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，这支队伍在应对传染病威胁（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已经确定，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，并且如果他们相信他们的机构正在采取额外措施来保护他们及其家人，那么他们更有可能对传染病事件做出反应。这些研究结果强调，在爆发前，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伦理和交叉法律的方面。需要提供指导，帮助地方卫生部门解决在平衡个人权利时出现的伦理紧张局势（即，员工）和公共利益。拟议项目的目标是为地方卫生部门制定一份道德上健全的指导文件，用于规划和执行其对传染病爆发的反应。我们的目标是：1）描述和描述与传染病爆发期间履行专业职责的意愿相关的法律的和伦理义务的看法（人为或自然）在当地卫生部门工作人员中（雇主/行政人员;雇员）和障碍，以最佳的政策制定，实施和执行使用（a）重点小组与成员的地方卫生部门的劳动力，（B）与当地卫生部门管理人员和一线工作人员进行的关键线人访谈，以及（c）对当地卫生部门工作人员进行的全国性调查; 2）为当地卫生部门的雇主/管理人员制定指导文件，将适当的道德规范和法律的考虑因素应用于我们的描述性调查结果，以确定道德义务与交叉的法律的标准之间的紧张关系以及自我报告的回应意愿，包括确定特别关注的详细例子;（B）征求相关利益攸关方的直接反馈意见。该项目将受益于一个专家咨询委员会的持续投入，并得到全国县市卫生官员协会的支持。在目前财政紧缩和公共卫生机构大幅裁员的情况下，必须采取创新措施，以确保有效应对传染病爆发。因此，特别迫切需要提供道德上知情的指导，以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.