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University of Minnesota
University of Minnesota

Redefining citizenship

November 13, 2009

Bottles of vaccine and a syringe.

One issue around vaccines is whether or not the government should force people who provide direct patient care to be vaccinated. "We don't give people the option of putting on gloves when they operate," says Jeffrey Kahn. "... I think there's a debate worth having about whether vaccine is like that."

U expert Jeffrey Kahn examines ethical concerns in a global pandemic

By Rick Moore

Months after the onset of the H1N1 flu pandemic, Minnesotans are aware of most of the dos and don'ts of staying healthy—and keeping others healthy. Wash your hands a lot. Keep your sneezes to yourself. If you're sick, stay home from work. And if your child is sick, keep him or her out of school.

But there are many other things to think about in a pandemic, according to Jeffrey Kahn, director of the Center for Bioethics at the University of Minnesota.

Fortunately, Minnesotans naturally tend to be good citizens. "We turn out to be a very well-behaved community when it comes to public health, he says. "We know this from the last time there was a shortage of flu vaccine. We told people, only come [for a vaccine] if you fall into one of the high-risk groups. And in fact, people were so well-behaved there was excess vaccine."

That's one example of what Kahn calls good citizenship in the time of a pandemic. There are other scenarios, other choices we make, where we may not be as conscious of the ramifications. People know it's not a good idea to go to work or to school when they're sick with the flu, but what about getting to the grocery store for soup and crackers or to the drug store for medications?


Good citizenship would dictate that we refrain from making those trips, and that the task goes to someone who's not sick. "A good citizen would know that their neighbors were ill and make a phone call and say, 'Can I go to Cub Foods for you? I'm going anyway. What can I buy you? I'll buy you groceries. I'll leave them on your doorstep.' ... But that requires us to behave in a particular way. So, I think we want to encourage people to think about what it takes to be a good citizen in a particularly difficult time in our community."



Part of the problem this fall is that people are finding it difficult to distinguish whether they have H1N1, seasonal flu, or a common cold. And as Kahn points out, you might not be able to stay home every time you have a cough.

That leads to another issue. For some families in which a single parent or both parents are working, it can be very difficult to have someone stay home with a sick child. In certain areas where parents had no other options for childcare, there have been much higher rates of H1N1 infection, Kahn says.

There may be another ethical dilemma down the road if there were to be a severe outbreak of H1N1: who would get to use a hospital's ventilators—an older person who's critically ill or a younger person who may not be as ill?

"We don't have lots of extra machines like that, so how do we decide who gets to stay on and who doesn't?" Kahn says.

It's questions like these that Kahn and others at the U are well situated to answer. "We have the interdisciplinary expertise [at the University] to bring to bear. We can work with people in public health, in ethics, in medicine and help the state come to grips with what we hope will never happen. But let's be prepared for the time it does."

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