摘要：Large-scale infectious epidemics present the medical community with numerous medical and ethical challenges. Recent attention has focused on the likelihood of an impending influenza pandemic caused by the H5N1 virus. Pregnant women in particular present policymakers with great challenges to planning for such a public health emergency. By recognizing the specific considerations needed for this population, we can preemptively address the issues presented by infectious disease outbreaks. We reviewed the important ethical challenges presented by pregnant women and highlighted the considerations for all vulnerable groups when planning for a pandemic at both the local and the national level. THE RECENT WIDESPREAD global attention on pandemic influenza planning comes at a time when society has had recent direct experience with large-scale disasters. Policymakers and health care providers are increasingly recognizing the importance of preemptive disaster preparedness for catastrophic events, whether environmental, infectious, or human made. Such events have produced a heightened awareness of the need for preemptive planning by the medical establishment for public health emergencies. Infectious agents, such as severe acute respiratory syndrome (SARS) or multidrug-resistant tuberculosis, foreshadow the potential for pandemics to result in widespread devastation. The capacity for such an agent to rapidly spread across borders raises challenging and compelling questions about the management of patients and members of the community during times of an unprecedented demand on resources. Recent natural disasters, such as Hurricane Katrina, serve as an example of the consequences of insufficient emergency planning. The potential large-scale devastation produced by an influenza pandemic in the 21st century could be unparalleled, given the nearly universal susceptibility to unique influenza strains and the availability of global travel enabling rapid transmission. An influenza pandemic has been the focus of recent discussions about public health emergencies. The avian H5N1 influenza strain, also known as the “bird flu,” appears to be one of the most likely agents capable of initiating a pandemic. The virus has demonstrated its aggressive course in those infected (approximately 60% mortality) and an endemic nature among avian populations in Southeast Asia. 1 It is projected that another influenza pandemic will happen as evidenced by the natural history and constant evolution of the influenza virus. What is not clear is exactly when this will occur, to what extent the outbreak will produce global morbidity and mortality, and how effectively the medical community will be able to temper the emergency by using the proposed and traditional countermeasures. 2 This situation provides a timely juncture for further discussion about pandemics and their effect on diverse groups of the population. Previous influenza pandemics suggest that pregnant women represent an important subset of the population that will likely have unique vulnerabilities to H5N1. The well-being of this group can also affect the health of the rest of the community. By recognizing the special risks associated with the management of pregnant women, health care providers and policymakers can be better prepared to recognize and address the needs of diverse populations and, in so doing, gain a better understanding of how such subpopulations play a critical role in outcome for the entire population. These types of considerations are critical when preparing rationing schemes aimed at effectively reducing the number of persons that become ill or die during a pandemic.
