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Ethically Preparing Minnesota for a Pandemic

The Minnesota Pandemic Ethics Project issued a preliminary report on Friday that addressed the ethical considerations of rationing health-related resources in the case of an influenza pandemic affecting Minnesota.

The Project issued a companion report that discussed the challenges and issues of implementing the ethical frameworks recommended by the first report.

The reports have been issued with a high degree of certainty that a pandemic will occur, reported the Star Tribune. In creating the ethical frameworks and recommendations, the reports assumed that nearly one-third of Minnesotans would become ill. The anticipated mortality rate from the disease is 2.1 percent, over 20 times that of seasonal influenza.

"A severe pandemic may cause 32,900 deaths over a 2-year period," said the first report.

The reports estimated that Minnesota is currently well short of being fully equipped for a pandemic, with the resources to vaccinate less than a quarter of the population, and with under 10 percent of the projected necessary number of ventilators.

The first report, For the Good of Us All: Ethically Rationing Health Resources in Minnesota in a Severe Influenza Pandemic included recommended ethical guidelines on the rationing of vaccines, antiviral medications, respirators, masks, and ventilators.

While the first report recommend that some groups, such as the elderly and infants, be de-prioritized for receiving a few specific treatments, the report suggested distributing other resources to them, and focusing on treatment of those who come in contact with them.

The second report, Implementing Ethical Frameworks for Rationing Scarce Health Resources in Minnesota during Severe Influenza Pandemic, recommended that the resources not be restricted to legal Minnesota residents, so as to address the possibility of non-Minnesotans becoming ill in Minnesota. The report also made recommendations concerning the development of plans by both the state and employers, the determination of key workers, possible review of institutional conduct during a pandemic, and the creation of ethics consultation committees.

The next step for the Project is seeking public feedback on the preliminary reports. Rationing based on age is one idea for which the Project is seeking public input, particularly because of an unconventional projected effect of an influenza pandemic with regard to age groups, reported the Pioneer Press. In addition to disproportionately affecting the very young or very old, an influenza pandemic would also substantially affect the 15-40 age group, according to the reports.

"While all of the panel‘s recommendations require public input," the report said, "the notion of age-based rationing was particularly controversial and merits broad public consideration."

The Minnesota Pandemic Ethics Project has developed a website for public comments that presents the material of the reports for public consumption. People can submit comments for the next six weeks.

"Ethically informed plans... require the considered judgment of Minnesotans with diverse experience and expertise. While rationing protocols must be informed by science and the best available evidence, the public may bring different value priorities to rationing... It is essential to inform, engage and consult with Minnesotans in order to ground rationing strategies on statewide values. It is important to know what different Minnesotans think about the recommended frameworks... We anticipate that this public engagement process will begin promoting the community-building necessary for pandemic preparedness concerning scarce health-related resource rationing... After more Minnesotans have provided input, these frameworks will be revised as needed to reflect Minnesotans‘ perspectives and values," said the first report.

The Minnesota Pandemic Ethics Project is led by members of the Minnesota Center for Health Care Ethics and the University of Minnesota Center for Bioethics, and over 100 experts contributed to the reports.