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Facing Ethical Challenges, Dealing with Outcomes: Stories from the Field. Harvey Kayman, MD, MPH, PHMO III University of California, Berkeley California Department of Public Health. Learning Objectives.

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Facing ethical challenges dealing with outcomes stories from the field

Facing Ethical Challenges, Dealing with Outcomes: Stories from the Field

Harvey Kayman, MD, MPH, PHMO III

University of California, Berkeley

California Department of Public Health


Facing ethical challenges dealing with outcomes stories from the field

Learning Objectives

  • List and describe public health ethical principles and an ethical framework to resolve moral tensions disasters might bring up

  • Review scenarios that will illustrate how the framework and principles can be used

  • Develop methods to make decisions with collaborators in the midst of a disaster


Facing ethical challenges dealing with outcomes stories from the field

Biomedical and Public Health Ethics

Personal autonomy vs. the common good

Obligation vs. responsibilities

Autonomy

Beneficence

Beauchamp, TL, Childress, JF. Principles of Biomedical Ethics. Oxford University Press, New York, any edition.


Facing ethical challenges dealing with outcomes stories from the field

Biomedical and Public Health Ethics (cont)

Non maleficence, minimize harm

Justice

Authority and decision making

Least unfair distribution of benefits and burdens

http://plato.stanford.edu

Kayman, H, Ablorh-Odjidja, A. Revisiting Public Health Preparedness: Incorporating Social Justice Principles Into Pandemic Preparedness Planning for Influenza J Public Health Management Practice. 2006. 12(4), 373–380.


Facing ethical challenges dealing with outcomes stories from the field

transparency

inclusion in decision-making process

accountability

precautionary principle

Kurland, J. Editorials and The Heart of the Precautionary Principle in Democracy.Public Health Reports. 2002. Nov–Dec. 117,491–500.


Facing ethical challenges dealing with outcomes stories from the field

The Precautionary Principle

Action, even coercive action, must be taken when there is a serious threat to the public’s welfare, often in the face of uncertainty.


Facing ethical challenges dealing with outcomes stories from the field

Personal autonomy and the common good

Least unfair distribution of benefits and burdens

Jay Johnson

Rob Elkins


Facing ethical challenges dealing with outcomes stories from the field

Obligation and responsibilities

Mark Oberle


Facing ethical challenges dealing with outcomes stories from the field

Authority and decision making

Carl Osaki


Facing ethical challenges dealing with outcomes stories from the field

Poll Question

Have you encountered any situations similar to these in your work?

Yes

Sort of

No

No, but I have encountered other kinds of ethical dilemmas

Click on the down arrow if you can’t see the response choices.


Facing ethical challenges dealing with outcomes stories from the field

Poll Question

Do you have a mechanism for handling ethical dilemmas such as these in your workplace?

Yes

Sort of

No

No, but I have some ideas of how we might handle these situations

Click on the down arrow if you can’t see the response choices.


Facing ethical challenges dealing with outcomes stories from the field

Decision Making and Problem Solving

Step 1

Identify the problem

Step 2

Explore alternatives

Step 3

Select an alternative

Step 4

Implement the solution

Step 5

Evaluate the situation

FEMA IS 241


Facing ethical challenges dealing with outcomes stories from the field

Step 1. Identify the Problem

Protocol for Decision Making in the Midst of Crises: Role of Convener

Gather & discusswith participantstrained to usemethod

Determine that adecision must be made

Define problem clearly

Assure data are accurate, complete and up to date

Gather all pertinent data

Describe desiredoutcomes

Proposed by Harvey Kayman, with adaptations from FEMA IS 241


Facing ethical challenges dealing with outcomes stories from the field

Step 1: Identify the Problem

Protocol for Decision Making in the Midst of Crises: Role of Convener

Gather appropriate stakeholders

Present data from evidence, models, & expert input

Describe problem, resources, and desired outcome

Discuss & analyze problem, data, and options

Describe timeframe to implementation

Proposed by Harvey Kayman, with adaptations from FEMA IS 241


Facing ethical challenges dealing with outcomes stories from the field

Step 2: Evaluate Alternatives

  • Does this solution fit the circumstances?

  • Is the action worth doing?

  • Will this option meet the objectives?

  • Has the cost/benefit ratio been considered?

FEMA IS 241


Facing ethical challenges dealing with outcomes stories from the field

Step 2: Evaluate Alternatives

Identify Constraints

Technical

Political

Safety

Financial

Social

Human resources

Environ-mental

Time urgency

Legal

Ethical

FEMA IS 241


Facing ethical challenges dealing with outcomes stories from the field

Step 2: Evaluate Alternatives

Checklist of Questions to Consider

  • If you should take on the responsibilities, who are your important partners, other stakeholders, consultants, etc.?

  • Do you have the data to support your choices?

  • Do you have the capacity to deliver the resource?

  • If not, what materials, resources and trainings are needed to expand capacity?

Proposed by Harvey Kayman, with adaptations from FEMA IS 241


Facing ethical challenges dealing with outcomes stories from the field

Step 2: Evaluate Alternatives

Ethical Questions to Consider (cont)

  • Is your decision about resource allocation equitable or does that matter?

  • Will it result in the “least unfair” distribution of benefits and burdens?

  • What gives you the authority to make this decision?

Proposed by Harvey Kayman, with adaptations from FEMA IS 241


Facing ethical challenges dealing with outcomes stories from the field

Step 2: Evaluate Alternatives

Ethical Questions to Consider

  • Do you have the time and expertise to examine for bias?

  • Will implementation interfere with some group’s autonomy in support of the common good?

  • What are potential consequences: negative, positive, undesired, not anticipated in the past, etc.?

Proposed by Harvey Kayman, with adaptations from FEMA IS 241


Facing ethical challenges dealing with outcomes stories from the field

Professionalism

Social Solidarity

attachment

interdependence

shared beliefs

commitment

involvement

public order

subsidiarity

safety

common good

ready access

evidence based

competence

consistency

adaptive

consensus driven

duty to act

reciprocity

transparency

integrity

Justice

informed consent/refusal

disclosure/truth-telling

nonmaleficence

confidentiality

beneficence

stewardship

autonomy

equality

equity

difference principle

proportionality

due process

liberty

J. F. Tuohey. A Matrix for Ethical Decision Making in a Pandemic. The Oregon Tool for Emergency Preparedness. Health Progress 88 (6) November–December 2007


Facing ethical challenges dealing with outcomes stories from the field

Step 3: Select an Alternative

Determine Objectives

Used to monitor progress and establish priorities

Based on analysis of the situation and contingencies

Objectives: measurable targets


Facing ethical challenges dealing with outcomes stories from the field

Step 4: Implement the Solution

Develop an Action Plan

  • Identify needed resources:

  • How much will it cost?

  • Do you have the money to support implementing your decisions?

  • If not, can you get the money in time?

  • What is the likely source of funding?

  • Will your partners provider in kind resources?

Proposed by Harvey Kayman, with adaptations from FEMA IS 241


Facing ethical challenges dealing with outcomes stories from the field

Step 4: Implement the Solution

Build a Plan

  • Who?

  • Will do what?

  • With whom?

  • By when?

  • Where?

  • How?

FEMA IS 241


Facing ethical challenges dealing with outcomes stories from the field

Step 5: Evaluate the Situation

Later Steps

Adapt for use by others

Create after action report

Share knowledge with others

Evaluate process

Improve as needed

Proposed by Harvey Kayman, with adaptations from FEMA IS 241


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