TY - JOUR
T1 - Making difficult ethical decisions in patient care during natural disasters and other mass casualty events
AU - Holt, G. Richard
N1 - Funding Information:
As a head and neck surgeon, Dr Pou was accustomed to caring for postoperative patients in the surgical intensive care unit, but during her ordeal at Memorial, she also took responsibility for caring for very sick and nearly terminally ill patients in an acute care long-term facility located within Memorial Hospital. As resources began to become scarce and the conditions in the hospital became more extreme, Dr Pou and other health care providers found it necessary to develop a simple priority system for patient evacuation when outside relief finally materialized. Under extremely harsh conditions, Dr Pou made medical decisions that cannot be second guessed by those who were not there. After her heroic efforts, Dr Pou found herself facing charges of homicide in the deaths of four elderly and critically ill patients at Memorial. Fortunately, after nearly 2 years of difficult personal and legal challenges, Dr Pou was exonerated by an Orleans Parish grand jury's refusal to indict her. During the ordeal, Dr Pou was supported by the AAO-HNS, the American Medical Association, the American College of Surgeons, and the Louisiana State Medical Society.– These societies acknowledged the difficult decisions that were required under conditions not previously experienced in the US civilian health care system.
PY - 2008/8
Y1 - 2008/8
N2 - Objective: Recent experiences in the United States with unprecedented terrorist attacks (9/11) and a devastating natural disaster (Hurricane Katrina) have demonstrated that the medical care of mass casualties during such disasters poses ethical problems not normally experienced in civilian health care. It is important to 1) identify the unique ethical challenges facing physicians who feel an obligation to care for victims of such disasters and 2) develop a national consensus on ethical guidelines as a resource for ethical decision making in medical disaster relief. Study Design: A survey of pertinent literature was performed to assess experience and opinions on the condition of medical care in terrorist attacks and natural disasters, the ethical challenges of disaster medical care, and the professional responsibilities and responsiveness in disasters. Conclusions: It is necessary to develop a national consensus on the ethical guidelines for physicians who care for patients, victims, and casualties of disasters, and to formulate a virtue-based, yet practical, ethical approach to medical care under such extreme conditions. An educational curriculum for medical students, residents, and practicing physicians is required to best prepare all physicians who might be called upon, in the future, to triage patients, allocate resources, and make difficult decisions about treatment priorities and comfort care. It is not appropriate to address these questions at the time of the disaster, but rather in advance, as part of the ethics education of the medical profession. Important issues for resolution include inpatient and casualty triage and prioritization, medical liability, altered standards of care, justice and equity, informed consent and patient autonomy, expanding scope of practice in disaster medicine, and the moral and ethical responsibilities of physicians to care for disaster victims.
AB - Objective: Recent experiences in the United States with unprecedented terrorist attacks (9/11) and a devastating natural disaster (Hurricane Katrina) have demonstrated that the medical care of mass casualties during such disasters poses ethical problems not normally experienced in civilian health care. It is important to 1) identify the unique ethical challenges facing physicians who feel an obligation to care for victims of such disasters and 2) develop a national consensus on ethical guidelines as a resource for ethical decision making in medical disaster relief. Study Design: A survey of pertinent literature was performed to assess experience and opinions on the condition of medical care in terrorist attacks and natural disasters, the ethical challenges of disaster medical care, and the professional responsibilities and responsiveness in disasters. Conclusions: It is necessary to develop a national consensus on the ethical guidelines for physicians who care for patients, victims, and casualties of disasters, and to formulate a virtue-based, yet practical, ethical approach to medical care under such extreme conditions. An educational curriculum for medical students, residents, and practicing physicians is required to best prepare all physicians who might be called upon, in the future, to triage patients, allocate resources, and make difficult decisions about treatment priorities and comfort care. It is not appropriate to address these questions at the time of the disaster, but rather in advance, as part of the ethics education of the medical profession. Important issues for resolution include inpatient and casualty triage and prioritization, medical liability, altered standards of care, justice and equity, informed consent and patient autonomy, expanding scope of practice in disaster medicine, and the moral and ethical responsibilities of physicians to care for disaster victims.
UR - http://www.scopus.com/inward/record.url?scp=47549085535&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=47549085535&partnerID=8YFLogxK
U2 - 10.1016/j.otohns.2008.04.027
DO - 10.1016/j.otohns.2008.04.027
M3 - Article
C2 - 18656712
AN - SCOPUS:47549085535
VL - 139
SP - 181
EP - 186
JO - Otolaryngology - Head and Neck Surgery (United States)
JF - Otolaryngology - Head and Neck Surgery (United States)
SN - 0194-5998
IS - 2
ER -