Ethical Standards to Improve Local Response Capacity to Infectious Disease Events

描述（由申请人提供）：当地卫生部门的工作人员位于公共卫生应急准备系统的中心。最近，越来越多的研究发现，在应对传染病威胁（从自然发生的大流行病到生物恐怖主义事件）的意愿方面，这方面的工作人员存在令人不安的态度差距。我们的研究小组成员进行的研究确定，如果公共卫生工作者认为他们的反应是强制性的，而不是自愿的，如果他们相信他们的机构正在采取额外的措施来保护他们和他们的家人，他们就更有可能对传染病事件作出反应。这些研究结果强调，在传染病爆发之前，地方卫生部门领导和一线工作人员需要更好地了解传染病应对的道德和交叉法律层面。需要提供指导，帮助地方卫生部门处理在平衡个人（即其雇员）权利和公共利益时出现的道德紧张关系。拟议项目的目标是制定一份合乎道德的指导文件，供地方卫生部门用于规划和执行它们对传染病爆发的反应。我们的目标是：1)描述和描述当地卫生部门工作人员（雇主/管理人员）在传染病暴发（人为或自然）期间履行专业职责的意愿相关的法律和道德义务的看法；使用(a)与当地卫生部门工作人员组成的焦点小组，(b)与当地卫生部门管理人员和一线工作人员进行的关键信息提供者访谈，以及(c)对当地卫生部门工作人员进行全国调查，研究最佳政策制定、实施和执行的障碍；2)通过(a)对我们的描述性调查结果应用适当的道德规范和法律考虑，为地方卫生部门雇主/行政人员制定指导文件，以确定道德义务与交叉的法律标准和自我报告的回应意愿之间的紧张关系，包括确定具体关切的详细例子；(b)征求相关利益相关者的直接反馈。该项目将受益于一个专家咨询委员会的持续投入，并得到全国县和市卫生官员协会的支持。在财政紧缩和公共卫生机构大量裁员之际，必须采取创新措施，确保对传染病爆发作出有效反应。因此，特别迫切需要在道德方面提供指导，平衡公共卫生工作人员的权利与公共利益。

DESCRIPTION (provided by applicant): The local health department workforce sits at the hub of the public health emergency preparedness system. A growing body of research has recently identified troubling attitudinal gaps among this workforce regarding willingness to respond to infectious disease threats, ranging from naturally-occurring pandemics to bioterrorism events. Research conducted by members of our study team has determined that public health workers are more likely to respond to infectious disease events if they perceive their response as mandatory rather than voluntary, and if they believe their agency is taking extra measures to protect them and their families. These findings emphasize the need for a greater understanding among local health department leadership and line staff of the ethical and intersecting legal dimensions of infectious disease response in advance of an outbreak. Guidance is needed to help local health departments address the ethical tensions that arise when balancing the rights of individuals (i.e., their employees) and the public good. The goal of the proposed project is to develop an ethically sound guidance document for local health departments to use in planning for and executing their responses to infectious disease outbreaks. Our aims are to: 1) Describe and characterize perceptions of legal and ethical obligations relevant to willingness to fulfill professional roles during infectious disease outbreaks (manmade or natural) among local health department workers (employers/administrators; employees) and barriers to optimum policy creation, implementation, and enforcement using (a) focus groups with members of the local health department workforce, (b) key informant interviews with local health department administrators and front line staff, and (c) a national survey of the local health department workforce; 2) Develop a guidance document for local health department employers/administrators by (a) Applying appropriate ethical norms and legal considerations to our descriptive findings to identify tensions between ethical obligations and intersecting legal standards and self-reported willingness to respond, including identifying detailed examples of particular concerns; (b) Solicit directed feedback from relevant stakeholders. This project will benefit from the on-going input of an expert Advisory Committee and has the support of the National Association of County and City Health Officials. In this time of fiscal austerity and significant workforce cutbacks in public health agencies, innovative measures are necessary to ensure effective responses to infectious disease outbreaks. Therefore, the need for ethically informed guidance that balances the rights of members of the public health workforce with the public good is especially acute.