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3 Ethical and Legal Considerations
Pages 13-20

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From page 13...
... . This chapter highlights the ethical difficulties of implementing CSC in real time, the questions and challenges of research to inform these realtime decisions, the differing perspectives of individual ethics versus population ethics, and how those varying points of view can impact CSC planning.
From page 14...
... These types of political or other actions are possible if we do not implement CSC wisely and ethically, with medical guidance and community input. QUESTIONS AND CHALLENGES OF RESEARCH TO INFORM CRISIS STANDARDS OF CARE DECISIONS Given the critical ethical implications of CSC decisions in a disaster or crisis state, the knowledge base and efficacy of the standards being set are important questions, Fink noted.
From page 15...
... Yet, planning in advance and executing CSC decisions with the best information available is legally defensible. If findings emerge later that initial choices were not ideal, adaptations in real time are made.
From page 16...
... Even under such austere conditions, the percentage of wounded service members who died of their injuries in Afghanistan decreased by nearly 50 percent between 2005 and 2013. In 2016, the National Academies published the report A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths After Injury, which provided recommendations on how to best incorporate these trauma advances into the civilian sector (NASEM, 2016)
From page 17...
... A participant from the Office of the Assistant Secretary for Preparedness and Response shared a modeling study that was done in 2011, which focused on triaging surgical procedures 48 hours after a nuclear detonation. He said that the authors found that in poorly resourced settings, "prioritizing victims with moderate life-threatening injuries over victims with severe life-threatening injuries saves more lives and reduces demand for intensive care, which is likely to outstrip local and national capacity" (Casagrande et al., 2011)
From page 18...
... Someone who has lesser access to care routinely will likely have more complications of their disease, she explained, so if they are penalized from a resource allocation perspective based on that, it is the moral equivalent of double jeopardy. Hodge added that without attention to CSC and building these frameworks, there are other inequities that would result, such as basing access to care or resources on factors unrelated to medical prognosis, like gender, sexual orientation, ability to pay, or domicile.
From page 19...
... He also offered the consensus that no one should be left to die -- though Fink cautioned the group about the moral distress that health care workers experienced during the Ebola outbreak, and how resource intensive the provision of palliative care can be. Finally, Wynia said, we need stories.


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