Framework In some instances, ethical principles will be enough to help individuals and groups respond to a pandemic in an ethical manner. However, there are particularly difficult ethical situations that may need greater support or analysis, particularly in a pandemic relating to public health. Marckmann et al describe a framework for thinking through the ethics of public health. 95 They describe a set of objectives that those who are making ethically complex public health decisions should aim for.
Making ethically complex public health decisions The following seven elements show the aims of ethically complex public health decisions. Public health focuses on groups of people rather than individuals and could involve decisions about a wide range of situations or services that impact the Te Whare Tapa Whā model of health. 1.
Transparency Transparency means that those making significant decisions during a pandemic can demonstrate how they considered and applied ethical principles and evidence. This element relates strongly to the principle of tika and enables openness and reasonableness.
2.
Consistency Consistency, or applying the same principles and criteria across different public health interventions, does not undermine the principle of equity. Instead, having identified that equity is a shared principle for Aotearoa New Zealand, consistency ensures that we do not put aside equity when it could be inconvenient, difficult, or politically inconvenient.
3.
Justification Justification implies a good faith effort to show how the pandemic decision is one that follows from the evidence and principles. Justification is particularly important for contributing to the principles of kotahitanga and liberty.
4.
Participation Participation is about helping those affected by public health interventions to participate in decisionmaking. Undoubtedly, this element would be difficult to implement in a pandemic, nevertheless, it links to tika and operating in an open manner, as well encouraging manaakitanga at a collective level.
5.
Managing conflicts of interest Managing conflicts of interest for decision-makers and minimising harm allows the principle of health and wellbeing to flourish.
6.
Openness for revision Being open to revising public health interventions in pandemics, following changes or new information is an important prerequisite to enabling the principles of health and wellbeing and tika.
7.
Regulation Having a regulatory framework that guarantees the other six decision-making elements means that New Zealanders have a clear indication about how decisions will be made and their relationship to the six national ethical principles for a pandemic.
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