Ethics in epidemics, emergencies and disasters: research, surveillance and patient care
Training manual
Overview
Epidemics, emergencies and disasters raise many ethical issues for the people involved, who include responders, public health specialists and policy-makers. This training manual provides material on ethical issues in research, surveillance and patient care in these difficult contexts, as well as related issues to reduce risks before, during and after events.
The idea for this manual can be traced back to a WHO technical consultation on Research ethics in international epidemic response (World Health Organization, 2010). In the resulting report, the experts took positions on three main issues. First, they asserted that “the principles and values embodied in international and national ethics guidelines, as well as human rights instruments, must be upheld” (p. 7) in the conduct of research in epidemic response. Secondly, they expressed reluctance to ground the need for ethical oversight on the classical distinction between health practice and research (i.e. the primary intent of the activity), recognizing that such a distinction easily becomes blurred during emergencies. Thirdly, the experts considered a number of adaptations of ethical oversight and processes, focusing on the deliberations of research ethics committees. Other issues were more directly related to surveillance and patient care during emergencies. The technical consultation reaffirmed the importance of addressing the conflicts among various ethical considerations during research, surveillance and patient care in emergencies, including access to standards of care, confidentiality, the duty to care, fairness, informed consent, liberty, moral relativism and privacy.