ABSTRACT
Tackling an outbreak as it unfolds is a complex, fluid and challenging task, which inevitably creates pressing ethical and social issues. There are at least four areas of possible tensions, and more are anticipated to emerge as different pandemic circumstances give rise to different ethical concerns. Expected tensions are around:
restrictions to personal freedoms: they have the greatest potential for generating discrimination, resulting in unequal burdens for various groups, creating new inequalities and exacerbating existing ones. They can also produce stigma;
duty to provide care: healthcare workers’ duty to provide care comes into conflict with other responsibilities for caring. Reciprocity may demand that healthcare workers are supported appropriately as they take on great risks;
priority setting and resource allocation: these are the issue likely to generate the most social and ethical tensions. Many principles can be invoked to decide who and how to prioritise, but they range widely and sometimes are in tension with one another;
international cooperation and global governance: there are wide disparities amongst health services in different countries. Ethical tensions arise around international solidarity, as well as around border and cross-border issues and in relation to specific groups (including refugees, tourists and displaced persons).
