Origins and Blame and Stories

January 11, 2011

2:00-3:00 pm

Your working group has one hour to discuss the following questions:

Where did these strains come from?

How did they spread?

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Dr. Ian Greenwald, an emergency physician at Duke University Medical Center and an expert in distaster response planning, offers his thoughts on a mass vaccination campaign in the Durham/Chapel Hill area in the face of a disruptive and widespread pandemic during Session III (Emergency Preparedness and Response: Global Pandemic, Local Contexts).

Although I will most likely go down in winter forum history as the girl that would readily kill her “65 year old retired grandpa over a ‘more useful and potentially productive’ 5 year old,” the entire discussion on rationing and dictating who receives vaccines (and in a sense who determines who lives or dies) was very eye-opening. Doctors have long been said to have “God complexes” and criticized for this mentality.  However today when you think of it, we were indeed playing the role of a higher power who had to dictate who was worthy of living. It was easy to laugh some of the comments off at the forum in order to take some of the weight from our shoulders. However, when we went into our breakout sessions we soon learned that being put into this decision is certainly stressful and I left the room with my head spinning, doubting whether I knew what criteria for selection was most important to me personally. The easy way out, would just be to give up and pray and hope for the best. However I think it is crucial, with each day new strains of viruses and spread being aided through the growth of infrastructure and commerce, the chances of another pandemic breaking out is likely. I also think it is important to put these measures in place because (just as Dr. Rosoff touched on a little through questions) in the end the people who end up having to make tough decisions (like in the case of Hurricane Katrina as he also spoke about) may be held accountable when the “wrong people are picked” or when socially unacceptable or pleasant decisions are made. Although it doesn’t sound pleasant, but I feel in the case of a pandemic there must be an acceptable loss of life and that we must set up a better system of who receives vaccines. If not, everyone loses in the end. Just some of the many thoughts that were swirling around up in my head.

Day II Evening Session: Palliative Care Dr. Philip Rosoff

Dr. Philip Rosoff, eloquently spoke about the ethical and moral obligation to provide palliative care for victims from the “pandemic”.  However, he cautions that this isn’t an endorsement of euthanasia.

How do you think the one can decide how to prioritize between the treating survivors and those expected to die?  How does the Hippocratic Oath (i.e. do no harm)  conflict with palliative care and euthanasia?

Tier 1: are required to receive the vaccine

-          Select government officials (mayor, governor, president, cabinet, Congress, Supreme Court)

-          Healthcare/emergency service workers (in direct patient contact)

-          Vaccine producers

Tier 2: (tier 2 and below have the choice to refuse the vaccine, which will then be given to the next person of a waiting list)

-          Pregnant women

-          Public safety

-          Active duty domestic military

-          Utility workers (workers necessary for basic societal functions)

-          IT/telecomm

-          Undertakers

Tier 3:

-          Other healthcare workers

-          Ages 6 – 24

Tier 4:

-          Everyone else unless in tier 5

Tier 5: lowest priority group

-          Terminal illness

-          Prisoners

Dr. Broverman leads a spirited discussion in a resource scarce setting (i.e. low amount of vaccine) who should get this life saving treatment?  What criteria could be used?  What should one use?  Who should make these decisions?