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Triage in Disaster Medicine: Ethical Strategies in Various Scenarios

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Disaster Bioethics: Normative Issues When Nothing is Normal

Part of the book series: Public Health Ethics Analysis ((PHES,volume 2))

Abstract

Based on the philosophical literature, research on disaster medicine and the experience of veterans of humanitarian relief teams, this paper explicates an outline for triage in mass-casualty disasters. This outline aims at reconciling—at least to a degree—utilitarian considerations with the moral psychology and professional identity of medical care-givers, while being attuned to the diversity of disaster arenas.

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Notes

  1. 1.

    We do not explore here the philosophical question of whether utilitarianism endorses the deliberate sacrifice of the few for the sake of saving the many (e.g. the question of "survival lottery"). Since no healthcare system in the world practices sacrificial care, we take this de-facto taboo as a given.

References

  • Barilan, Y. M. 2004. Towards a dialogue between utilitarianism and medicine. Medicine Healthcare and Philosophy 7:163–173.

    Article  Google Scholar 

  • Burris, D. G., D. R. Welling, and N. M. Rich. 2004. Dominique Jean Larrey and the principle of humanity in warfare. Journal of the American College of Surgeons 198:832–835.

    Article  Google Scholar 

  • Calabresi, G., and P. Bobbitt. 1978. Tragic choices: the conflicts society confronts in the allocation of tragically scarce resources. New York: Norton.

    Google Scholar 

  • Emanuel, E. J., and A. Wertheimer. 2006. Who should get influenza vaccine when not all can? Science 312:854–855.

    Article  Google Scholar 

  • Fleck, L. 2009. Just caring: Healthcare rationing and democratic deliberation. Oxford: Oxford University Press.

    Google Scholar 

  • Gross, M. 2006. Bioethics and armed conflict: Moral dilemmas of medicine and war. Cambridge (MA): MIT Press.

    Google Scholar 

  • Hodge, J. G., and E. D. Anderson. 2008. Principles and practice of legal triage during public health emergencies. New York Annual Survey of American Law 64:249–292.

    Google Scholar 

  • International Federation of Red Cross. 1995. The code of conduct for the International Red Cross and Red Crescent Movement and non-governmental organisations (NGOs) in disaster relief. http://www.ifrc.org/Docs/idrl/I259EN.pdf. Accessed 6 May 2013.

  • Iserson, K. V. 2008. Flight or fight: The ethics of emergency physician disaster response. Annals of Emergency Medicine 51:345–353.

    Article  Google Scholar 

  • Iserson, K. V., and N. Pesik. 2003. Ethical resource distribution after biological, chemical or radiological terrorism. Cambridge Quarterly of Healthcare Ethics 12:455–465.

    Google Scholar 

  • Kass, N. E., J. Otto, D. O’Brien, and M. Minson. 2008. Ethics and severe pandemic influenza: Maintaining essential functions through fair and considered response. Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science 6:227–236.

    Article  Google Scholar 

  • Mayerfeld, J. 1999. Suffering and moral responsibility. Oxford: Oxford University Press.

    Google Scholar 

  • Merin, O., N. Ash, G. Levy, M. J. Schwaber, and Y. Kreiss. 2010. The Israeli field hospital in Haiti—ethical dilemmas in early disaster response. New England Journal of Medicine 362:e38.

    Article  Google Scholar 

  • Parfit, D. 1978. Innumerate ethics. Philosophy and Public Affairs 7:285–301.

    Google Scholar 

  • Rawls, J. 1971. A theory of justice. Cambridge: Harvard University Press.

    Google Scholar 

  • Sorokin, P. A. 1942. Man and society in calamity. New York: Dutton.

    Google Scholar 

  • Updegraff, J. A., R. Cohen Silver, and E. A. Holman. 2008. Searching for and finding meaning in collective trauma: Results from a national longitudinal study of 9/11 terrorists attacks. Journal of Personality and Social Psychology 95:709–722.

    Article  Google Scholar 

  • White, D. B., M. H. Katz, J. M Luce, and B. Lo. 2009. Who should receive life-support during public health emergency? Using ethical principles to improve allocation decisions. Annals of Internal Medicine 150:132–138.

    Article  Google Scholar 

  • Williams, B. 1973. Problems of the self. Cambridge: Cambridge University Press.

    Book  Google Scholar 

  • Winslow, G. R. 1982. Triage and justice. Berkeley: University of California Press.

    Google Scholar 

  • World Medical Association. 2006. Statement on medical ethics in the event of disasters. http://www.wma.net/en/30publications/10policies/d7/. Accessed 6 May 2013.

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Correspondence to Y. Michael Barilan .

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Barilan, Y., Brusa, M., Halperin, P. (2014). Triage in Disaster Medicine: Ethical Strategies in Various Scenarios. In: O’Mathúna, D., Gordijn, B., Clarke, M. (eds) Disaster Bioethics: Normative Issues When Nothing is Normal. Public Health Ethics Analysis, vol 2. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-3864-5_4

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