This article provides an excellent outline of the ethical landscape and the ethics of disaster management.
- The most important question that arises after a disaster is the appropriate and fair allocation of relief funds to help with the recovery.
- Research in disaster settings also faces a unique dilemma. The researcher must determine how to balance the critical need for research with the ethical obligation of respect for, and protection of, the interests of research participants
The article outlines that there are 8 cardinal virtues that are present in a disaster response.:
- Self effacing charity
This paper outlines the importance and definition of ethics.
“Ethics is the study of codes of conduct and moral judgements concerning what is right and what is wrong” (Jenson, 1997).
The paper also outlines the three divisions of ethical theory.
MetaEthics questions the foundation of ethical principles by asking where these come from and questions the intrinsic meaning of these principles.
Normative Ethics is more practical in its application and seeks to determine moral standards that could be used to regulate conduct and determine what is right and what is wrong.
Applied Ethics involves the examination of specific controversies that require a moral interpretation or position.
The author mentions important ethical concepts that can be applied to the ethics of disaster risk management;
- The concept of “Lifeboat Ethics” discusses the allocation of resources when resources are scarce and helps to describe some of the difficulties involved in ethical decision making when needs overwhelm resources.
- The concept of “Triage” – The commonsense rule to serve person who requires immediate attention and defer care to those who are more stable and can afford to wait.
Applying the concept of Triage to disasters – the conclusion is then that the most seriously injured are left to the end so that those who can be saved can be cared for. This is also an example of a situation where utilitarianism is applied in health care.
Disasters require a coordinated multidisciplinary response to ensure that the necessary relief which can include transportation, food and water and medical supplies arrives at the right place at the right time.
Disaster responders can face very specific challenges. Hence, it is important that the basic ethics of beneficence and respect for autonomy and individual ethics of the healthcare provider complement each other.
Health care disaster ethics are “A set of principles and values that serve to direct the duties, obligations and parameters of the delivery of health care in a disaster situation” (State Expert Panel on the Ethics of Disaster Preparedness, 2006, p. 1).
Triage is a recognized system that involves the medical screening of patient according to their need for treatment balanced with the available resources. Commonly recognized examples of triage include prehospital, disaster, emergency room, intensive care, waiting list for lifesaving treatments such as organ transplants, and battlefield situations (Repin et al. , 2005).
Disaster Triage differs significantly from day-today triage because of overwhelming number of victims present at emergency room.
In a disaster or mass casualty incident the goal of triage is the rapid sorting of victims with the intention of doing the greatest good for the greatest number of people applying utilitarian concept of ethics as proposed by Hutcheson.
Disaster triage optimizes care for the maximum number of salvageable victims. Differentiation between patients who will survive with minimum care and those who will die even with all possible interventions is the role of triage. The system ensures that the scarce resources go to victims who will benefit most from optimal care and rapid surgical intervention. Effective triage both at the scene and later within the health care facility is often a major determinant of outcome.
Triage systems developed for use in civilian populations fall into two groups: primary and secondary. There are a number of different systems in use for primary triage of mass casualties; primary triage prioritizes victims for evacuation from the scene and transportation to definitive medical care. Secondary triage systems determine the order in which patients receive treatment once they reach definitive care or, if necessary when transport is delayed or lengthy, at the scene ( Jenkins et al. , 2008).
Although the Triage system is a Utilitarian Principle, Aristotelian virtues also come into play as the system requires Courage to the ethical decision that the patient cannot be saved.
Triage should, however, adhere to well defined, quantifiable criteria. Triage must respect humanitarian law, allow where possible for informed consent, and be based on established medical criteria (Hogan and Lairet, 2007).
Two Approaches to Disaster Management.
- After a disaster, the ethics of allocation of funding are guided by the following approaches: utilitarian, rights, fairness or justice, common-good, and virtues (The Markkula Center, 2002).
- The rights approach recognizes the right to be treated equally by the government and the right of the freedom of choice for the donors (The) Markkula Center, 2002).
In the fairness or justice approach, funding is distributed according to the economic impact, which means that those who were high-income earners have, in effect, suffered a greater loss and therefore should be compensated to make up for that greater loss (The Markkula Center, 2002).
Humanitarian aid is given without consideration of race, creed, nationality, age, gender, or other qualifiers and is prioritized based on need alone (InternationalFederation of Red Cross and Red Crescent Societies, 2010).