JMIR Publications

ABSTRACT

Background:

This study considers the role of community and culture in the ethical apportionment of scarce health resources during an influenza pandemic. It builds upon a previous exploration of the values and preferences of Maryland residents regarding how a finite supply of mechanical ventilators ought to be allocated during a severe global outbreak of influenza. An important finding of this previous research was the need to convene a diverse, regionally varied sample of state residents to capture different ways of thinking about scarcity that local history and place seemed to engender.

Objective:

Given the intrastate variation in the themes expressed by Maryland participants, the project team sought to examine interstate differences by implementing the same protocol elsewhere to answer the following: Would the same core values regarding the allocation of scarce resources continue to hold in other areas of the United States (US)? Did variation in ethical frames of reference exist among US regions? What practical implications does evidence of sameness and difference possess for pandemic planners and policymakers at local and national levels?

Methods:

Research using the same deliberative democracy process from the Maryland study, was conducted in Central Texas in March 2018 among 30 diverse participants; half identified as Hispanic or Latino.

Results:

Familismo—the strong identification, attachment, and obligation of persons toward their nuclear and extended families—emerged as a distinctive regional and ethnic core value that has practical implications for the substance, administration, and communication of allocation frameworks.

Conclusions:

Convenors of other pandemic-related public engagement exercises in the US have primarily advocated the benefits of transparency and inclusivity in developing an ethical allocation framework; this study demonstrates cultural competence as a further advantage.