Ethical guidance for disaster response
Citation: Leider JP, DeBruin D, Reynolds N, et al. Ethical Guidance for Disaster Response, Specifically Around Crisis Standards of Care: A Systematic Review. American Journal of Public Health. 2017;107:e1–9.
DOI: 10.2105/AJPH.2017.303882
URL: https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2017.303882
Language: Abstract and full text available in EN.
Free to view: Yes.
Funding sources: Minnesota Department of Health (USA).
What is this? Humanitarian crises and disasters create complex challenges for health systems. Crisis standards of care (CSCs) might help with the efficient use of clinical resources in resource-limited settings and ethical guidance should be a core part of CSCs to ensure equitable provision of health care.
In this systematic review, the authors searched for studies of ethical guidance for disaster response, specifically around CSCs. They did not restrict their searches by language of publication and did the search for studies published since 1 January 2012 in November 2016. They included 38 articles.
What was found: At the time of this review, most of the literature addressing ethics in the context of CSCs focused on ethical justifications and guidelines for implementing CSCs.
Ethical issues relating to CSCs are the necessity of rationing (resource and staff constraints), duty of care (moral obligation to provide care) and use of triage as a core component of a CSC.
Implications: The authors of the review concluded that “As governments and health care systems plan for mass casualty events, ethical guidance that is theoretically sound and practically useful can – and should – form an important foundation from which to build practical guidance for responding to disasters with morally appropriate means.”
Other considerations: The authors of the review did not discuss their findings in the context of issues relating to health equity.
This summary was prepared by Surya Ramachandran, checked by Yasmeen Saeed and Cristián Mansilla, and finalized by Mike Clarke.