Wednesday, February 26, 2014

Thinking Ahead, Preventing Tragedy

By: Mohini Banerjee

When natural disasters become central to bioethics discussions, it usually invokes a public health lens. Furthermore, the ethics involved concern disaster response, otherwise known as the aftermath. As detailed in Sheri Fink’s Five Days At Memorial, ethical quandaries arose when they were unable to evacuate certain patients from a flooded hospital. Health care professionals faced the demand to both create and execute a moral equation determining who could survive if moved and who would most likely survive. In the midst of Hurricane Katrina’s wrath, some doctors euthanized patients that could not be evacuated, saving them from languishing in agony as their machines failed. These physicians had some ethics training, but nothing that could have prepared them for that situation.

If we had to make difficult decisions in the midst of a disaster, what would we choose? During Hurricane Katrina many also took to the streets to find food and services when no help came. This led to horrific police and civilian violence. The racial and socio-economic implications of the fallout in the Gulf states only add to the tragedy. Although there are immense problems with the response to Katrina, we must also consider disaster preparedness. Foresight and energy could preempt and thus mitigate many of the worst disaster outcomes.

One difficulty in the ethics of disasters, as opposed to issues that arise in clinical settings, is that one cannot assume a controlled environment. There is no time to consult an ethics board, family members, or the courts. Disaster situations involve technological and communication failure on massive scales, such as falling telephone lines and power outages. Health care professionals also grapple with their own safety in ways foreign to most instances of medical care. For example, as Fink outlines in her book, many of the doctors at Memorial struggled with dehydration and injuries themselves from the hospital conditions. Lastly, national and state-based plans often cannot be implemented on the local level, lacking a detailed understanding of the community’s needs. For all these reasons, work done ahead of time could insure fairer outcomes in the aftermath.

Disaster preparedness is not a new phenomenon, and it would be foolhardy to dismiss the long efforts to mitigate ensuing chaos. Yet, in the world of ethics, how we prepare is less discussed than what happens when the chaos is in full force. What I suggest is a closer look at the methods for protecting ourselves and our communities when the unimaginable hits. The principles that govern disaster response, such as the responsibility to provide each person with life-saving care and protection, will only go so far. Since disasters often undermine the infrastructure facilitating medical care, evacuation, or housing, it is especially important to implement community-based initiatives to meet these needs.

The San Francisco partnership, established by Mayor Edwin M. Lee this past summer, epitomizes a community ethic in disaster preparation. It is a coalition between the Department of Emergency Management and Bayshare, a collection of sharing economy organizations. The partnership insures that during disasters people could use sharing economy mechanisms for free. Services include Lyft, a ride-share service that would transport emergency medical care and basic supplies. Another is the room rental scheme, Airbnb, which provides housing for people with nowhere to go. Providing these services in a disaster’s fallout would use the community’s resources to help itself. The San Francisco model demonstrates how members of the local community could use their resources to aid one another.

Although internationally recognized ethics standards for disaster response exist, preparedness is seldom discussed considering equality or fairness. Oftentimes preparing for disasters is left to the government or to the individual, such that those with less lose out. Further, the obligations of individual families extend beyond themselves and complying with the government’s safety measures. Strategies, such as San Francisco’s, which distribute much needed and underutilized resources facilitate a community’s ability to help itself.

It is not only preferable, but ethically necessary, to have a system in place that ensures sharing resources. Governmental bodies should not be the sole providers of resource planning. Community members understand best what is available locally and are situated to help first responders prevent harms within a chaotic situation. While each person will first provide for her own family’s safety, the next considerations should extend to those in one’s proximity. Preparing as a community will help foster social cohesion, which again feeds back to those difficult decisions. Gaining more responsibility for ourselves and for those around us can avert the desperation that so many have already suffered.  

Mohini graduated from Smith College in May 2013 and is a research assistant at The Hastings Center, an independent non-profit research institute in bioethics. She founded Bioethx Under 25 in January and acts as Editor in Chief. For interest in the blog please email her at

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