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CanPREP Public Symposium 'Ethics & Pandemic Influenza'

On the afternoon of September 23rd 2009, the CanPREP project held a public symposium at the University of Toronto Joint Centre for Bioethics. The aim of this symposium was to address the ethical issues raised by the current H1N1 pandemic, including the duty to care of health care providers, allocation of scarce resources, risk communication, and the use of restrictive measures. Symposium attendees included health care providers, professional college representatives, community organizations, and the public. The symposium was also covered extensively by various media representatives and was broadcasted live online. The afternoon consisted of two sessions, each consisting of a CanPREP presentation, a panel discussion, and a discussion period.

Dr. Ross Upshur began the symposium with an overview of CanPREP’s current research in duty to care, priority-setting, restrictive measures, and global ethics. Preliminary research findings from each of these areas were shared, including national survey results and CanPREP Pandemic Town Hall data. These findings focused on data collected through public engagement, a main focus of the CanPREP project.

Panelists for both sessions were selected from various disciplines involved in pandemic planning and response. The panelists for the first respondent panel were Brian Schwartz, Ontario Agency for Health Protection and Promotion; Elaine Johnston, Mamaweswen North Shore Tribal Council; Cindy Bruce-Barrett, Hospital for Sick Children; and Jeff Blackmer, Canadian Medical Association. Panelists for the second panel were Barbara Yaffe, Toronto Public Health; Tara Tyson, Toronto Community Care Access Centre; Gerda Kaegi, Canadian Pensioners Concerned Inc.; and Gillian Howard, Toronto Academic Health Science Network.

CanPREP research was highlighted once again in the second session where work on current research topics was shared. While the project is working on several current research topics, our work on vaccines, risk communication, vulnerability, and public trust were presented.

The CanPREP White Paper Series was also made available at the symposium. The CanPREP team prepared a series of ‘white papers’ on the ethical challenges posed by pandemic influenza. This series contains nine 3-page white papers outlining research findings from the major CanPREP themes.

The panelists shared many emerging issues relating to their specific area of influenza pandemic work. Some of the major ones included the need for culture to be addressed, especially in the First Nations communities. Different cultures contain different aspects, thus altering their perceptions on H1N1 response. Furthermore, the use of correct language and terminology must be implemented for clear messaging and communication.

Influenza pandemic issues that pediatric patients will face were also brought forward. Many current protocols are adult focused, thus there must be more work done on these through a pediatric lens. When working with children, families are often involved in decision making and this must be implemented when forming pandemic triaging protocols.

Ventilator scarcity and triaging was brought up once again, however the issue of when to remove patients from ventilators was also mentioned.

Overall, a clear recurring theme that arose throughout the panelist discussions was the particular challenges that may arise in the community during an influenza pandemic. CanPREP hopes to tackle these issues in its upcoming research work.

The CanPREP team would like to thank all panelists and attendees for making the CanPREP 'Ethics & Pandemic Influenza' Public Symposium a great success. Many more ethical issues must be addressed revolving around the H1N1 pandemic, thus CanPREP is in the preliminary stages of organizing a second symposium in November. Details will be released in next month's CanPREP Digest and on this page.

The entire online broadcast of this symposium can be viewed below:

'Ethics & Pandemic Influenza' Public Symposium - Media Coverage:

Several major news sources such as The Globe and Mail, Ottawa Citizen, CTV News, The National Post, Global TV, and the Canadian Free Press all covered the CanPREP Symposium. Radio interviews were also given on Calgary’s AM 770 and CBC Radio.

Below is a list of media coverage from various sources:

Critical Care Triage for H1N1: A Symposium on Emerging Ethical Issues

Priority setting and the allocation of ventilators and other scarce resources have been important areas when discussing ethical issues in a pandemic. On November 25th, 2009 CanPREP held a bioethics symposium at the Joint Centre for Bioethics in hopes of bringing some of these ethical issues forward. Not only do difficult questions still remain concerning priority setting of scarce resources, but strategies for triage and discharge in the intensive care unit (ICU) are also posing as challenges. The Symposium, entitled: ‘Critical Care Triage for H1N1: A Symposium on Emerging Ethical Issues,’ included a panel discussion with panelists chosen to provide current insight and discussion into the issues facing critical care during the progression of the H1N1 pandemic.

Invited panelists:

Dr. Ross Upshur commenced the symposium with an overview of current and upcoming CanPREP research. This was followed by an introduction by Shawn Winsor on critical care triaging during the H1N1 pandemic and the various triage plans that are currently in circulation. He also spoke on the need for supplementary criteria, which can be used as non-clinical criteria secondary to the SOFA scoring scale. Winsor is the chair for the Joint Centre for Bioethics Pan Flu Supplementary Triage Criteria Taskforce. The aim of this taskforce is to generate a list of criteria that can help in the ICU admission process, once ventilated beds become limited.

Each panelist was then invited to the podium to discuss their current work in pandemic triaging. Andrea Frolic began by introducing the Hamilton Health Sciences Triage Plan, which was completed earlier this fall as a way of filling in the gaps of the Ontario pandemic plan. Frolic mentioned the need for an ethical framework, as a duty to individuals and the community. She also mentioned that the implementation of ethics in health policy brings forward several issues, including: ‘who should be included as an expert?’, ‘what if the legal, medical, ethical, community, etc. views clash during deliberation?’, and ‘what is the definition of “good” when we are trying to do the most good for society?’

Gerda Kaegi, representing older adult populations, spoke on the continuous need for public engagement in order to build trust. She also expressed gratitude towards the CanPREP team for their engagement with the public in various research assignments. Kaegi stressed upon the ageism criterion, which is currently found in many pandemic plans, and the drawbacks in implementing this criterion. She points out that ageism is not a medical criteria and that decision-makers must broaden their thinking of ageism in order for policies to be fair and ethical to all.

The final panelist of symposium was Michael Christian, a co-author of the critical care triage plan which has been implemented into the Ontario Health Pandemic Influenza Plan. Christian explained his protocol and clarified that at the time of the plan’s preparation (2006) it was the best protocol they had. He discussed the inconsistencies between institutions and the need for a balanced playing field across hospitals. The need for supplementary criteria, after medical criteria have been applied, is also an area Christian believes must be focused on. He is also a current member of the Joint Centre for Bioethics Pan Flu Supplementary Triage Criteria Taskforce.

The ethical, as well as legal, issues brought forward by the panelists are all concerns that must be addressed when formulating pandemic triage plans. Furthermore, public engagement and communication between the general public and stakeholders is needed to ensure that ethical frameworks are implemented into pandemic plans correctly. CanPREP looks to tackle these ethical issues in future research.

The CanPREP team would like to thank all panelists and attendees for making the “Critical Care Triage for H1N1: A Symposium on Emerging Ethical Issues” a success.

The entire online broadcast of this symposium can be viewed below: