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July 2004, Vol 94, No. 7 | American Journal of Public Health 1096-1102
© 2004 American Public Health Association

GOVERNMENT, POLITICS, AND LAW

Ethical Challenges in Preparing for Bioterrorism: Barriers Within the Health Care System

Matthew K. Wynia, MD, MPH and Lawrence O. Gostin, JD

Matthew K. Wynia is with the Institute for Ethics, American Medical Association, Chicago, Ill. Lawrence O. Gostin is with the Center for Law and the Public’s Health, Georgetown University, Washington, DC.

Correspondence: Requests for reprints should be sent to Matthew Wynia, MD, MPH, Director, the Institute for Ethics, American Medical Association, 515 N State St, Chicago, IL 60610 (e-mail: matthew_wynia{at}ama-assn.org).

Preparedness for bioterrorism poses significant ethical challenges. Although public health ethics and preparedness have received attention recently, health care ethics must also be considered.

In epidemics, the health care system assists public health in 3 tasks: detection, containment, and treatment. Detection might fail if all patients do not have access to care, or if physicians do not understand their obligation to report infectious diseases to public health authorities. Containment might fail if physicians view themselves only as advocates for individual patients, ignoring their social obligations as health professionals. Treatment might fail if physicians do not accept their professional duty to treat patients during epidemics.

Each of these potential ethical barriers to preparedness must be addressed by physicians and society.




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