Ethical Dilemmas
Examining ethical issues in environmental health practice is a new NCCEH series intended to elicit discussion and perhaps debate. The scenarios presented are loosely based on real practice.
Please send us your comments on the first scenario via the discussion forum below. Comments are posted in the language they are submitted in. If you have a suggestion for another ethical issue, please contact us.
Listeria monocytogenes (LM) in ready-to-eat foods and the facilities that produce them
- In response to the 2008 Canada-wide outbreak of listeriosis associated with ready-to eat (RTE) meat products, the research section of a provincial health ministry proposed to sample the work environment and products of provincially-licensed facilities which produce processed RTE meat, tofu, poultry, and fish. Budgetary constraints limited the project to a sample of all such plants operating under provincial license. Local health inspectors, who have a mandate to inspect food processing facilities under provincial food safety regulations, took swabs of both cutting surfaces and product, which were cultured for LM at the provincial microbiology laboratory.
Questions to consider:
- 1.1 Are the health inspectors participating in a study, or are their inspection notes and culture swabs an extension of their regular activities?
- 1.2 Prior to the inspector’s visit, what should the facilities be told about the project and its implications?
1.3 Should the facilities inspected be offered the possibility of refusal to participate?
- 1.1 Are the health inspectors participating in a study, or are their inspection notes and culture swabs an extension of their regular activities?
- There are 80 RTE processors in the province. Of these, 28 (35%) were sampled. Of 21 sampled facilities where tofu, meat, and poultry-based items were produced, two yielded environmental samples (floors, walls) positive for LM with no positives for cutting surfaces or edible product. Of the seven fish product processors sampled, four had both environmental and food contact surfaces as well as product samples positive for LM, and of the four, LM at very high levels was cultured from several products at two of the processors.
Questions to consider:
- 2.1 Given that not all provincial plants were sampled, and that the results relate to a project, should the local health inspectors order special hygiene measures in the facilities which sampled positive?
- 2.1 Given that not all provincial plants were sampled, and that the results relate to a project, should the local health inspectors order special hygiene measures in the facilities which sampled positive?
- LM is of particular risk to pregnant women and their fetuses, and to persons with immune deficits. An initial assessment revealed that much of the contaminated RTE product was sold in bulk, with most to small specialty stores. About half of the implicated lots could be recovered, but the other half would already have been in the possession of consumers, or consumed.
Questions to consider:
- 3.1 Would you advise a public recall, or other public advisory? How? Why?
- 3.1 Would you advise a public recall, or other public advisory? How? Why?
I find this scenario difficult to fit under the umbrella of an ethical dilemma, because as practitioners we have a duty to protect this health and safety of the public. The only ethical dilemma I see here is one of a jurisdictional nature.
Since health and safety of the public should be of primary importance, the local health inspectors' results should be considered as part of their normal activities. Any special hygiene measures required, should be directed and carried out. Inspections that are unannounced provide a truer representation of normal routine practices at any establishment, and therefore should not be scheduled. Facilities should not be given the opportunity to refuse participation when the health and safety of the public is at stake.
Information in 2011 regarding Listeria monocytogenes (LM) is publicized more widely than it was in 2008. However, further research may be required to understand the information being specifically disseminated to pregnant women and to persons with immune deficits regarding LM. The scope, quality and impact of this information requires study before a limited public advisory can be relied upon. A public recall should be given through the CFIA with the assistance of local Boards of Health when necessary.
I suggest that this is a "research study" only if the results are blinded from the EHO and the Ministry. Since it is not, I think the EHO is obligated to act in the best interest of public health based on the findings. The licensed facilities should be told this at the beginning that this is so and that this activity is an "audit " action based on past LM outbreaks. No refusal should be possible under the Health Act as this is a serious PH matter.
For the Fish processor, a public statement is needed for alert and recall with risk information regarding those most susceptible with signs and symptoms and recommendations for seeking health care. A closure of this fish facility with a review of critical control point processes that led to heavy contamination before re-opening is needed. For future, a process for determining the flow of product should be developed.
For the other processor, the environmental samples indicate a failure of the cleaning as a critical control point which needs to be addressed with the operator.
I know that some of my cohorts will not see an ethical dilemma or issue in using the 'research' findings for enforcement work, while others will be confounded by it all and question their role & responsibilities. I've been involved in similar scenarios and it's sometimes a fine line between being a regulator and a fact-finder. Our corporate culture is that if someone is cooperative and willing to let us study them, we tend not to make them regret it but use it as a teaching tool of sorts. The opposite tends to be true for the uncooperative types. So is that fair?? I dunno. I guess it's an ethical question...