Ethical decision-making in disasters: Who comes first?

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.