Not surprisingly, the literature on clinical ethics has little to say about disaster preparedness and how to make decisions about such things as triage under extraordinary circumstances. The ethics literature on bioterrorism and battle-field triage informed our thinking and called our attention to important issues such as the duty to care, reciprocity, equity and good stewardship [20] [21] [22] [23] [24] [25] . The importance of having ethically robust criteria and policies developed in advance of a pandemic influenza outbreak is underscored in this literature, for "critical decisions like these should not be made on an individual case-by-case basis" and "physicians should never be placed in a position of individually deciding to deny treatment to patients without the guidance of policy or protocol" [22] . Robust disaster preparedness requires practising preventive ethics.