262025 Ethical decision-making in disasters: Who comes first?

Tuesday, October 30, 2012 : 1:30 PM - 1:50 PM

Kathleen Powderly, CNM, PhD , John Conley Division of Medical Ethics and Humanities, SUNY Downstate Medical Center, Brooklyn, NY
Claritza Rios, MD , Department of Emergency Medicine/Internal Medicine, SUNY Downstate Medical Center, Brooklyn, NY
Michael Redlener, MD , Fdny, Emergency Medical Services Fellow, Brooklyn, NY
Stephan Kohlhoff, MD, PhD , Pediatrics, SUNY Downstate Medical Center, Brooklyn, NY
Eric Cioe, MD , Dept of Emergency Medicine, SUNY Downstate Medical Center, Brooklyn, NY
Patricia Roblin, MS , Division of Disaster Medicine, SUNY Downstate Medical Center, Brooklyn, NY
Bonnie Arquilla, DO , Director, Emergency Preparedness, SUNY Downstate Medical Center, Brooklyn, NY
Stephan Rinnert, MD , Department of Emergency Medicine, SUNY Downstate Medical Center, Brooklyn, NY
The dilemmas facing healthcare first responders and receivers are numerous and often entail choosing between undesirable alternatives. In the context of disaster, decisions made on an ethical basis may have significant and lasting impacts on the communities served. The Ethical Decision Making in Disaster conference invited a diverse group of experts to discuss, identify and compose a position paper on triage protocols in a disaster. It has long been an understanding within the disaster community that there will be a process known as “Black Tag” during disasters, which would mean that those victims who are hopeless will be denied care in order to conserve resources for other victims, who are perceived to be salvageable. This proposed practice is the exact opposite of how we practice medicine, generally devoting the most resources to the sickest victims. Questions asked included: Who has the authority to make such significant ethical decisions? How should ethical decisions be made? What principles and values should guide those engaged in ethical decision making processes? What is the responsible action in response to human need? The methodology needed for ethical decision-making must reflect the complexity of human and international relationships, technological developments, environmental vulnerability, and interdependency. Tensions and shifts in fundamental concepts of reason, truth and goodness challenge our longstanding decision-making procedures. The traditional tools of “objective” logic, rationality, and consistency may not be adequate. The results of this conference will provide additional perspectives to increase understanding of major aspects of disaster management that require important ethical decisions.

Learning Areas:
Administration, management, leadership
Ethics, professional and legal requirements
Program planning
Public health or related public policy
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
1. Discuss balancing appropriate patient care with the broader public health goal of saving the most number of people in a disaster. 2. Compare responses to patient scenarios indicating that someone has been "black tagged" in a disaster. 3. Analyze how to triage, during a disaster, special needs populations including: geriatrics, pediatrics, pregnant women, those with mental impairments, trauma and surgical patients and those with acute exacerbation of chronic diseases.

Keywords: Ethics, Disasters

Presenting author's disclosure statement:

Not Answered