268379 Crisis Standards of Care: Ethical Issues

Tuesday, October 30, 2012 : 2:50 PM - 3:10 PM

Tia Powell, MD , Montefiore-Einstein Center for Bioethics, Albert Einstein College of Medicine, Bronx, NY
Umair A. Shah, MD, MPH , Deputy Director, Harris County Public Health and Environmental Services, Houston, TX
Bruce Altevogt, PhD , Board on Health Sciences Policy, Institute of Medicine - National Academies, Washington, DC
Dan Hanfling, MD , Department of Emergency Medicine, Inova Fairfax Hospital, Falls Church, VA
     
Background/Purpose: During a catastrophic disaster, ethical standards must drive the allocation of scarce resources to improve and maximize the population's health while tending to the needs of individual patients. Determining these standards and planning for the value judgments that must be made when crisis standards of care (CSC) are implemented is best accomplished prior to an actual disaster; therefore, the basis of all CSC plans must be a common set of ethical principles.

Methods: The second phase of the Institute of Medicine's Committee on Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations reiterates and builds on the ethical framework posited in its 2009 Letter Report Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations.

Results/Outcomes: The ethical framework laid out in the first phase of the committee's work was built on seven key features: fairness, the duty to care, the duty to steward resources, transparency, consistency, proportionality, and accountability. These key features as applied to CSC planning and implementation are again explored in the committee's current report. The second phase of the committee's work goes further to explore the implications of community engagement, the use of non-medical criteria to help decide treatment, and the role of families in supplementing scarce health care resources on planning for and providing care during catastrophic disasters.

Conclusions: CSC justify limiting access to scarce treatments, and provide clinicians with a guide on how best to allocate resources in a catastrophic disaster.

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

Learning Objectives:
•Identify the key elements of crisis standards of care and the associated ethical issues

Keywords: Disasters, Emergency

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am Director of the Montefiore-Einstein Center for Bioethics and have participated in numerous workgroups to assess ethical issues in public health disasters, including efforts sponsored by IOM, CDC, the American College of Chest Physicians and NY State.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 4318.0: Crisis Standards of Care