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Chapter Eight: Ethical Issues

Published online by Cambridge University Press:  24 June 2020

Abstract

Ethical questions and dilemmas associated with disasters and their management are numerous and are compounded when international assistance is involved. This Chapter is intended to raise awareness and promote important and ever-relevant discussions; it is not a treatise on ethics. It discusses the issues associated with human rights and obligations and identifies important aspects of international law associated with such issues, hazard exportation, the right to know, needs assessments, as well as aid and assistance. Issues raised by the actions and policies of relief organizations, those associated with actions of the media, and those associated with the competence of the responding individuals and organizations also are examined. Triage and other forms of rationing of medical care create additional dilemmas that are discussed. Lastly, the problems associated with disaster research and application of the Helsinki Declaration are explored.

Type
Conceptual Framework
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2002

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References

1.Ludwig Edelstein, L: The Hippocratic Oath. Text, Translation, and Interpretation, by Ludwig Edelstein. Baltimore: Johns Hopkins Press, 1943.Modern version: International Code of Medical Ethics of the World Medical Association (1949). Adopted by the Third General Assembly of the World Medical Association at London in October 1949 (World Medical Association Bulletin, 1949;1(3):109,111.). This was followed by The World Medical Association Declaration of Geneva Physician's Oath (1948) adopted by the General Assembly of the World Medical Association, Geneva, Switzerland, September 1948 and amended by the 22ndWorld Medical Assembly, Sydney, Australia, August 1968.Google Scholar
2. United Nations General Assembly. Resolution 217 A, (III) Article 1, 2, and 3. 10 December 1948.Google Scholar
3.United Nations Conference on International Organization: Charter of the United Nations and Statute of the International Court of Justice. New York: United Nations, 1945, p 1.Google Scholar
4.World Health Organization: Health for All in the 21st Century. Policy document, Geneva: WHO, May 1998.Google Scholar
5. World Medical Association: Guidelines for Medical Doctors Concerning Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment in Relation to Detention and Imprisonment. Declaration adopted by the 29th World Medical Assembly, Tokyo, Japan, October 1975.Google Scholar
6. OFDA/CRED International Database, Université Catholique de Louvain – Brussels – Belgium. Available at: http://www.cred.be/emdat. Accessed 09 November, 2002.Google Scholar
7. Geneva Conventions of 12 August 1949, and their additional Protocols.Google Scholar
8. Force Commanders Policy Directive 20, Paragraph 10. United Nations Peace Force in Former Yugoslavia. 1995 Edition.Google Scholar
9. Hague Convention of 29 July 1899: Convention with Respect to the Laws and Customs of War on Land (Hague II), amended 18 October 1907 (Hague IV).Google Scholar
10.Hoffman, M: Physicians and international humanitarian law in complex emergencies: Controversies and future opportunities. Prehosp Disast Med 2001;16:239243.CrossRefGoogle Scholar
11. Personal Communication: Halvor Gude, MD, former Red Cross Medical Delegate to Cambodia.Google Scholar
12.Heller, J: Catch 22. New York: Simon and Schuster, 1961.Google Scholar
13. United Nations: Resolution “Right to Intervene”: Resolution of 5 April 1988 of the UN General Assembly instituting the right to enter sovereign territory to save lives and the Resolution of 8 December 1988 of the UN General Assembly establishing the right of access to victims of natural disasters and emergency situations of the same order.Google Scholar
14.Dembo, D, Dias, CJ, Kadwani, A, Morehouse, W, (eds): Nothing to Lose but Our Lives. Empowerment to Oppose Industrial Hazards in a Transnational World. New York: Council on International and Public Affairs, 1987.Google Scholar
15.Jasanoff, S: The Bhopal disaster and the right to know. Social Science and Medicine 1988;21(10):11131123.CrossRefGoogle Scholar
16.Tyagi, YK, Rosencranz, A: Some international law aspects of the Bhopal disaster. Social Science and Medicine 1988;27(10):11051112.CrossRefGoogle ScholarPubMed
17.Rubin, M, Heuvelman, H, Tomic, A, Birnbaum, ML: Health-related relief in the former Yugoslavia: Needs, demands, and supplies. Prehosp Disast Med 2000;15(1):111.CrossRefGoogle ScholarPubMed
18. Personal Communication: Sverre Kilde, Former Head of International Department, Norwegian Red Cross, 1985.Google Scholar
19.Berckmans, P, Dawans, V, Schmets, G, Vandenbergh, D: Inappropriate drug-donation practices in Bosnia and Herzegovina, 1992–1996. N Engl J Med 1997;337:18421845.CrossRefGoogle Scholar
20. HH Prince Sadruddin Aga Khan: Improving the Disaster Management Capability of the United Nations. United Nations Management & Decision-Making Project, UNA-USA: United Nations Association of the United States of America, January 1987.Google Scholar
21.Autier, P, Ferir, MC, Hairapetien, A, et al: Drug supply in the aftermath of the 1988 Armenian earthquake. Lancet 1990;335:13881390.Google ScholarPubMed
22.Ali, HM, Homieda, MM, Abdeen, MA: “Drug dumping” in donations to Sudan. Lancet 1988;335:538539. (Letter).CrossRefGoogle Scholar
23.Cohen, S. Drug donations to Sudan. Lancet 1988;336:745. (Letter)CrossRefGoogle Scholar
24.Offerhaus, L: Russia: Emergency drug aid goes awry. Lancet 1990;336:745.Google Scholar
25.Cuny, CF: Principles of disaster management. Lesson 14. Criteria for assessing a program. Prehosp Disast Med 2001;16(4):303306.CrossRefGoogle ScholarPubMed
26.Sundnes, KO, Teklehaimanot, A: Louse-borne relapsing fever epidemic in Ethiopia. Lancet 1993;342:12131215.CrossRefGoogle ScholarPubMed
27.Sundnes, KO: War with Other Means. UN Medical Support in a Balkan Sideshow. Norwegian Institute for Defense Studies IFS Info 4/96. Monograph.Google Scholar
28.Sundnes, KO: Personal communication. In 1992 a request to retrospectively evaluate different anaesthetic methods for brain injury as conducted during 1990 and 1991, at the ICRC hospital in Kabul, was turned down as it was considered unethical to do research on war victims.Google Scholar
29. The Declaration of Helsinki (Document 17.C) is an official policy document of the World Medical Association (WMA), the global representative body for physicians. It was first adopted in 1964 (Helsinki, Finland) and revised in 1975 (Tokyo, Japan), 1983 (Venice, Italy), 1989 (Hong Kong), 1996 (Somerset-West, South Africa) and 2000 (Edinburgh, Scotland). Note of clarification on Paragraph 29 added by the WMA General Assembly,Washington 2002.Google Scholar
30.de Ville, de Goyet C: Stop propagating disaster myths. Prehosp Disast Med 1999;14(4):213214.Google Scholar
31.Domres, B, Koch, M, Manger, A, Becker, HD. Ethics and triage. Prehosp Disast Med 2001;16(1):5358.CrossRefGoogle ScholarPubMed