholders about specific cases. We describe how public health officials can use the Code to guide deliberation in helping communities prepare to address the tragic choices when allocating scarce ventilators in an influenza pandemic.