Research: Public Health Ethics

Canadian Program of Research on Ethics in a Pandemic (CanPREP)
An innovative program of community-partnered research comprised of three interlinked collaborative working groups targeting three key ethical issues:

  • Health care provider (HCP) obligations and institutional support for HCPs
  • Priority setting for scarce resources
  • Risk communication and knowledge transfer

Each working group will bring together study investigators, end-users, community partners, and research trainees in interdisciplinary scholarship with immediate policy relevance. Complementing the three key ethical issues are three cross-cutting themes

  • Promoting public trust
  • Incorporating voices from vulnerable and special needs populations
  • Public engagement and the use of social networking tools

The CanPREP proposal has three specific objectives:

  • Knowledge Generation: Generate new knowledge on key ethical questions for pandemic preparedness through innovative interdisciplinary and participatory research by study investigators, end-users, community partners, and research trainees.
  • Public Engagement: Develop innovative public engagement strategies that will: a) improve values-based decision making; b) enhance risk communication and public trust; and c) facilitate increased public engagement and broad stakeholder consultation/commitment in order to produce a social mandate that will guide and involve decision making in pandemic preparedness.
  • Capacity Building: Through an academically rigorous and policy relevant interdisciplinary training program, create a cadre of highly-qualified researchers with diverse methodological and conceptual skills relevant to pandemic preparedness and applicable to other public health hazards.

CanPREP website


Ethics and Pandemic Planning: Engaging the Voices of the Public

An influenza pandemic will be associated with many ethical challenges. Experts in public health and bioethics at the University of Toronto have identified four key ethical challenges Canadians will face and must be prepared to make informed choices.

  • What are the obligations of health care providers in a pandemic when they face risk of infection to themselves?
  • Who should receive influenza vaccines or antiviral medications when all cannot receive them?
  • Should public health use methods that may restrict cherished civil freedoms such as quarantine to control influenza?
  • What role can Canadians play in the global control of influenza?

This expert group has also identified key values that should be taken into consideration in pandemic planning. However, the perspective of the public has not been taken into account in this analysis. The purpose of this study is to use methods of public engagement to hear the voices of the public on these key ethical issues in pandemic planning.


Publications from this project are available here.


Severe Acute Respiratory Syndrome (SARS)

In response to the occurrence of SARS in Toronto, the JCB aimed to increase knowledge of the ethical implications of SARS within the health care system and provide insight into the ethical dimensions of infectious diseases. A combination of qualitative research and conceptual scholarship methodologies were employed.

Our research had four specific objectives:

  • To analyze the ethics of quarantine and the use of restricted means to achieve public health goals and characterize stakeholder views on the effectiveness and justifiability of such measures.
  • To determine, by way of the accountability of reasonableness framework, the effects of the collateral damage of SARS, particularly in the context of priority setting and public health.
  • To analyze the ethical issues involved in the setting of boundaries of health care professional engagement and their duty to care for patients with SARS and the reciprocal obligations of institutions to workers through a consideration of professional codes of ethics, views of health care providers, regulatory bodies, and the public.
  • To examine the ethical issues of SARS within a global context through the consideration of the actions, roles, and responsibilities of national and transnational organizations.

Publications from this project are available here.


Stand on Guard for Thee

Coping effectively with a predicted influenza pandemic that threatens to affect the health of millions worldwide, hobble economies and overwhelm health care systems will require more than new drugs and good infection control. An international medical ethics think-tank says that all-important public cooperation and the coordination of public officials at all levels requires open and ethical decision making. Stand on Guard for Thee is a report published by the Influenza Pandemic Working Group at the University of Toronto Joint Centre for Bioethics. The report recommends a 15-point ethical guide for pandemic planning, based in part on experiences and study of the Severe Acute Respiratory Syndrome (SARS) crisis of 2003.


The report states plans to deal with an influenza pandemic need to be founded on commonly held ethical values. People need to subscribe in advance to the rationale behind such choices as: the priority recipients of resources, including hospital services and medicine; how much risk front line health care workers should take; and support given to people under restrictions such as quarantine. Decision makers and the public need to be engaged so that plans reflect what a majority of people will accept as fair, and good for public health.


The report concludes that flu pandemic plans universally need an ethical component that addresses four key issues:

  • Health workers’ duty to provide care during a communicable disease outbreak;
  • Restricting liberty in the interest of public health by measures such as quarantine;
  • Priority setting, including the allocation of scarce resources such as medicines;
  • Global governance implications, such as travel advisories.

Publications from this project are available here.