RESPONSIBILITIES IN EPIDEMICS
A disease epidemic occurs when there are more cases of
that disease than normal.
A pandemic is a worldwide epidemic of a disease
Ex: Severe influenza pandemic occurred in 1918-1919 and
caused an estimated 40 to 50 million deaths world wide.
• Physicians duty???
Responsible for ensuring the health of the nation
• The ethical framework are:
1. health workers’ duty to provide care during a communicable
2. restricting liberty in the interest of public health by measures
such as quarantine;
3. priority setting, including the allocation of scarce resources,
such as vaccines and antiviral medicines; and
4. global governance implications, such as travel advisories.
• The 1847 AMA Code was organized by
relationships: physician-patient, physician-
physician, and physician-public.
• Each relationship was addressed as generating
both duties and reciprocal rights.
• Physician-public relations, espoused a new
obligation, not found in earlier English codes:
When pestilence prevails, it is [physicians’] duty
to face the danger, and to continue their labors
for the alleviation of suffering, even at the
jeopardy of their own lives. (Baker, Caplan et
• All three features of medical care were clearly
present for physicians to accept a duty to treat
- risks were present and recognized,
When an epidemic prevails, a physician
must continue his labors for the alleviation
of suffering people, without regard to the
risk to his own health or to financial return.
(Baker, Caplan et al. 1999)
EX: influenza pandemic
• A new influenza virus appears against which the human
population has no immunity.
• With the increase in global transport (urbanization and
• Pandemics can be either mild or severe in the illness
and death they cause, and the severity of a pandemic
can change over the course of that pandemic.
• WHO pandemic preparedness and response
planning to assure the protection of these
populations in the event of a pandemic outbreak
social justice and distributive justice in assuring the
protection of all individuals
Preparing for an influenza
• Difficult, particularly in the face of limited
resources and other urgent problems and
priorities, especially in developing countries.
• Improving public health infrastructure through
pandemic planning has immediate and lasting
benefits, increasing overall response capacity for
all threats to public health.
• Strengthening coordination mechanisms at
national and international levels contributes to
better global preparedness and response for
disasters and public health emergencies.
• Justice requires a distribution of opportunity
for care, and government is the appropriate
instrument to guarantee equality of distribution.
• Its mean 'that justice requires that everyone
get the resources needed to be healthy',
• Justice requires everyone has a claim to health
care needed to provide an opportunity for a level
of health equal, as far as possible, to other
• Infectious disease poverty: bad nutrition, dirty
water, crowded living conditions, poor education,
lack of access to basic medicines, disempowerment
of women, and a complex host of other factors
combine to make the populations of developing
nations especially vulnerable to infectious diseases:
RELATIONSHIP BETWEEN POVERTY
AND INFECTIOUS DISEASE
AIDS pandemic and the health care situation in Africa at the
beginning of the 21st Century.
• Of the (roughly) 40 million people estimated to be living with
HIV/AIDS in 2002, 28 million – or 70% – lived in sub-Saharan
• 95% [in 2001] live in developing nations.
• Most of the infected people who live in these countries have
no access to new or existing drugs for HIV/AIDS. But the
problem of access to medications goes far beyond the
HIV/AIDS pandemic: people in developing nations also cannot
afford medications used to treat or prevent malaria,
tuberculosis, cholera, dysentery, meningitis, and typhoid
Etiology AIDS epidemics (South
• Complex: its present state is the result of a wide variety of
social, political, economic, and historical factors.
• Urbanization, overcrowded living conditions, migrant working
conditions, poor education, fatalistic behavior, prostitution,
and other ravishes of poverty (including poor nutrition,
widespread infection with worms, and lack of treatment for
other) each contribute to the AIDS epidemic – and are each
(at least partly) the result of exploitative racist colonial
oppressive practices – corroborates the point that the South
African AIDS epidemic should largely be blamed on social
Key ethical values to guide ethical
• Individual liberty
• Protection of the public from harm (quarantine)
• Duty to provide care
Procedural values to guide ethical
• Open and transparent