IFGH 2012: Training to prepare for ethical dilemmas in disasters

At the Irish Forum for Global Health conference (February 2nd – 3rd) at the Royal College of Surgeons in Ireland (RCIS) Dr. Donal O’Mathúna of Dublin City University (DCU) spent time highlighting the importance of bioethics training, and preparation for disaster settings.

O’Mathúna makes the point that disasters are increasingly common, listing examples such as pandemics, earthquakes, and flooding. Indeed, the United Nations identified disasters as a high priority. O’Mathuna’s work focuses on the challenges which face health care responders during a disaster, and the difficult choices they must make. He argues that there is a lack of preparedness amongst health care responders when it comes to dealing with ethical issues, resulting in many feeling unable to return to such settings.

He notes that “(m)any disasters occur in lower income countries, with responders from wealthier countries, leading to cultural and ethical conflicts” (IFGH Book of Abstracts, 2012:83), and believes that the training and preparation responders receive are far removed from the realities they experience in the field. Thus, they are inadequately equipped to deal with any conflicts that arise.

Currently, there is a lack of evidence surrounding this topic. This deficiency in itself presents ethical and logistical challenges. O’Mathúna’s research is an attempt to respond to this gap in knowledge. His work raises important questions; ‘how, exactly, does one go about providing the necessary training to deal with a disaster setting, a setting which by its very nature is chaotic and unpredictable?’, ‘is it ethical to consider a disaster site as a potential source of research?”, and ‘how do we marry our good intentions with the  immediacy of death and destruction these disasters inevitably present us with?’. Unethical practices in the past have resulted in unwillingness to engage with questions such as these. Nonetheless, in order to produce coherent guidelines on ethics, research and evidence is required.

O’Mathúna makes the argument that there is a disconnection between the type of training currently provided, and the training that is needed. The current model of training operates on a dichotomy of right or wrong responses. O’Mathúna believes that in reality it is often a case of having to choose between two ‘wrong’ options, and having to judge which is the least damaging. This constitutes a radically different dilemma. It runs contrary to the logic of intervention and cure that medicine is based upon. It requires an understanding that patients may have different ideas and assumptions about what is a good quality of life, in turn effecting the decisions made and the course of treatment.

It is important to note that Dr. O’Mathúna’s project is still in the funding stage. The work he presents is part of a process to create awareness around the issue and to work towards building a suitable model to train for ethical dilemmas in disaster settings. Still the topic of bioethics represents an important part of health care. Indeed, it is one which is closely aligned with my own research into the evolving relationship between health and security agendas.

During his discussion, O’Mathúna raised the question, “how does disaster response tie in with long term development goals?”. A disaster setting represents a dramatically altered stage for intervention and outcomes, and with the rise in disasters this is something we have to take into consideration in the future. O’Mathúna’s decision to position bioethics as a critical point is a step in the right direction for dealing with these challenges.

Eileen Murphy
    Key Correspondent
    Email: [email protected]
    Source: http://www.keycorrespondents.org/2012/02/13/training-to-prepare-for-ethical-dilemmas-in-disasters/

This article was written as part of a series of articles written by the Key Correspondent Team (KC Team) who covered the IFGH 2012 International Conference.

For more information on the KC Team click here: www.keycorrespondents.org