Bioethics Blogs

CRISIS ETHICS: Hope for the best, prepare for the worst

by Craig Klugman, Ph.D.

An Ebola epidemic rages through Western Africa. Civil unrest and terrorist turmoil rocks Syria/Iraq, Libya, Israel/Gaza, and Ferguson, Missouri. A 6.1 earthquake damages Napa and shakes the entire San Francisco Bay Area. All of these events are examples of crisis—a catastrophic disaster (natural or human-made) that disrupts the regular operating of a region.

In terms of health, a crisis is a “state of being that indicates a substantial change in health care operations and the level of care than can be delivered in a public health emergency, justified by specific circumstances” (IOM, Crisis Standards of Care: A Systems Framework for Catastrophic Disaster Response 2012). In other words, these are situations that strain the ability of the health care system to provide needed treatment to all patients. An epidemic of a deadly disease, civil unrest (whether because of invasion, terrorism, or uprising), and natural disasters are all situations where the regular infrastructure collapses and the ability to provide a regular standard of care is compromised threatening high rates of morbidity and mortality as well as a shortage of supplies and personnel.

In 2013, the Institute of Medicine released its third report on crisis preparedness and management: “Crisis Standards of Care: A Toolkit for Indicators and Triggers” is a framework for states and cities to develop plans for dealing with mass casualty situations. The IOM program requests conversations between and among state and local governments, EMS programs, hospitals, care systems, and the public for planning in the event of crisis.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.