Canadians might agree to suspend civil liberties in pandemic: Survey

Canadians are bullish on giving government officials permission to restrict personal freedoms in a flu pandemic, with half of those surveyed agreeing that violation of a quarantine order would be tantamount to manslaughter.

As well, 90 per cent of Canadians surveyed for a research report in pandemic ethics believe doctors and nurses have an obligation to report to work during a pandemic, provided safety precautions are in place. Almost half (48 per cent) say that health care workers who do not show up for work without a legitimate excuse should be fired or lose their professional licenses.

The survey, conducted by the University of Toronto Joint Centre for Bioethics, is based on a random sample of 500 Canadians surveyed by phone, and nearly 100 more via a series of town hall meetings. It was taken between August 2008 to February 2009 — just before the H1N1 outbreak began in April — and was designed to inject the public’s voice into debates usually left to the experts, and comes as officials brace for an anticipated second wave of H1N1 flu.

Researchers are warning that the serious ethical challenges that could accompany a pandemic need to be thought through now, while there’s still time to respond.

“There’s going to be a lot of uncertainty to decision making, even in a mild pandemic,” says Dr. Ross Upshur, director of the U of T bioethics centre, which Wednesday released a series of research papers on pandemic ethics.

“Often the complaint is that the public has never been asked how they think about these issues, what they think the desired goals are of a response, whether the resources are properly allocated.

“To the best of our knowledge, we’re the only group that has, for all of its warts, any data on public deliberation and attitudes on some of the pressing ethical issues that we may face in the H1N1 response.”

The reports draw on lessons learned from the SARS outbreak and address issues from whether health care workers have an implicit duty to treat patients, to fraught ethical questions, including who should get the last bed and ventilator in an intensive care unit — a cyclist who has suffered a severe, but potentially reversible brain injury, or a nurse infected with H1N1 while caring for patients who need immediate ventilation support?

“Even though there may be some skepticism about perhaps overreaction to H1N1, let’s remember the past. We weren’t prepared for SARS,” Upshur says.

“There’s still a lot of uncertainty about H1N1. It’s still a new pathogen. It seems to be tracking reasonably mild. But there are still ethical issues that require discussion.”

Past surveys have suggested anywhere from 25 to 85 per cent of health-care workers would be unwilling to show up for work in a pandemic.

“If you think of it, that’s a pretty stunning number,” Upshur says. He says professional codes of ethics and regulatory bodies haven’t set clear directives on what they expect of health care professionals in a disease crisis.

A large majority (85 per cent) of those who responded to the U of T survey agreed governments should have the power to suspend some individual rights, such as travelling and the right to assemble, during a flu pandemic. But they also said governments have an obligation to provide for the basic needs of restricted individuals, such as food, shelter and social support.

“Canadians are accepting of duly issued orders by public health authorities if they’re clearly communicated . . . and they’re not left on their own to fend for themselves without support of some kind,” Upshur said.

Asking people to suspend their civil liberties “is legitimate, for a time limited period, if it’s clearly communicated and measures for support are put in place,” he said.

The survey found that 85 per cent of respondents believe governments should provide disability insurance and death benefits at no charge for health care workers at risk during an influenza crisis. But they were more conflicted on what to do with workers who do not report for work without a legitimate excuse: 48 per cent agreed they should face loss of employment or professional licence, whereas 38 per cent disagreed.

When asked whether health care workers should be conscripted into service during a pandemic, 47 per cent agreed, while 43 per cent disagreed.

But survey respondents also said that having to care for a sick relative, or having a serious health problem that could make people more vulnerable to flu, were legitimate excuses from work.

Upshur said hard decisions will need to be made about who should have access to ventilators, vaccines, antivirals and other resources in a flu outbreak. Ninety-four per cent of those surveyed said health care workers should receive priority for antivirals, followed by children. They said scarce medical resources ought to be given to those most likely to survive.

“With H1N1, where the push that’s going to come is how acceptable are some of the social distancing measures,” to slow the spread of infection, Upshur says.

One of the most contentious issues could be vaccination. The report notes that a newly developed vaccine “has increased uncertainty about its effectiveness and the immune response it will generate.”

The researchers are calling for “rigorous” surveillance systems to monitor for vaccine safety and effectiveness and a no-fault compensation program for all of Canada to accompany the roll out of the H1N1 flu shots.  - Ottawa Citizen