In the Wake of Terror: Medicine and Morality in a Time of Crisis
Falkenheimer, Sharon A., Ethics & Medicine
In the Wake of Terror: Medicine and Morality in a Time of Crisis Jonathan D. Moreno, Ed. Cambridge, MA: MIT Press, 2003 ISBN 0-262-13428-4
Much has been written since 9/11 dissecting events and lessons learned to aid future planning, but little discussion has been devoted to bioethical issues. In the Wake of Terror acknowledges that bioethical norms in extreme circumstances post-attack may differ from those in normal daily life. Therefore, there is a need to develop ways of responding ethically after these events. A continual theme throughout is the need to analyze these issues and their underlying values before attack and to develop and build consensus between those involved in the aftermath, including the public.
In the Wake of Terror is the seventh volume in the Basic Bioethics Series edited by Glenn McGee and Arthur Caplan. Among its twelve authors are such well-known ethicists as George Annas, Arthur Caplan, and James Childress. In four major sections (public health [PH], resource allocation, health care workers and industry obligations), the authors outline familiar bioethical issues and apply them to massive emergencies.
The four chapters devoted to PH focus on previous research abuses and the pros and cons of the recently proposed Model State Emergency Health Act (MSEPHA). Chapter one discusses how "Official secrecy, vulnerable populations, and the terrors of both disease and war make for a perilous combination" (p. 12-13), using examples from the World War II era, and the need to insure such abuses are not repeated. The second chapter outlines the MSEPHA, drafted in the wake of 911, as a comprehensive guideline for Grafting PH laws for both the WOT and the threat of emerging infectious diseases, and discusses the advantages of and individual protections in the Act. George Annas, in chapter 3, argues against the MSEPHA believing it encroaches on human rights and that its language presents PH authorities as the "good guys" and the public as the potentially non-compliant "enemy." He compares the MSEPHA and its adverse impact to situations, such as the Guantanamo detainment of Iraqis, where abridgement of human rights resulted in adverse publicity and loss of respect for the United States. The last chapter of this section outlines the history of PH controls and authorities. It supports Annas' views, although the author acknowledges that other approaches to control outbreaks of virulent contagious diseases may be inevitable.
The remaining three sections of two chapters each touch on other bioethical issues that must be addressed in pre-attack preparations.
Chapters five and six deal with resource allocation. Chapter five provides an excellent discussion of triage, its rationale and justifications. It presses for public participation and cooperation as an essential in designing policies, priorities, and protocols for massive emergencies. Chapter six distinguishes disaster triage from clinical and battlefield triage. It recommends a decentralized approach to care in catastrophes based on neighborhood treatment centers with pre-assigned medical staffs and sheltering-in-place. …