IFGH 2012: Disaster Bioethics: Preparing Health Workers for Ethical Dilemmas
Author Affiliations:School of Nursing and Health Sciences, Dublin City University
Option 2- Lessons from the field; project and programme evaluations; and syntheses or analyses Presented as – Oral Poster
The incidence of disasters is increasing. Their devastating impact is visible in the 2011 earthquake and tsunami in Japan, 2011 flooding in Australia, 2010 earthquake in Haiti, and elsewhere. Disasters generate massive healthcare needs, and health workers are prominent amongst those responding to disasters. Many disasters occur in lower income countries, with responders from wealthier countries, leading to cultural and ethical conflicts. Health workers often return from disasters experiencing moral distress, linked to ethical decisions made in those settings.
As part of a larger project, case studies have been collected and developed to incorporate into training materials for health workers responding to disasters. For example, triage decisions must be made about who to treat or not; limited resources must be distributed fairly; disaster responders are sometimes provided additional protections or resources compared to local populations.
Without experience or proper preparation ethical decision-making is difficult and may cause severe stress. Ethics training is often lacking, or focused on resolving ethical dilemmas assuming ideal conditions. However, ‘Not all wrongs can be rectified, not all losses can be compensated, not everything can be repaired or replaced, and ... not everyone can recover.’ Such non-ideal circumstances exist in disaster settings, and have implications for disaster bioethics training. Approaches need to address emotional issues like guilt, grief and anger, in additional to traditional moral reasoning.
We are working with the European Master in Disaster Medicine to incorporate ethics into their training materials. Together we aim to make policy proposals that ensure disaster health workers are better prepared to tackle ethical issues and thereby protect the dignity of disaster victims.