Canadians are bullish on giving government officials permission to restrict personal freedoms in a flu pandemic, with half of those surveyed agreeing that violation of a quarantine order would be tantamount to manslaughter.

As well, 90% of Canadians surveyed for a research report in pandemic ethics believe doctors and nurses have an obligation to report to work during a pandemic, provided safety precautions are in place. Almost half -- 48% -- say that health care workers who do not show up for work without a legitimate excuse should be fired or lose their professional licenses.

The survey, conducted for the University of Toronto Joint Centre for Bioethics, is based on a random sample of 500 Canadians surveyed by phone, and nearly 100 more via a series of town hall meetings. The survey was taken between August 2008 to February 2009 -- just before the H1N1 outbreak began in April.

The town halls straddled the start.

Both were designed to inject the public’s voice into debates usually left to the experts, and the results come as officials brace for an anticipated second wave of H1N1 flu.

Researchers are warning that the serious ethical challenges that could accompany a pandemic need to be thought through now, while there’s still time to respond.

“There’s going to be a lot of uncertainty to decision making, even in a mild pandemic,” says Dr. Ross Upshur, director of the UofT bioethics centre, which Wednesday released a series of research papers on pandemic ethics.

The reports draw on lessons learned from the SARS outbreak and address issues from whether health care workers have an implicit duty to treat patients, to fraught ethical questions such as: who should get the last bed and ventilator in an intensive care unit -- a cyclist who has suffered a severe, but potentially reversible brain injury, or a nurse infected with H1N1 while caring for patients who need immediate ventilation support?

“Even though there may be some skepticism about perhaps overreaction to H1N1, let’s remember the past. We weren’t prepared for SARS,” Upshur says.

“There’s still a lot of uncertainty about H1N1. It’s still a new pathogen,” he says. “It seems to be tracking reasonably mild. But there are still ethical issues that require discussion.”

Past surveys have suggested anywhere from 25% to 85% of health-care workers would be unwilling to show up for work in a pandemic.

“If you think of it, that’s a pretty stunning number,” Dr. Upshur says. He says professional codes of ethics and regulatory bodies haven’t set clear directives on what they expect of health care professionals in a disease crisis.

A large majority -- 85% -- of those who responded to the UofT survey agreed governments should have the power to suspend some individual rights, such as travelling and the right to assemble, during a flu pandemic, and “social distancing”measures such as school closures. But they also said governments have an obligation to provide for the basic needs of restricted individuals, such as food, shelter and social support.