May 22, 2009
Whether referred to as “utilization of scarce resources,” “altered standards of care,” or “rationing,” decisions regarding patient care during a pandemic will be difficult for health care providers, patients and the public.
In 2006, the NC Institute of Medicine conducted a year-long look at the ethical considerations regarding these difficult decisions and published their initial findings, “Stockpiling Solutions: North Carolina's Ethical Guidelines for an Influenza Pandemic”. These findings were brought to a series of public forums to discuss how the principles would play out in clinical and public settings.
This year, the NC Division of Public Health and the North Carolina Medical Society (NCMS) are developing guidelines for health care practitioners. These guidelines will attempt to provide OBJECTIVE guidelines for use in SUBJECTIVE circumstances when faced with competing demands. Those demands include:
Preserving the guidelines’ objectivity will be accomplished through persistent review of the scientific literature and review of other states’ activities. To that end, we recently participated in the National Academy of Sciences’ Institute of Medicine’s regional summit on altered standards of care and we are working within the Region IV Emergency Support Function 8 (Health and Medical) Unified Planning Coalition with other southeastern states to share promising practices.
The North Carolina guidelines are being developed through a series of meetings of an expanded NCMS Ethical and Judicial Affairs Committee. The committee’s goal is to have the first draft completed by this fall for thorough vetting by a large, multidisciplinary task force. General public review and comment via the NCMS website is expected in late 2009 or early 2010.
For further information, please stay tuned or contact Jan Rhyne, MD (JRhyne@nhcgov.com) or Julie Casani (Julie.casani@dhhs.nc.gov)