Ethical and Legal Challenges in Disaster Medicine

Ethics of Conservation Triage

“…The field of disaster ethics is in its infancy (Thompson et al, 2006;O'Mathúna et al, 2014, but early efforts have looked toward preparedness, including special protocols, for example, stating that the decision not to treat cases considered "beyond emergency care" cannot be considered a failure to come to aid (World Medical Association, 2006), giving legitimacy to the utilitarian aspects of triage. Such protocols need to be set, agreed on, and clearly communicated prior to a disaster context in order to be effective, and even still they can be challenging to implement on an individual level (Pou, 2013;O'Mathúna et al, 2014). Biodiversity conservation has often been compared to a "crisis", although some individual cases are clearly more urgent and severe than others.…”

“…The temptation to over-triage is often exaggerated when long wait times may result in increased harm (Aacharya et al, 2011), if there is emotional involvement or high possibility of litigation (Pou, 2013), or if there is institutional or financial incentive to do so (FitzGerald et al, 2010). The conservation sector must also be cognizant about such conditions that may lead to incorrect or undesirable triage decisions.…”

“…In the broader system of health care these principles also enact the need for preventative medicine to reduce the need for symptomatic care, and palliative care for cases with an imminent inevitability of death (Hobbs and Kristjanson, 2003;Pou, 2013). Here, it becomes evident of the small, but important role that triage systems play in a wider system of medical healthcare (Figure 2): triage systems themselves typically aim to facilitate the initiation of further assessment and treatment, but do not typically concern resources for that further care (FitzGerald et al, 2010).…”

“…To illustrate, we draw on the ethical principles that underpin triage in emergency medicine. The concept of triage is central to emergency medicine, including within hospitals and in field settings, and is rarely questioned by patients, practitioners, or institutions (FitzGerald et al, 2010;Aacharya et al, 2011;Pou, 2013), to the point of being intuitively implemented (FitzGerald et al, 2010). Our aim is to contrast the concept and practice of triage in emergency medicine and conservation in order to discern why it is more accepted in medicine yet polarized in conservation, and to identify areas in conservation triage that may benefit from further research attention.…”

Ethical surgical triage of patients with head and neck cancer during the COVID‐19 pandemic

“…There is an extensive literature on appropriate crisis triage, based on experience during warfare [11][12][13] and natural disasters. 14,15 This was most recently seen in our own country with the crisis in New Orleans in the aftermath of Hurricane Katrina, when physicians in hospitals had to triage civilian patients in a manner normally seen only in the midst of battle. 14,15 While we can extrapolate from triage and management models developed for times of war or natural disaster, this global pandemic is a different entity entirely, affecting almost the entire planet at once.…”