of life and order.” Sutton, who has taken a similar approach to defining an ethic of biodefense and bioterrorism (Sutton, 2005) views ethics as a precursor to law (see also Chapter 3 and the Summary and Assessment), while Capron portrays ethics as integral to public health policy.

Capron’s essay also features “straightforward, practical suggestions” for pandemic preparations that are supported by ethical principles. At the national level he advocates advanced planning, communication, and public involvement in order to realize an “ethically responsible and appropriate response.” At the international level, he calls on governments of wealthier nations to announce support for poor, early-affected countries out of both ethical responsibility and self-interest. Even if public debate results in differences in pandemic policies among communities and countries, Capron contends, civic engagement will promote the understanding and acceptance of necessarily imperfect—but beneficial—public health measures.

Focusing on the disproportionate burden that a pandemic is likely to place on the world’s poorest people and countries, Ruth Faden of Johns Hopkins University asserts in her contribution to this chapter that “the greatest moral challenge posed by a pandemic is how to respect commitments to social justice in the face of the overwhelming and entrenched inequalities.” Such inequalities result from efforts to control avian influenza that disproportionately burden poor countries and benefit wealthy ones, and they are also likely to result from an exacerbation of social injustice within the U.S. and other wealthy countries in the response to a pandemic. Therefore, Faden argues, governments bear a moral responsibility to identify where social injustices are likely to occur as the result of a pandemic and to take reasonable steps to prevent or reduce the worst among them. In order to support this effort, Faden and fellow members of the Bellagio Group have developed a set of principles that are intended to uphold the rights and interests of disadvantaged groups in pandemic planning and response as well as a set of checklists to guide the incorporation of these principles into pandemic planning and response. In her essay, Faden describes these principles, the rationale behind them, and their significance to public health policy and practice.

As noted in the Summary and Assessment, several workshop participants raised concerns regarding the lack of clear authority for decision-making in public health emergencies. Sutton has described the history and consequences of the longstanding conflict between federal and state claims to public health authority and has suggested a potential resolution through a system of “cooperative federalism” in which the federal government establishes standards for pandemic measures that are subsequently administered by state government and implemented at the local level (Sutton, 2001). This model of federal leadership is endorsed and expanded upon in the chapter’s third essay, by speaker Shelley Hearne of Johns Hopkins University, who argues that “from an ethical standpoint, federal health agencies should play a more directive role in establishing standards and critical requirements for state and local jurisdictions in order to ensure equal



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