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Academia and the Profession |

Clinical Decision Making during Public Health Emergencies: Ethical Considerations

Bernard Lo, MD; and Mitchell H. Katz, MD
[+] Article, Author, and Disclosure Information

From the University of California, San Francisco, and the San Francisco Department of Public Health, San Francisco, California.

Acknowledgments: The authors thank Patricia Zettler for her expert research assistance.

Grant Support: By the Greenwall Foundation.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Bernard Lo, MD, Division of General Internal Medicine, University of California, San Francisco, Room C 126, 521 Parnassus Avenue, San Francisco, CA 94143-0903; e-mail, bernie@medicine.ucsf.edu.

Current Author Addresses: Dr. Lo: Division of General Internal Medicine, University of California, San Francisco, Room C 126, 521 Parnassus Avenue, San Francisco, CA 94143-0903.

Dr. Katz: San Francisco Department of Public Health, 101 Grove Street, Room 308, San Francisco, CA 94102.

Ann Intern Med. 2005;143(7):493-498. doi:10.7326/0003-4819-143-7-200510040-00008
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Recent public health emergencies involving anthrax, the severe acute respiratory syndrome (SARS), and shortages of influenza vaccine have dramatized the need for restrictive public health measures such as quarantine, isolation, and rationing. Front-line physicians will face ethical dilemmas during public health emergencies when patients disagree with these measures. Patients might request interventions that are not recommended or for which they are not eligible, or they might object to intrusive or restrictive measures. The physician's primary responsibility in such emergencies is to the public rather than to the individual patient. In public health emergencies, physicians need to address the patient's needs and concerns, recognize their changed roles, and work closely with public health officials. Physicians can still work on behalf of patients by advocating for changes in policies and exceptions when warranted and by mitigating the adverse consequences of public health measures. Before an emergency occurs, physicians should think through how they will respond to foreseeable dilemmas arising when patients disagree with public health recommendations.


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Physician responses when patients disagree with public health guidelines in an emergency.
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