Hospital administrators and public health officials have pandemic plans in place. While there may or may not be a deadly pandemic, climate changes will fast-track scary epidemics. It’s good to have emergency and contingency plans in place against pathogens. However, pandemic planning seems to predict that patients, families and loved ones will accept decisions about priority for treatment. If so, is this a reasonable expectation? It is foreseeable that not all people will do as they are told, especially when they are frightened and ill. Yet, almost no country, state, region or community has a Conflict Management Planning Manual associated with their Emergency Planning Manual.
What scenarios might a Conflict Management Planning Manual address:
The plans developed for the last flu scare dealt lightly with policies for such items as who gets what in which order of priority. When a hockey team was inoculated with scarce vaccine ahead of other priority citizens, there was an uproar.
Do pandemic plans take into account the conflict that comes with fear of scarce resources and the frantic desire to get a share?
Is there an appeal mechanism, place for advocacy to have someone bumped up the priority scale, or process for the patient who argues with the ranking given?
Where is the plan for dealing with people who refuse the ranking that might mean death for a child, spouse, parent, or friend?
What are the provisions for when the three-person team making the ranking decisions cannot agree? Is there a void in the plan, or is the plan just silent on how decision makers will keep the peace by keeping patients in their place?
Conflict creates hard choices
Even when decisions, policies and plans are ethically and scientifically based, not everyone will fall into line behind them. That’s human nature. If Planners and Politicians believe that science and medicine will deal with the conflicts their plans create, they are mistaken.
In each pandemic plan should be conflict management strategies and training for the daily dramas that come with staff shortages, contagion fears, dread of disease, burn-out of those who are filling in, stress related illness, and too little of everything.
At the very least, those making the treatment ranking decisions must have strategies and training for resolving the conflicts that will almost certainly arise during their decision-making.