Hostname: page-component-76fb5796d-25wd4 Total loading time: 0 Render date: 2024-04-26T09:37:19.862Z Has data issue: false hasContentIssue false
  • English
  • Français

Ethical Considerations in Emergency Planning, Preparedness, and Response to Acts of Terrorism

Published online by Cambridge University Press:  28 June 2012

Gregory Luke Larkin  and
Jeffrey Arnold
Gregory Luke Larkin*
Affiliation:
Professor of Surgery, Director of Academic Development, Division of Emergency Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
Jeffrey Arnold
Affiliation:
Medical Director, Yale New Haven Center for Emergency and Terrorism Preparedness, New Haven, Connecticut, USA
*
Director of Academic Development, Division of Emergency Medicine, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390–8579 USA, E-mail: Gregory.larkin@utsouthwestern.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

Throughout the globe, healthcare providers are increasingly challenged with the specter of terrorism and the fallout from weapons of mass destruction. Preparing for and responding to such manmade emergencies, however, threatens the ethical underpinnings of routine, individualized, patient-centered, emergency healthcare. The exigency of a critical incident can instantly transform resource rich environs, to those of austerity. Healthcare workers, who only moments earlier may have been seeing two to three patients per hour, are instantly thrust into a sea of casualties and more basic lifeboat issues of quarantine, system overload and the thornier determinations of who will be given every chance to live and who will be allowed to die. Beyond the tribulations of triage, surge capacity, and the allocation of scarce resources, terrorism creates a parallel need for a host of virtues not commonly required in daily medical practice, including prudence, courage, justice, stewardship, vigilance, resilience, and charity. As a polyvalent counterpoint to the vices of apathy, cowardice, profligacy, recklessness, inflexibility, and narcissism, the virtues empower providers at all levels to vertically integrate principles of safety, public health, utility, and medical ethics at the micro, meso, and macro levels. Over time, virtuous behavior can be modeled, mentored, practiced, and institutionalized to become one of our more useful vaccines against the threat of terrorism in the new millennium.

Keywords

disasteremergencyemergency managementethicsterrorismweapons of mass destruction
Type
Special Reports
Information
Prehospital and Disaster Medicine , Volume 18 , Issue 3: Terrorism-II: Special Reports , September 2003 , pp. 170 - 178
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2003

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Homer. The Iliad, translated by EV. Rieu; 1946.Google Scholar
2.Aristotle: The Nichomachean Ethics. Boston: Reidel Publishing; 1975.Google Scholar
3.Hardie, W: Aristotle's Ethical Theory. New York: Oxford University Press; 1980.CrossRefGoogle Scholar
4.Aquinas, T: Readings in Summa Theologiae; translated by Jordan., M.Notre Dame, IN: University of Notre Dame Press; 1990.Google Scholar
5.Machiavelli, N: The Prince. (Trans. with Intro.). New York: Penguin Books; 1975.Google Scholar
6.Hobbes, T: Leviathan. Harmonsdworth: Penguin Books; 1985.Google Scholar
7.Rand, A: The Virtue of Selfishness. New York: New American Library; 1965.Google Scholar
8.MacIntyre, A: After Virtue. 2d ed.Notre Dame, IN: University of Notre Dame Press; 1984.Google Scholar
9.Pelligrino, E, Thomasma, D: The Virtues in Medical Practice. New York: Oxford University Press; 1993.CrossRefGoogle Scholar
10.Larkin, GL: The Cardinal Virtues of Emergency Medicine. Presented Paper at the Society of Ancient Greek Philosophy. Binghampton, New York 1997.Google Scholar
11.Plato: The Republic. Tr ans B. Jowett. Roslyn, New York, 1942.Google Scholar
12.Shakespeare, W: The Complete Works of William Shakespeare. Garden City, New York: Doubleday & Company, Inc., 1936.Google Scholar
13.Rilke, R: In: Mitchell, S (ed), The Enlightened Mind: An Anthology of Sacred Prose. New York; 1991.Google Scholar
14.Beauchamp, T, Childress, JF: The Principles of Biomedical Ethics. Vo l 44. New York: Oxford University Press, 1994.Google Scholar
15.American Heritage Dictionary. 6th ed. New York: Random House; 1982.Google Scholar
16.Larkin, GL, Weber, JE, Moskop, JC: Resource utilization in the emergency department: the duty of stewardship. J Emerg Med 1998; 16: 499–503.CrossRefGoogle ScholarPubMed
17.American College of Emergency Physicians. Code of Ethics for Emergency Physicians. 2002 (25 July 2002).Google Scholar
18.Fields, W, Asplin, B, Larkin, GL, et al: The Emergency Medical Treatment and Labor Act as a Federal Health Care Safety Net Program. Acad Emerg Med 2001; 8(11): 1064–1069.CrossRefGoogle ScholarPubMed
19.McGloin, J, Widom, C: Resilience among abused and neglected children grown up. Development and Psychopathology 2001: 1021–1038.CrossRefGoogle ScholarPubMed
20.Waysman, M, Schwarzwald, J, Solomon, Z: Hardiness: An examination of its relatioship with positive and negative long term changes following trauma. Journal of Traumatic Stress 2001; 14(8): 531–548.CrossRefGoogle Scholar
21.Domres, B, Koch, M, Manger, A, Becker, HD: Ethics and triage. Prehosp Disast Med 2001;16(1):53–58.CrossRefGoogle ScholarPubMed
22.Pesik, N, Keim, M, Iserson, K: Terrorism and the ethics of emergency medical care. Ann Emerg Med 2001; 37: 642–646.CrossRefGoogle ScholarPubMed
23.Mill, JS: Utilitarianism. Vol 10. New York: Liberal Arts Press; 1957.Google Scholar
24.Jacobson, v. Massachusetts: Supreme Court; 1905.Google Scholar
25.Larkin, GL, Moskop, J, Derse, A, Iserson, K: Ethics Manual. ACEP. Available at www.acponline.org/ethics/ethicman.htm. Accessed 21 May 2002.Google Scholar
26.Salib, E: Effect of 11 September 2001 on suicide and homicide in England and Wales. Br J Psychiatry 2003; 183(3): 207–212.CrossRefGoogle ScholarPubMed
27.Pfefferbaum, B, North, C, Flynn, B, et al: The emotional impact of injury following an international terrorist incident. Public Health Rev 2001;29(2–4): 271–280.Google ScholarPubMed
28.Ahern, J, Galea, S, Resnick, H: Television images and psychological symptoms after the September 11 terrorist attacks. Pyschiatry 2002; 65: 289–300.CrossRefGoogle ScholarPubMed
29.Schuster, M, Stein, B, Jaycox, L: A national survey of stress reactions after the September 11, 2001 terrorists attacks. N Engl J Med 2001; 345: 1507–1512.CrossRefGoogle Scholar
30.Duggal, HS, Berezkin, G, Vineeth, S: PTSD and TV viewing of World Trade Center. J Am Acad Child Adolesc Psychiatry 2002; 41(5): 494–495.CrossRefGoogle ScholarPubMed
31.Veenema, T, Schroeder-Bruce, K: The aftermath of violence: Children, disaster, and posttraumatic stress disorder. J Pediatr Health Care 2002; 16(5): 235–244.CrossRefGoogle ScholarPubMed
32.Mullin, S: Public Health and the media: The challenge now faced by bioter-rorism. J Urban Health 2002; 79(1): 12.CrossRefGoogle Scholar
33.Glass, T: Understanding public response to disasters. Public Health Rep 2003; 116 Suppl 2: 69–73.CrossRefGoogle Scholar
34.Njenga, F, Nyamai, C, Kigamwa, P: Terrorist bombing at the USA Embassy in Nairobi: The media response. East Afr Med J 2003; 80(3): 159–164.Google ScholarPubMed