This paper explores the use of an ethics framework based on the Public Health Code of Ethics to guide rationing decisions during a pandemic flu crisis involving a shortage of ventilators. While the law provides public health officials with authority to act, public health officials, as community leaders and health department managers, must address complex questions about how they should use their legal authority, how they can ethically justify a particular action, how they should engage community stakeholders in decision making, and how the process of public justification should take place. Recognising the need for a tool that could help public health officials manage ethical tensions in practice, such as allocation of scarce resources, the Public Health Leadership Society led efforts todevelop a Public Health Code of Ethics. The 12 Principles in the Code were written to express the general norms implicit in the practice of public health professionals. The Code offers no hierarchical weighting of the different principles and anticipates that weights and specification of the principles would take place in the context of each community through a process of engagement between public health officials and community stakeholders about specific cases. We describe how public health officials can use the Code to guide deliberation in helping communities prepare to address the tragic choices when allocating scarce ventilators in an influenza pandemic.

Sometimes, states face emergencies: situations where many individuals face an imminent threat of serious harm. Some believe that in such cases certain sorts of actions which are normally morally prohibited might be permissible. In this paper, I discuss this view as it applies in both the contexts of war and of public health policy. I suggest that the deontologist can best understand emergencies by analogy with the distinction between act- and rule consequentialism. In real world cases, we must often make decisions in ‘epistemically murky’ situations, such that the application of deontological principles to particular cases is unclear. I suggest that we develop conventions to deal with such cases in a manner which we think is most likely to approximate the demands of abstract deontologicalprinciples across time. I claim that we can best understand ‘supreme emergencies’ as situations which ‘epistemic murkiness’ is resolved. In such cases, there may be a conflict between what would be valid application of abstract deontological principles and the conventions which normally guide us in epistemically murky situations.