Media Release
5 July 2006
Feedback sought on values identified to guide pandemic response
The Minister of Health’s independent advisor on ethical issues is seeking the public’s feedback on values to guide planning and response to a potential pandemic.
The National Ethics Advisory Committee (NEAC) today released a discussion document which describes widely shared ethical values to govern how and what decisions are made in the event of an influenza pandemic.
“To prepare ourselves for a potential pandemic, one thing we should do is to think through our values – the things that matter to us. This would give us a shared basis for making decisions,” NEAC chair Andrew Moore said.
“Identifying our shared values now might also help us to act quickly and adapt well later, when there may be less time,” he added.
Ethical considerations have been factored into pandemic planning in line with a recommendation from the World Health Organisation.
A study conducted following the outbreak of SARS (Severe Acute Respiratory Syndrome) in late 2002 found that decisions guided by ethical values could help instil and maintain public trust in decision-makers in crisis situations.
In the discussion document, a good decision-maker is described as one who is inclusive, open, reasonable, responsive and responsible.
Good decisions, on the other hand, are those that seek to minimise harm and are marked by respect, fairness, neighbourliness/whanaungatanga, reciprocity and unity/kotahitanga.
The discussion document includes two hypothetical cases: a community response to a pandemic and a hospital based case. The community case is based on the actual response of New Zealanders to the 1918 pandemic.
“We are seeking feedback from the public to help make this a better statement of the shared values of New Zealanders that are relevant to pandemic decision-making” Dr Moore explained.
In particular, NEAC would like to determine whether the scope of the statement of values is appropriate, whether the values it has identified are those the public feels are important in planning for and responding to a pandemic, and whether the statement of values can be made more usable.
The public, particularly organisations involved in pandemic planning and communities that may be affected by a potential pandemic, is invited to submit their comments by August 16.
ENDS
Read the discussion document online: www.neac.health.govt.nz
Questions and Answers
What is the National Ethics Advisory Committee (NEAC)?
The National Ethics Advisory Committee (NEAC), Kāhui Matatika o te Motu, is an independent advisor to the Minister of Health on ethical issues of national significance concerning health and disability matters. It was established in 2001 by section 16 of the New Zealand Public Health and Disability Act 2000.
The members of NEAC, appointed by the Minister, bring expertise in ethics, health and disability research, health service provision and leadership, public health, epidemiology, law, Māori health and consumer advocacy.
www.neac.health.govt.nz
Why has NEAC produced this discussion document?
An influenza pandemic would be likely to lead to high levels of illness and death, both in New Zealand and other countries. Pandemic planning aims to prevent a pandemic wherever possible, and to limit these negative impacts where prevention is not possible.
The World Health Organization (WHO) lists consideration of ethical issues as part of its checklist for countries involved in pandemic preparedness planning. This statement of ethical values helps to satisfy the WHO recommendation for New Zealand pandemic planning.
It is important to consider issues specific to New Zealand; for instance, the importance of improving health outcomes for Māori and giving special consideration to population groups in New Zealand that are disadvantaged by health inequalities and may be further disadvantaged in the event of a pandemic.
Seeking feedback from the people, organisations and sectors involved in and affected by pandemic planning in New Zealand may help us to carry out pandemic planning that is reasonable, ethical and likely to be effective at minimising harm from any pandemic.
In some areas, attempts to minimise harm from a pandemic will depend upon the ethical behaviour of communities and professions. For example:
- during a pandemic, the provision of care, and the maintenance of other essential services, will depend upon carers and workers accepting a degree of personal risk in the course of helping others;
- during a pandemic, much illness is likely to be managed in communities. Individuals and families who are ill are likely to depend on assistance from neighbours and others in the community, which may carry some degree of personal risk for those community members;
- the way in which pandemic planning and communication is carried out may play an important role in enabling such ethical behaviour.
What is in the discussion document?
What values do we share that can help pandemic decision-making? The National Ethics Advisory Committee (NEAC) has made a first attempt to answer this question. The discussion document contains a statement of Ethical Values for Planning for and Responding to a Pandemic. An earlier version of this statement is included as an appendix in the current New Zealand Influenza Pandemic Action Plan (NZIPAP).
We have tried to state values that would be useful in many settings. To make their potential use vivid, we have included two hypothetical cases: a community response to a pandemic and a hospital based case. The community response case is based on the actual response of New Zealanders to the 1918 pandemic. Both these hypothetical cases involve major pandemic outbreaks. With good planning and response – keeping it out at the border and stamping out any clusters that get through – our aim is, of course, to prevent any major outbreak from ever occurring. Even so, we should think about how we would get through even this most difficult situation. We have also tried to state values that can apply at all pandemic stages, from planning right through to recovery. We have also tried to state values that New Zealanders share for how to make decisions as well as for what decisions to make.
What sort of values are we talking about?
The statement of values says that in good decision making processes we are inclusive, open, reasonable, responsive and responsible.
The statement says that good decisions are those we base on minimising harm, respect, fairness, neighbourliness/whanaungatanga, reciprocity and unity/kotahitanga.
What other work has been done in this area?
A notable piece of work in this area is the Canadian report Stand on Guard for Thee by the Joint Center for Bioethics, which was carried out following the outbreak of SARS (Severe Acute Respiratory Syndrome). This report found that if ethical values had been more widely used to guide decision-making there would have been greater trust and solidarity within and between health care organisations and communities. Having ethics clearly built in to pandemic planning, and having buy-in from multiple sectors of society, may lead to greater acceptance of plans, and more trust in decision-makers.
Who is the statement of Ethical Values for Planning for and Responding to a Pandemic in New Zealand for?
A wide range of people, including health professionals, planners, policy makers and members of the public and the business community can use this statement of values as they plan for and think about their potential response to a pandemic.
When should the statement be used?
Ideally, this statement of values should be used before or during the decision-making process. It might also be useful in retrospect, when we review how well our decision-making measured up to our values. In practice, this may mean having an understanding of the relevant ethical values and processes in advance, and then referring to the statement during decision-making where needed. Ethical issues may arise at all five stages of pandemic planning in New Zealand (see table below), and this statement aims to be useful during each of these stages. The statement may also be useful in analysing, from an ethical perspective, our own decisions and those of others.
Five stages of pandemic planning in New Zealand
| Planning | “Plan for it” |
| Border management | “Keep it out” |
| Cluster control | “Stamp it out” |
| Pandemic management | “Manage it” |
| Recovery | “Recover from it” |
Source: Ministry of Health 2006
How can your input help make the statement better?
NEAC is interested in your comments on any aspect of the discussion document and statement of values and is particularly interested in your thoughts on the following questions:
- Is the scope of the statement of ethical values appropriate?
- Do the ethical values described in the statement correspond to those you feel are important in planning for and responding to a pandemic?
- Can the statement of ethical values be made more usable?
You can comment on NEAC’s discussion document/statement of values by:
- writing your details on the form provided at the back of the discussion document and posting your feedback to NEAC
- completing the questions as an electronic Word document and either emailing it or printing it out and sending it by post to NEAC
- writing your comments as an email or as a letter that you can send to NEAC.
Postal address:
NEAC
PO Box 5013
WELLINGTON
Email: neac@moh.govt.nz (Please put “Pandemic” in the subject line)For further information contact:
Luz Baguioro
Media Advisor
Ph: 04 496 2067