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A New Ethical Model for Examining Emergency Medicine
A New Ethical Model for Examining Emergency Medicine
A New Ethical Model for Examining Emergency Medicine
A New Ethical Model for Examining Emergency Medicine
A New Ethical Model for Examining Emergency Medicine
A New Ethical Model for Examining Emergency Medicine
A New Ethical Model for Examining Emergency Medicine
A New Ethical Model for Examining Emergency Medicine
A New Ethical Model for Examining Emergency Medicine
A New Ethical Model for Examining Emergency Medicine
A New Ethical Model for Examining Emergency Medicine
A New Ethical Model for Examining Emergency Medicine
A New Ethical Model for Examining Emergency Medicine
A New Ethical Model for Examining Emergency Medicine
A New Ethical Model for Examining Emergency Medicine
A New Ethical Model for Examining Emergency Medicine
A New Ethical Model for Examining Emergency Medicine
A New Ethical Model for Examining Emergency Medicine
A New Ethical Model for Examining Emergency Medicine
A New Ethical Model for Examining Emergency Medicine
A New Ethical Model for Examining Emergency Medicine
A New Ethical Model for Examining Emergency Medicine
A New Ethical Model for Examining Emergency Medicine
A New Ethical Model for Examining Emergency Medicine
A New Ethical Model for Examining Emergency Medicine
A New Ethical Model for Examining Emergency Medicine
A New Ethical Model for Examining Emergency Medicine
A New Ethical Model for Examining Emergency Medicine
A New Ethical Model for Examining Emergency Medicine
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A New Ethical Model for Examining Emergency Medicine

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Talk by Omar Ha-Redeye at the 16th World Congress on Disaster and Emergency Medicine on Thursday May 14, 2009. …

Talk by Omar Ha-Redeye at the 16th World Congress on Disaster and Emergency Medicine on Thursday May 14, 2009.
For more details see Ha-Redeye, O (2009). Assessing the Needs of Health Professionals and Stakeholders. Chapter 6 in Population Health, Communities & Health Promotion (Eds. Sansnee Jirojwong, Pranee Liamputtong). Oxford University Press. ISBN: 9780195560558

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    • 1. A New Ethical Model for Examining Emergency Medicine Omar Ha-Redeye AAS, BHA(Hons.), CNMT, RT(N)(ARRT), J.D. Candidate Thursday May 14, 2009
    • 2. Why a New Ethical Model? <ul><li>System for planning, decision-making, evaluating disaster response </li></ul><ul><li>Method for identifying shortcomings and areas of improvement </li></ul>
    • 3. Agenda <ul><li>Describe bioethical model </li></ul><ul><ul><li>Different ethical principles </li></ul></ul><ul><ul><li>Limits of Utilitarian approach </li></ul></ul><ul><li>Case Study </li></ul><ul><ul><li>Short Exercise: SARS in GTA </li></ul></ul>
    • 4. <ul><li>“ every discourse about health care has not only a scientific but also a moral dimension, [pandemic influenza] plans also presuppose certain ethical values, principles, norms, interests and preferences” </li></ul><ul><ul><li>Kotalik, J. Addressing issues and questions relating to pandemic influenza planning: final report and recommendations . Health Canada; 2003. </li></ul></ul>
    • 5. 3 Bioethical Principles Beneficence “ Do Good” Justice “ Do Fair” Autonomy “ Self Rule”
    • 6. Composite Model for Disaster Relief
    • 7. Beneficence <ul><li>Most aid today is strictly beneficent, using a utilitarian ethos </li></ul><ul><ul><li>Triage= Egalitarian or Utilitarian </li></ul></ul><ul><li>Egalitarian - first-come, first-serve basis </li></ul><ul><ul><li>treatment restricted to the easily treated group by queuing or by random selection </li></ul></ul><ul><li>Utilitarian (reverse) triage - pre-prioritize individuals according to: </li></ul><ul><ul><li>immediate community contribution; need for urgent, non-urgent, or palliative care </li></ul></ul>
    • 8. Shortcomings of Triage <ul><li>Geneva Conventions and Protocols: casualties “shall be treated…without any adverse distinction…only urgent medical reasons will authorise priority in the order of treatment”. </li></ul><ul><li>Often ignores principles of autonomy, justice </li></ul><ul><ul><li>lacks the status of a universal moral obligation, and leads to an impersonal view of the valuing of life. </li></ul></ul><ul><ul><li>life-saving decisions involve medical, social, economic, and political criteria, and thus perpetuates existing injustices. </li></ul></ul><ul><ul><li>Incompatible with the liberal political philosophy of liberty and justice for all </li></ul></ul>
    • 9. Justice <ul><li>Corruption of local officials </li></ul><ul><li>Poor preparedness, early warning, and hazard reduction </li></ul><ul><li>Funding delays, inequity in distribution </li></ul><ul><ul><li>Inappropriate distribution of care </li></ul></ul><ul><ul><li>Disorganized chaotic response </li></ul></ul>
    • 10. Autonomy <ul><li>Most Western aid countries highly individualistic </li></ul><ul><ul><li>Communal culture provided support mechanisms for survivors </li></ul></ul><ul><ul><li>Need for outsides with respect for collectivist values </li></ul></ul>
    • 11. Self-Determination <ul><li>Recognize local leadership </li></ul><ul><li>Consultation of locals </li></ul><ul><li>Allow self-identification of needs </li></ul><ul><li>Promote self-direction of programs </li></ul>
    • 12. Human Rights
    • 13. Empowerment <ul><li>Distribute aid directly through vulnerable populations </li></ul><ul><li>Form social bonds with IDPs and aid communities </li></ul><ul><li>Understand unique social, cultural situations </li></ul><ul><li>Seek to meet unique needs ignored by others due to bureaucracy </li></ul>
    • 14. Severe Acute Respiratory Syndrome (SARS) <ul><li>March 5, 2003 Sui-chu Kwan, a 78-year-old woman who had travelled to Hong Kong in February, dies of SARS in Toronto. </li></ul><ul><li>March 17, 2003 Health Canada announces 11 suspected cases of SARS in Canada. There are nine in Ontario, one in B.C. and one in Alberta. </li></ul><ul><li>March 19, 2003 Health Canada suggests people should postpone travel to high-risk parts of Southeast Asia, including Vietnam and Singapore. World death toll of SARS estimated at 11. </li></ul><ul><li>March 26, 2003 Ontario declares a public health emergency and orders thousands of people to quarantine themselves in their homes. There are 27 probable cases of SARS in the province. Toronto hospitals begin barring visitors. </li></ul>
    • 15. Brief Case Study: SARS <ul><li>Alison K Thompson, Karen Faith, Jennifer L Gibson, and Ross EG Upshur. Pandemic influenza preparedness: an ethical framework to guide decision making. BMC Med Ethics. 2006; 7:12. </li></ul><ul><li>Leo J Paquin. Was WHO SARS-related Travel Advisory for Toronto Ethical? Canadian Journal of Public Health. 2007;98:3. </li></ul><ul><li>Peter A Singer, Solomon R Benatar, Mark Bernstein, Abdallah S Daar, Bernard M Dickens, Susan K MacRae, Ross E G Upshur, Linda Wright, Randi Z Shaul. Ethics and SARS: Lessons from Toronto. BMJ. 2003; 327. </li></ul><ul><li>Thomson et al. Stand on Guard for Thee. Ethical Considerations in Preparedness Planning for Pandemic Influenza. University of Toronto Joint Centre for Bioethics Pandemic Influenza Working Group. November 2005. </li></ul><ul><li>Gostin LO, Bayer R, Fairchild AL. Ethical and Legal Challenges posed by severe acute respiratory syndrome: Implications for the control of severe infectious disease threats. JAMA. 2003; 290:24. </li></ul>
    • 16. Ethical Costs <ul><li>Costs of not addressing ethical concerns during SARS in GTA included: </li></ul><ul><ul><li>loss of public trust </li></ul></ul><ul><ul><li>low hospital staff morale </li></ul></ul><ul><ul><li>confusion about roles and responsibilities </li></ul></ul><ul><ul><li>stigmatization of vulnerable communities </li></ul></ul><ul><ul><li>misinformation </li></ul></ul>
    • 17. SARS <ul><li>Duty to Provide Care </li></ul><ul><li>Professional duty to respond-in tension with barriers (personal; organizational; societal) </li></ul><ul><ul><li>SARS revealed tensions </li></ul></ul><ul><ul><li>Is there a difference in obligations when risk is known Vs. unknown? </li></ul></ul><ul><ul><li>Need for decision review process </li></ul></ul>
    • 18. SARS <ul><li>Equity </li></ul><ul><li>All patients have equal claim-in tension with need to prioritize (triage) during crisis </li></ul><ul><ul><li>Preserve equity as much as possible </li></ul></ul><ul><ul><li>Procedural fairness-maximize buy-in </li></ul></ul><ul><ul><li>Fair criteria </li></ul></ul><ul><ul><li>Stewardship </li></ul></ul>
    • 19. SARS <ul><li>WHO Travel Ban </li></ul><ul><li>U.N. states, “liberty of movement is an indispensible condition for the free development of a person” </li></ul><ul><li>5/6 cases of Canadian contracted SARS were people leaving Toronto </li></ul><ul><li>Cost GTA $1.1 billion </li></ul>
    • 20. SARS <ul><li>Individual Liberty </li></ul><ul><li>Autonomy rights </li></ul><ul><ul><li>in tension with public good </li></ul></ul><ul><li>Limitations to rights of individual during public health crisis </li></ul><ul><li>Proportionality, protecting public good, least restrictive means, without discrimination to certain groups </li></ul>
    • 21. SARS <ul><li>Proportionality </li></ul><ul><li>Personal liberty/rights </li></ul><ul><ul><li>in tension with restrictions </li></ul></ul><ul><li>Restrictions to individual/group in proportion to risk to public health </li></ul><ul><li>Justifies use of more coercive measures when least coercive measure have failed to achieve appropriate “ends” </li></ul><ul><li>“ Collateral Damage” of thousands in Toronto denied care </li></ul><ul><li>Severe illnesses; cancer, heart disease </li></ul>
    • 22. SARS <ul><li>Protection of the Public From Harm </li></ul><ul><li>Public well-being & safety-in tension with individual autonomy </li></ul><ul><li>Compliance of individuals for public good </li></ul><ul><li>Rationing –priority setting </li></ul><ul><li>Least restrictive means used </li></ul><ul><li>Transparency of consequences </li></ul><ul><li>Individual’s interest in the well-being of community </li></ul>
    • 23. SARS <ul><li>Privacy </li></ul><ul><li>Right to privacy </li></ul><ul><ul><li>in tension with demands of crisis for shared information </li></ul></ul><ul><li>Protection from stigmatization </li></ul><ul><li>Disclose only that which is necessary to protect public health </li></ul>
    • 24. SARS <ul><li>Solidarity </li></ul><ul><li>Interdependence </li></ul><ul><ul><li>in tension with territoriality (individual/department/institutions) </li></ul></ul>
    • 25. SARS <ul><li>Reciprocity </li></ul><ul><li>Support for those enduring a disproportionate burden during crisis </li></ul><ul><ul><li>Measures taken to address/minimize burden where-ever possible </li></ul></ul>
    • 26. SARS <ul><li>Trust </li></ul><ul><li>Fundamental value on all levels from bedside to boardroom </li></ul><ul><ul><li>Maintaining trust </li></ul></ul><ul><ul><ul><li>in tension with having to impose limits </li></ul></ul></ul>
    • 27. SARS <ul><li>Stewardship </li></ul><ul><li>Decision-makers have obligations when allocating resources to: </li></ul><ul><ul><li>Avoid/minimize collateral damage </li></ul></ul><ul><ul><li>Maximize benefits </li></ul></ul><ul><ul><li>Protect and develop resources </li></ul></ul><ul><li>Good stewardship entails consideration of: </li></ul><ul><ul><li>Good outcomes (benefits to the public good) </li></ul></ul><ul><ul><li>Equity (fair distribution of benefits and burdens) </li></ul></ul>
    • 28. Decision Review <ul><li>Essential Features: </li></ul><ul><li>Transparency </li></ul><ul><ul><li>Access for decision review </li></ul></ul><ul><ul><li>Criteria for review </li></ul></ul><ul><ul><li>Review process/leadership </li></ul></ul><ul><li>Accountability : </li></ul><ul><ul><li>Monitoring outcomes </li></ul></ul>
    • 29. For More Information <ul><li>Ha-Redeye, O (2009). Assessing the Needs of Health Professionals and Stakeholders. Chapter 6 in Population Health, Communities & Health Promotion (Eds. Sansnee Jirojwong, Pranee Liamputtong). Oxford University Press. ISBN: 9780195560558 </li></ul><ul><li>[email_address] </li></ul>

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