Development of a framework for better incorporating ethical considerations in public health policy during emergencies

为应对COVID-19大流行，各国政府出台了前所未有的政策（如封锁），并提出了许多具有挑战性的问题。英国对疫情的应对尤其有争议。英格兰的COVID-19死亡率非常高。它也是封锁时间最长的国家之一。封锁限制了人们的行动自由，对人们的心理健康、工作保障、福祉和儿童的学习能力产生了不利影响。本来就处于不利地位的人受到了不成比例的影响。公共卫生从业人员和科学顾问在向政治家提供建议时应如何平衡这些相互矛盾的关切？这种平衡非常困难，在大流行期间更是如此。为指导决策，为应对2002-2004年严重急性呼吸系统综合症（SARS）疫情和2014-2016年埃博拉病毒疫情等早期流行病，制定了道德准则和建议。然而，目前尚不清楚现有的指导方针和道德框架是否（如果有，如何）在COVID-19大流行期间帮助了政策制定。我们必须从目前的大流行应对中吸取教训，并相应地修订框架，以便在未来的突发公共卫生事件中使用。我旨在回答以下问题：在紧急情况下提供政策建议时，利益相关者如何做出（隐性或显性）价值判断？有哪些工具可以帮助利益相关者，这些工具的优缺点是什么？我们如何从英格兰实施封锁等政策的经验中学习，以更好地应对未来的突发公共卫生事件？为了帮助我理解应对措施和替代政策，我将首先系统地从学术文献中收集证据。然后，我将在英国和国际上采访大约35名利益相关者。其目的是深入了解利益相关者是如何做出决策的，并特别关注他们想要促进的目标。我将调查伦理方面的学术文献，这些文献涉及目标和伦理考虑，以检查利益相关者和伦理文献之间的协议和分歧的要点。我将在两个研讨会上向公共卫生从业人员、科学顾问和伦理学家介绍我的临时分析，并根据他们的反馈，就如何更好地将伦理考虑纳入未来突发公共卫生事件的政策提出建议。潜在的应用和益处一个改进的突发公共卫生事件伦理决策框架至关重要。在突发公共卫生事件中作出政策决定时，决定的内容和时机将决定成千上万人的生死、失去或保留收入来源，以及他们被限制在家中的时间是更长还是更短。仔细研究利益攸关方在就全国范围内的封锁提供建议时可用的（正式和非正式）框架，将使我们深入了解2019冠状病毒病大流行期间做出的一些最重要的政策决定。利用这些知识制定一个框架，可用于改进我们对未来突发公共卫生事件的集体反应。最后，如果我们学会如何在突发公共卫生事件期间改进政策建议，这可以作为学术伦理学家如何使他们的工作与政策更相关的一个有价值的模型。

ContextIn response to the COVID-19 pandemic, governments have introduced policies (such as lockdowns) which are unprecedented and raise many challenging questions. The response to the pandemic in England has been particularly contested. England has had very high death rates from COVID-19. It is also one of the countries with the longest periods of lockdown. Lockdowns curtail the freedom to move around and adversely affects people's mental health, job security, well-being, and children's ability to learn. People who are already disadvantaged have been disproportionally affected. How should public health practitioners and scientific advisors balance these competing concerns when giving advice to politicians? This balancing act is extraordinarily difficult, even more so in a pandemic.To guide policymaking, ethical guidelines and recommendations have been developed in response to earlier epidemics, such as the Severe Acute Respiratory Syndrome (SARS) outbreak in 2002-2004, and the Ebola virus epidemic in 2014-2016. However, it is unclear whether (and if so, how) existing guidelines and ethical frameworks helped with policymaking during the COVID-19 pandemic. It is essential that we learn from the current pandemic response and revise frameworks accordingly for use in future public health emergencies. Aims of the researchI aim to answer the following questions: How do stakeholders make (implicit or explicit) value judgements when giving policy advice in an emergency? What tools exist to aid stakeholders, and what are the strengths and weaknesses of these tools? How can we learn from the experience of implementing policies such as lockdowns in England to do better in future public health emergencies? To help me understand the response and alternative policies, I will first systematically gather evidence from the academic literature. I will then interview approximately 35 stakeholders in England and internationally. The aim is to get a rich understanding of how stakeholders made their decisions, with a particular focus on what aims they wanted to promote. I will survey the academic literature in ethics, which deals with aims and ethical considerations, to examine the main points of agreement and disagreements between stakeholders and the ethics literature. I will present my provisional analysis to public health practitioners, science advisors and ethicists in two workshops and, based on their feedback, develop recommendations for how ethical considerations can be better incorporated into policy in future public health emergencies.Potential application and benefitsAn improved framework for ethical decision-making in public health emergencies is of paramount importance. When policy decisions are made in public health emergencies, the content and timing of decisions will dictate whether thousands of people live or die, lose or retain their source of income, and whether they are confined to their homes for a shorter or longer period. A close study of the (formal and informal) frameworks stakeholders had at their disposal when giving advice about nationwide lockdowns will give us insight into some of the most important policy decisions made during the COVID-19 pandemic. The development of a framework that draws on this knowledge can be used to improve our collective response in future public health emergencies. Finally, if we learn how to improve policy advice during a public health emergency, this could serve as a valuable model for how academic ethicists can make their work more relevant for policy.