4/14 "Ethical Triage and Emergencies" by Kuschner, et al.docx

4/14 Ethical Triage and Emergencies Kuschner, et al 2007 Thesis -During PHE (public health emergency), standards of care may need to be altered to respond to imbalance of needs and resources -PHE are different and should be viewed differently -Organizations and clinicians have to balance PH responsibilities and duties to individual patients -Both are important, but survivability in the population is the main goal Some Terms -Public health emergency: a threat to a population that unfold over an extended, but finite, period of time- like pandemic, natural disaster -Surge capacity: an organization?s ability to expand quickly beyond normal services to meet urgent, increased demand for medical care -Ex. can take care of 60 but have 150 -Triage: people that are not expected to survive, people that are expected to survive, and people that are only expected to survive with care; when we don?t have resources to treat everyone Policies and Procedures -Must be developed in advance -Must be communicated in advance (ex. disaster drills) -Failure to do so? -Unfair to clinicians -Would result in injustice -Would result in chaos Policies & Procedures: Values -Cultivation of trust -Stewardship -Duty to provide care -Equitable access to care -Protect public from harm -Preserve individual liberty, privacy, and confidentiality?unless PH goals dictate other wise -When PH needs require curtailment of civil liberties, use least restrictive interventions Quarantine, Triage, Rationing -May be enforced against wishes of patient -Must be necessary and effective -Must be least restrictive option to achieve goal -Must be fairly distributed within population -Procedural due process must be available The Veil of ignorance -Thought experiment -Behind a veil that blinds you to your situation -A good tool to come up with an emergency policy Policies & Procedures: Process -Transparency -Stakeholder engagement (other members of the community should be involved) -Public dissemination of decisions and reasons for them -Flexibility to modify as new info emerges Triage -Goal is to direct scarce resources away from patient who are not expected to survive and patients who are expected to survive without them Lifesaving Treatment can be Withheld -Likelihood of survival is small -Resources are scarce and likely to benefit other with greater survivability -Amount of resources needed per case may be considered -Personal/demographic factors may not be considered Care May NOT be Withheld -Patients must never be abandoned -Patients must never be actively euthanized -Palliative care (pain relief) may use doctrine of double effect -Use alternative standards of care/scope of practice -Patients must be re-assessed periodically Healthcare Providers -?are different in a PHE -Have different status -Have different duties -Professional codes of ethics indicate duty to provide care during a disaster -Duty includes personal risk -Have special skills -Are under an ?implicit contract? -Have freely assumed risk -Physicians enjoy a privileged position in society -Status -Money -Partly-subsidized education -Are the most valuable resource in a PHE -Duties to HCP include -Provide for safety of HCP during PHE -Provide for vulnerable 3rd parties that are related to HCP during PHE