Ethical Guidance for Disaster Response, Specifically Around Crisis Standards of Care: A Systematic Review
Published by Leider, PhD, et al., in the American Journal of Public Health, September 2017
Ethical guidance, alongside legal and medical frameworks, is an increasingly common component of disaster response plans. This systematic review examines how frequently ethical guidance is offered for crisis standards of care (CSC) during disaster response. A CSC declaration is a recognition that resources are limited and that everyday standards of clinical care are not possible under the circumstances.
When we screened 580 peer-reviewed articles mentioning ethics and CSCs or disaster planning, 38 (6%) included substantial discussion of ethical considerations (rather than, for example, focusing primarily on scientific treatment protocols.) The systematic review of the CSC ethics literature since 2012 showed that authors were primarily focused on the ethical justifications for CSCs (n=20) as well as a need for ethics guidelines for implementing CSCs; the ethical justifications for triage (n=19), both as to which criteria to use and the appropriate processes by which to employ triage; and the notion of a “duty to
care” or respond in disasters (n=11).
As governments and health care systems plan for disasters, 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.