Final Exam – Ethical Case Study
Lila Gaudrault
The University of New England
IHS 310: Ethics for Interprofessional Practice
Professor Eryn Neptune
May 11th, 2022
Final Exam – Ethical Case Study
As a healthcare professional faced with an emergency situation, the question of who is treated first is often just as important as the treatment itself. When disasters or mass casualty incidents occur, providers are frequently faced with a number of dilemmas: How does one define who is truly the “sickest” or has the greatest needs? Are some members of society more important or valuable than others, thus meriting prioritization of their treatment? How do we balance the needs of individuals with those of the community? All of these questions come into play with Case 13, which explores the dilemmas faced when providing treatment to a remote community following a natural disaster. Ultimately, an ethical response to large-scale disasters should focus on prioritizing those with the greatest medical needs and ensuring the community as a whole can access basic necessities and resources.
The case details the struggles of the small, remote community of Malinche following a major hurricane. Residents are faced with a lack of running water, electricity, and healthcare, and reports of missing children, oil spills, and untreated medical emergencies are circulating. As a member of a healthcare team, you are tasked with triaging patients for immediate evacuation, evaluating further threats, and ensuring collaboration between local officials and healthcare providers. From the case report, we know that Malinche can only be accessed by helicopter, and that its population includes a number of children and elderly individuals. Additionally, with temperatures topping 90 degrees each day and more rain forecasted, these populations are left especially vulnerable. Finally, we are aware that most residents have congregated at a local high school, where available food is rationed and generators provide limited power. Yet this report also leaves us with a number of unanswered questions. For example, what is the population of the town? Of this number, how many are unaccounted for? What are the specific medical concerns of those who are injured or ill? It is only once we recognize the extent of the issue that we truly can begin to make sound ethical evaluations. As with every ethical case, it is of utmost importance to fully understand the individuals, statistics, and facts associated with the scenario before proceeding to make decisions.
It is clear that there are a number of ethical issues presented in this case. In essence, we must decide which individuals need treatment and evacuation first, and which issues merit the greatest and quickest allocation of resources. Common reasoning would likely support triaging each ill or injured patient and treating them according to need. However, the issue is more complex than this. In the scenario, some, including the US Centers of Disease Control, support treating caregivers and providers first. This would allow for the possibility of a more resilient community down the road, yet it also neglects the individuals with the most desperate needs at the moment. Additionally, our healthcare team has been contacted by the town mayor, who requests that his wife, who has broken her arm, be treated immediately. There is also the question of whether to allocate more resources to search for missing and stranded individuals. Reports indicate that multiple families with small children, as well as elderly individuals, are stranded in their homes. Children have also been reported missing. Given that we don’t know the condition of these people, should we assume that they have the greatest need? Finally, we must address the environmental effects of the disaster. A potential oil spill raises health concerns, as does lack of electricity and running water. Should we devote our attention to controlling these environmental threats, which could further damage an already struggling community? These questions and more must be considered as we decide how to proceed with the scenario.
Arguably the most pressing concern at hand is which individuals merit the quickest treatment. This is where ethical principles can play a role in guiding our decisions. First, utilitarianism would support providing care, evacuation, and resources in a way that benefits the greatest number of people and allows for the best consequences overall (Spike & Lunstroth, 2016). Thus, if taking this approach, we would likely focus on treating caregivers and providers first. If the needs of these individuals are initially addressed, they can subsequently transition from the role of patient to provider and give care to others. Essentially, this approach would allow our response team to grow, and we would be able to address other needs, including missing children and environmental threats, in a more efficient manner. Additionally, treating the wife of the town mayor would be a priority, given that he could likely provide better leadership if he knows his family is safe and cared for. Yet this plan is not without fault. In our rush to treat potential caregivers and providers, we may worsen the situation for patients who have more urgent needs. For example, how can we justify treating a woman’s broken arm when children are missing and potentially being exposed to oil spills, excessive heat, and no water? Yet a utilitarian approach would support these actions, arguing that providing for the greatest benefits down the road is key.
Deontologists, on the other hand, would disagree with this approach. They would claim that we have a moral obligation to treat the sickest patients first, regardless of whether these individuals can support our response team down the road. A deontological approach would involve triaging patients based on immediate medical need and treating them accordingly. Universal, unchanging laws would be applied to this process. For example, as an EMT, I have been taught to use the START method, a system of triaging patients in mass-casualty incidents. Similar to this scenario, START involves a set of rigid guidelines for identifying patients with the greatest treatment needs (U.S. Department of Health & Human Services, 2021). A deontological approach would favor a method like this, where patients are evaluated based on their current condition. Another benefit of this approach is its efficiency. Whereas identifying potential caregivers could be a lengthy process, triaging patients would allow for care to be given quickly and focus on the needs in front of us.
Other alternative ethical theories could also play a role in this situation. Of particular interest are casuistry and feminist ethics. First, casuistry, or the comparison of new cases to influential ones in history, provides a framework to view the current situation through the lens of past ones (Spike & Lunstroth, 2016). We could look at responses to other disasters, such as Hurricane Katrina, and gain wisdom from its successes and failures. A second alternative approach, feminist theory, involves looking at ethical dilemmas with special consideration given to underrepresented and disadvantaged groups, whether they be racial minorities, financially insecure, or elderly individuals (Spike & Lunstroth, 2016). In this situation, we could apply feminist ethics by devoting special attention to marginalized populations and ensuring they receive equitable treatment.
Considering all of these approaches, I believe that the best course of action is to employ a bit of each method. While our resources are limited, this is still possible. I would recommend identifying experienced healthcare and disaster management professionals in the community and ensuring their needs are met so they can better serve other individuals. Yet this shouldn’t be our only focus. Instead, we will utilize a triage system to identify patients with the greatest need, and evacuate them accordingly. From the group of providers, we will organize a response team with three goals: Coordinating a missing person search effort, mitigating environmental risk, and providing necessities such as food and water. An approach like this allows us to address both patients with critical needs and the community’s well being as a whole. When undertaking this plan, we will be willing to adapt as necessary, but also try our best to follow through with every step. It is important to anticipate arguments and conflicts, and we will strive to build consensus and negotiations as we navigate challenges, listening to the voices of all involved and evaluating our methods as the situation progresses. As a whole, while this is a difficult, multi-faceted case, with ethical principles in mind, as well as a commitment to character, courage, and justice, we can address the needs of a community in crisis.
