Ethical & Legal Issues for Schools of Nursing During

SARS: Lessons for Pandemic Planning

Betty Burcher, RN, MSc Faculty of Nursing, University of TorontoCASN Council Breakfast: November 15,

2006

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SARS & the Faculty of Nursing

• Extraordinary impact on Faculty of Nursing

• Created SARS Fast Response Team • “To protect the health and safety of

our students, faculty and staff during the SARS situation.”

• Community of 670 individuals [May 2003]

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Impact on Education During SARS 1

• BScN program: – Students suspended from hospitals for

6 - 8 weeks, missed parts of rotations– Classes continued– Web-based learning, creative

alternatives • MN program:

– Classes suspended week by week– Hospitals needed staff or prohibited

intermingling with other health care workers

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SARS 2 - Our Turn

• 185 BScN students in 22 clinical sites• 50 students & faculty in quarantine• 8 students ill during quarantine

and/or placement in level 2 or 3 units • 2 students infected with SARS (from

workplace exposures)• Disrupted, delayed, extended or

replacement clinicals but all completed!

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Lack of Information & Communication

• Lack of communication between:– university administration, – health sciences faculties, – hospitals and – public health

• No central “desk” for education sector• Resorted to newspapers, scanning of

websites, personal contacts, rumours, frequent back-door calls to Toronto Public Health & expertise of each other

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Issues Re Clinical Placements

• Truth-telling: did we have confidence in reported hospital status?

• Some hospitals delayed reporting their status to public health

• Inconsistent infection control practices across and within 22 clinical sites: we needed to be consistent for our students

• Who makes the decision? Clinical site, educational institution, local public health agency or the provincial MOH

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Issues Re Students

• Complex status of ill students: – Students (full-time or part-time), – Health care workers (full-time or part-time), – Ill patients in the health-care system,– Suspect SARS case or PUI [person under

investigation]: surveillance from public health

• No occupational health services so we did it ourselves:– Privacy issues: faculty monitoring the health

of students & other faculty– Confidentiality issues: quarantine, PUI & SARS

cases: sharing information with h-c providers, workplaces, students & faculty

– Classmate/faculty support versus stigma

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Decision-making Issues for Our SARS Team

• Decision-making: fear or evidence?• What were our parameters of responsibility?• No precedents for decision-making during a

crisis• Many students and part-time faculty were

also hospital employees • What was our risk-management and

liability?• Issues of communication within the faculty

& university• Repercussions of our decisions for

relationships with our hospital partners

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SARS to Pandemic Planning

• Health sciences education sector advocacy post-SARS

• SARS was primarily a nosocomial infection

• Ontario health plan for an influenza pandemic [2006]

• Council of Ontario Universities• U. Of Toronto Health Sciences

Pandemic Planning Committee

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Summary: Legal Issues

• Clarity re authority, roles & decision-making responsibilities – Decision-making body in university – Decision-making body in Faculty with

clear parameters– Risk-management & risk-

communication expertise– Infection control, occupational health

& disease surveillance

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Summary: Ethical Issues

• Privacy for students, faculty & staff • Confidentiality for students & faculty • Transparency & accountability • Duty to care• Planning, priority-setting &

preparedness• University of Toronto Joint Centre for Bioethics

Pandemic Influenza Working Group (2005). Stand on Guard for Thee: Ethical considerations in preparedness for pandemic influenza. Retrieved from http://www.utoronto.ca/jcb/home/documents/pandemic.pdf

Thank You