Bioethics and the Worst Case Scenario

BioEdge has an interview with George J. Annas, author of the new Worst Case Bioethics: Death, Disaster and Public Health. Here's a clip:

BioEdge: Worst case scenarios aren’t exclusively bioethical – the Y2K bug springs to mind – so is there something in our culture which encourages us to frame the future as Doomsday? Is it the legacy of the Cold War and mutually assured destruction, or something deeper?

GJA: It has to do with our deep fear of death. The first sentence of the book is, “Death is almost everyone’s personal worst case scenario.” This, in turn, makes “saving lives” a universal justification for action—both in medicine and in government. Mostly, we deal with our mortality by denial, by not dealing with it. We simply put our faith in modern medicine and scientific progress that somehow we will be provided with new technologies that will permit us to postpone death indefinitely—or at least for a long time. In effect, we fight worst case scenarios by imagining best case scenarios.

BioEdge: What are the effects of US health policy moving away from public health to public security?

GJA: US health policy has never been based on public health and population-based prevention—but rather on individuals and treatment of their illnesses and injuries, at least those who can afford to pay. To the extent that concerns over bioterrorist attacks and pandemic flu and SARS have commanded attention and at least some resources on public health, we have been responding by adopting a military national security model – complete with public health officials in military uniforms. This has encouraged our government to predictably concentrate on 19th century interventions like mandatory vaccinations and quarantine when an epidemic threatens, rather than scientific information, and at least some public health officials still expect Americans to simply “follow orders” in a public health emergency rather than make informed decisions. This is delusional.