Disaster Bioethics: Normative Issues When Nothing Is Normal (Public Health Ethics Analysis, Vol. 2)

By Falkenheimer, Sharon A. | Ethics & Medicine, Summer 2015 | Go to article overview

Disaster Bioethics: Normative Issues When Nothing Is Normal (Public Health Ethics Analysis, Vol. 2)


Falkenheimer, Sharon A., Ethics & Medicine


Disaster Bioethics: Normative Issues When Nothing Is Normal (Public Health Ethics Analysis, Vol. 2) Dónal P. O'Mathúna, Bert Gordijn, and Mike Clarke (Eds). Dordrecht: Springer, 2013. ISBN: 978-9400738638, 219 PAGES, CLOTH, $99.64.

Ebola and other infections, hurricanes, earthquakes, tsunamis, plane crashes, and masses of displaced people are frequent topics in the media. But limited resources and sometimes limited infrastructure in the face of these unexpected and very complex emergencies raise ethical questions for caregivers. While best thought through in advance, these issues must be faced, "ready-or-not," when they occur. Where do we find the guidance needed in such times?

Disaster bioethics, like the field of public health, has until recently been largely neglected in the plethora of book-length treatments in bioethics. The goal of Disaster Bioethics: Normative Issues When Nothing Is Normal, second in the series on Public Health Ethics Analysis, is meant to fill this gap. Disasters are a public health emergency, and a public health perspective differs, in many respects, from that typical of the individual healthcare practitioner. Public health, and therefore the ethics involved, require different considerations and emphases than the ethics of direct patient care because the population or community level perspective dictates that its practitioners consider more than the individual. For instance, distributive justice plays an important role in the choices that need to be made about the best use of available resources.

This collection discusses a wide range of disaster-related considerations and ethical issues-prevention, triage, resource allocation, training, communications, and disaster-related research. It identifies disaster victims as a vulnerable population that must be protected from exploitation and identifies informed consent as something that could easily be overlooked in an effort at expediency. Nearly half of the text focuses on issues and tensions pertinent to disaster-related research and sets a high bar for those who plan and conduct such research.

Two chapters deal with topics not usually addressed in publications in this field. Chapter two, on "macro-triage," introduces the concept of "the moral geography" of disasters and humanitarian relief. The author focuses attention on the military background underlying the bulk of publications on triage and the paternalism which often underlies military decisions. This could subordinate individual human rights to the "public good." In addition, preventable disasters frequently recur in the same areas repeatedly. Unfortunately, post-disaster efforts often fail to rectify the factors responsible, such as the long-term effects of colonialism or the lack of available funds to adequately prepare the population or build infrastructure able to withstand recurrent weather systems or natural events such as earthquakes. Even when these underlying factors are evident, political, international, and financial problems as well as culture often stymie change. Critical and innovative thinking is warranted to identify new and executable ways to correct or ameliorate these issues. …

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