title: Restrictive measures in an influenza pandemic: a qualitative study of public perspectives.
abstract: OBJECTIVE
  Recent experiences have demonstrated that restrictive measures remain a useful public health tool during infectious disease outbreaks. However, the use of restrictive measures is not without controversy, as there is no agreed-upon threshold for when and how to invoke restrictive measures. The objectives of this study are to solicit perspectives from Canadians on the ethical considerations of using restrictive measures in response to influenza pandemics, and in turn, to use public views to contribute to a better understanding of what is considered to be the justifiable use of restrictive measures.
  
  
  METHODS
  A series of town hall focus groups with Canadian residents from June 2008 to May 2009, in three Canadian regions, in order to achieve broad public engagement (n=3 focus groups with a total of 17 participants).
  
  
  RESULTS
  Two key themes emerged from all town hall focus groups: 1) create an environment for compliance through communication rather than enforcement, and 2) establish the delineation between individual rights, community values, and the greater good.
  
  
  CONCLUSIONS
  While there is a need for a decision-making authority and even a mechanism for enforcement, our data suggest that a more tractable approach to restrictive measures is one that enables individuals to voluntarily comply by creating an environment to compel compliance based on communication. This approach requires restrictive measures to be a) proportional to the threat, b) implemented along with reciprocal arrangements provided to those affected, and c) accompanied by open and transparent communication throughout all stages so that citizens can both understand and participate in decision-making.
authors.affiliation: Joint Centre for Bioethics and Dalla Lana School of Public Health, University of Toronto, Toronto, ON. max.smith@utoronto.ca
authors.forename: Maxwell J
authors.initials: MJ
authors.lastname: Smith
authors.forename: Cécile M
authors.initials: CM
authors.lastname: Bensimon
authors.forename: Daniel F
authors.initials: DF
authors.lastname: Perez
authors.forename: Sachin S
authors.initials: SS
authors.lastname: Sahni
authors.forename: Ross E G
authors.initials: RE
authors.lastname: Upshur
mesh_terms: D002170:Canada; D003142:Communication; D017144:Focus Groups; D006801:Humans; D007251:Influenza, Human / Q000453:epidemiology / Q000517:prevention & control*; D058873:Pandemics / Q000517:prevention & control*; D015980:Public Health Practice / Q000941:ethics*; D011639:Public Opinion; D036301:Qualitative Research
keywords: Bioethics; Influenza; Pandemics; Public Health; Qualitative Research; Quarantine