OVERVIEW

Disaster situations present numerous moral and ethical challenges at the micro, meso, and macro levels. These dilemmas embroil not only patients and their providers, but they also involve a variety of stakeholders outside the doctor–patient dyad: peers, provider organizations, the press, the general public, payers, policymakers, politicians, public health leaders, and even corporate interests in the private sector. This group of moral agents may be considered the “Ten Ps” (Table 5.1). The principles and concepts in this chapter are relevant to all candidate stakeholder and disaster organizations as well as individuals. This chapter first acknowledges the spectrum of medical–ethical and moral problems inherent in disaster preparedness and response, while focusing primarily on those that impact healthcare workers as individuals working in the trenches. After exploring some of the disaster-relevant bioethical principles and codes of conduct, it describes the fundamental virtues that inform ethical decision making in clinics, hospitals, and emergency departments and in the field in the immediate aftermath of a disaster.

CURRENT STATE OF THE ART

The Spectrum of Disaster Dilemmas

Although thoughts of disaster ethics generally conjure up visions of distributing life vests on a sinking Titanic, there are many other less dramatic examples of ethical challenges that confront the clinician working in the wake of a catastrophe. The broad array of potential ethical dilemmas in a disaster situation is vast and involves both individual and corporate actions.