Abstract
Objectives
Recent experiences have demonstrated that restrictive measures remain a useful public health tool during infectious disease outbreaks. However, the use of restrictive measures is not without controversy, as there is no agreed-upon threshold for when and how to invoke restrictive measures. The objectives of this study are to solicit perspectives from Canadians on the ethical considerations of using restrictive measures in response to influenza pandemics, and in turn, to use public views to contribute to a better understanding of what is considered to be the justifiable use of restrictive measures.
Methods
A series of town hall focus groups with Canadian residents from June 2008 to May 2009, in three Canadian regions, in order to achieve broad public engagement (n=3 focus groups with a total of 17 participants).
Results
Two key themes emerged from all town hall focus groups: 1) create an environment for compliance through communication rather than enforcement, and 2) establish the delineation between individual rights, community values, and the greater good.
Conclusion
While there is a need for a decision-making authority and even a mechanism for enforcement, our data suggest that a more tractable approach to restrictive measures is one that enables individuals to voluntarily comply by creating an environment to compel compliance based on communication. This approach requires restrictive measures to be a) proportional to the threat, b) implemented along with reciprocal arrangements provided to those affected, and c) accompanied by open and transparent communication throughout all stages so that citizens can both understand and participate in decision-making.
Résumé
Objectifs
Des expériences récentes ont montré que les mesures restrictives demeurent un outil de santé publique efficace durant les éclosions de maladies infectieuses. Toutefois, le recours à ces mesures est controversé, car il n’y a pas de seuil communément accepté qui indique quand et comment s’en prévaloir. Les objectifs de notre étude étaient de sonder l’opinion des Canadiens sur les considérations éthiques qui soustendent l’emploi de mesures restrictives en réaction aux pandémies d’influenza, et en retour, d’utiliser les résultats de ce sondage pour mieux comprendre ce qui justifie le recours à des mesures restrictives aux yeux du public.
Méthode
Nous avons organisé une série de discussions publiques avec des résidents canadiens entre juin 2008 et mai 2009 dans trois régions du Canada pour obtenir une vaste mobilisation populaire (n=3 groupes de 17 participants en tout).
Résultats
Deux grands thèmes se sont dégagés des discussions publiques; il faudrait: 1) créer un climat de conformité par la communication plutôt que par des mesures coercitives et 2) délimiter les frontières entre les droits individuels, les valeurs collectives et le bien commun.
Conclusion
On aurait besoin d’un pouvoir décisionnel et même d’un mécanisme d’application, mais nos données montrent que l’on peut aborder les mesures restrictives avec plus de doigté en permettant aux gens de se conformer volontairement en créant un climat qui favorise la conformité par la communication. Une telle approche exige que les mesures restrictives soient a) proportionnelles à la menace, b) appliquées en même temps que des accords de réciprocité avec les personnes touchées et c) accompagnées par des communications ouvertes et transparentes à chaque étape pour que les citoyens puissent à la fois comprendre les décisions et participer au processus décisionnel.
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Acknowledgements: This project was financially supported by the Canadian Institutes of Health Research Pandemic Planning Strategic Research Initiative. Mr. Smith is supported by a CIHR Frederick Banting and Charles Best Canada Graduate Scholarship. Dr. Upshur is supported by the Canada Research Chair in Primary Care Research. The authors thank the participants of the Vancouver, Winnipeg, and Saint John town hall meetings, as well as those who collaborated with, and who are team members of, the Canadian Program of Research on Ethics in Pandemic (CanPREP).
Conflict of Interest: None to declare.
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Smith, M.J., Bensimon, C.M., Perez, D.F. et al. Restrictive Measures in an Influenza Pandemic: A Qualitative Study of Public Perspectives. Can J Public Health 103, e348–e352 (2012). https://doi.org/10.1007/BF03404439
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DOI: https://doi.org/10.1007/BF03404439