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ETHICAL DILEMMAS OF DOCTORS DURING DISASTERS


Ethical Dilemmas of Doctors during Disasters Providing care in a catastrophic crisis is the worst-case scenario and significantly strains healthcare providers and systems. Multiple euthanasia charges against doctors and two nurses at the Memorial Medical Center in New Orleans during the Hurricane Katrina crisis are the most apparently suspected violations of accepted legal and bioethical norms. Hurricane Katrina hit New Orleans in August 2005, killing more than 1,300 people and making Louisiana the most devastating natural disaster.


Despite the supposed intuitive moral identity of emergencies and evacuation, I believe the actions taken at the monument are morally unreasonable. I aim to take two approaches to this discussion. First, the triage system has inherent biases and ambiguous judgments about the patient's health and disfavors the individual in the most challenging situations. The second point is that euthanasia without consent, even to relieve the patient's distress, violates the written contract between the doctor and the patient and contradicts the individual's physical autonomy and freedom of choice.


First, moral relativism has a rational basis, but by changing certain contextual elements, behavior that is morally undesirable in one case is ethically acceptable in another. It goes against logic to conclude. It argues that universal moral norms are useless and that there is no ethical framework for measuring our behavior. Second, establishing specific moral standards to enable particular actions in a crisis shows that people who act in these situations are not given the option. For example, in the case of memorials, the ethical scope should be expanded to include the doctors who provided fatal doses because they were forced or had no choice. The doctor may have chosen to leave the situation absolving themselves.


After the hurricane, memorial staff struggled to make judgments as hospitals lacked adequate disaster contingency plans. Physicians instinctively employ triage strategies, usually when there is a clear imbalance between available resources and victim demands. Two opposing classification systems were used, prioritizing the least competent and emphasizing the most qualified. However, both approaches violate the generally held principle of "equality," according to which an individual's circumstances should not be considered when determining one's fate. Most would argue that the most ethically ideal way to assign evacuation priorities in an emergency is a random draw without bias or influence.


This raises questions. If they are most likely to live a long and fruitful life, why is it immoral to prioritize the evacuation of more capable people? The two most urgent concerns are the quantity of energy saved and the most significant number of "years of life" that can be maintained. On the other hand, can life be measured mathematically? Intuition alone can conclude that a triage system prioritizes people without disabilities will save more lives. Still, in contrast to those involved in life support, those who can stand and walk may argue that those left behind are more likely to live. One end of the inequality has more 'lives saved' than the other does not automatically justify it. Even given a patient's medical history, it's difficult for a doctor to forecast a patient's future health or life expectancy.


These factors point to Memorial's ethical flaws in employing the triage method. According to reports, only one individual, Dr. Anna Pou, allocated numbers to patients after scanning their medical records. The immorality of triage and its application at Memorial is exacerbated by the contentious decision to designate Do Not Resuscitate (DNR) patients as third-priority patients, based on the rationale that DNR patients would have the "least to lose" because they had previously refused revival measures if their hearts stopped beating.


The DNR order allows doctors to delay life-saving efforts without feeling guilty if a person's heart stops. This suggests that the clinical death was caused by someone other than the doctor. In this case, the action was not taken, nor were they told to relieve the doctor of any moral responsibility or obligation to the person's life. In this case, the physician is directly responsible for any harm the patient may suffer due to being designated a low-priority evacuation, placing the physician in a position of moral responsibility. Consequently, it is unethical for a physician to act in this capacity.


The second-level reasoning being killing a priority "3" patient with a lethal amount of drug is unethical. However, the memorial staff remains reluctant to admit that what they did involve any form of killing. Euthanasia is the more popular name for this procedure. Euthanasia is frequently used to end the lives of those clinically dead or those on life support. In all cases, clinicians must consult with the patient or consult the patient's family if the patient cannot discuss alternatives independently. That's not the case with the Memorial, though. Dr. Pou and senior physician Dr. Ewing Cook actively embraced that some patients would have to be left behind, and those seriously ill would likely die if they stayed.


The main ethical question is, are they abandoning their patients and subjecting them to a long and painful death? Should they use lethal drugs to speed up something they think is imminent? They couldn't let their patients fend for themselves, so they decided to do it themselves. This is the first flaw in their decision. They may have been lured by the potential of leaving the hospital sooner or evacuating their personnel in their drive to commit this deed, making them even less reasonable and lucid than usual. However, the most surprising aspect of all these events wasn't the choice to beg for mercy in the first place. Given the constraints at the time and the circumstances, many people may have come to this conclusion.


At the heart of the moral error of euthanasia at the Memorial, neither doctors nor nurses asked patients for their consent as they continued to deliver lethal drugs. The inability to reach family members is understandable. If they realize they can't get absolute permission, they should abandon the concept of individual autonomy and free will altogether. Again, this is a blatant violation of physicians' unwritten commitment to patients seeking the best possible treatment on a medical level. According to Dr. Pou, an operation is a form of "consolation care" designed to ensure people die peacefully and painlessly. On the other hand, the principle of double effects states that we cannot be sure of someone's death unless we commit it deliberately. The link between moral responsibility and action and inaction mentioned by patients with DNR may also be relevant to the concept of "merciful killing." Whatever the purpose, intentional killing, as the doctors at Memorial Hospital did, is morally dishonorable. Our duty to save others is less important than our duty not to kill. The doctors at the Memorial cannot be expected, morally or otherwise, to have the will and ability to save everyone at risk of death. Lastly, the tragedy involving the LifeCare patients and claims highlights the need for disaster planning compatible with society's legal and ethical standards.


References- ● Ozge Karadag, C, and A Kerim Hakan. “Ethical dilemmas in disaster medicine.” Iranian Red Crescent medical journal vol. 14,10 (2012): 602-12. ● Jan, Akbar N., et al. “Ethical Dilemmas of Decision Making in a Crisis: Tragedy at Memorial Medical Center, New Orleans.” IUP Journal of Organizational Behavior, vol. 20, no. 4, Oct. 2021, pp. 455–73. ● Willett, James, and Sandra Nasrallah. "Resolving Ethical Dilemmas: A Guide for Clinicians." (2010): 1163-1163. ● Barron Ausbrooks, C.Y., Barrett, E.J. & Martinez-Cosio, M. Ethical Issues in Disaster Research: Lessons from Hurricane Katrina. Popul Res Policy Rev 28, 93–106 (2009). ● Curiel TJ (2006) Murder or mercy? Hurricane Katrina and the need for disaster training. N Engl J Med 355:2067–2069 ● Qureshi K, Gershon RRM, Sherman MF et al. (2005) Health care workers’ ability and willingness to report to duty during catastrophic disasters. J Urban Health 82:378–388 ● Holt GR. Making difficult ethical decisions in patient care during natural disasters and other mass casualty events. Otolaryngol Head Neck Surg. 2008 Aug;139(2):181-6. ● Schaffer, Amanda. “The Moral Dilemmas of Doctors During Disaster.” The New Yorker, 12 September 2013. Accessed 25 October 2022. ● “Hurricane Katrina: Government Ethical Dilemmas | Free Essay Example.” StudyCorgi ● Grimaldi, Mary Elizabeth. "Ethical decisions in times of disaster: choices healthcare workers must make." Journal of Trauma Nursing| JTN 14.3 (2007): 163-164. ● Klein, Kelly R., et al. "Evolving need for alternative triage management in public health emergencies: A Hurricane Katrina case study." Disaster medicine and public health preparedness 2.S1 (2008): S40-S44. Ankita Chadha Masters student at Tata Institute of Social Sciences, Mumbai

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