Disaster Bioethics: Normative Issues When Nothing is Normal by Dónal P. O’Mathúna Bert Gordijn & Mike Clarke

Author:Dónal P. O’Mathúna, Bert Gordijn & Mike Clarke
Language: eng
Format: epub
Publisher: Springer Netherlands, Dordrecht

A parallel argument has been made in medical education, for example, when we claim that the only way medical students can learn would be to practice on patients, and thus there is an ethical obligation to use patients to improve care and assist future patients.

8.2 Disasters and Research Ethics

Less enthusiastic investigators, however, while acknowledging the constraints and difficulties of doing research in time of disaster, recognise that ‘disasters rarely constitute an ideal environment to conduct research … [They] are the most chaotic, stressful and dangerous environments imaginable for doing … clinical research on human beings’ (Bohannon 2011, pp. 1261–1263) . Investigators may rush to a disaster site and embark on a research project which has not been fully developed and properly reviewed for its scientific and ethical merit. Procedures may be hastily applied, and protocol transgression may seem justified by the goal of improving future responses and saving lives. Yet, the research could be added onto already burdened humanitarian rescuers, and this added burden could cause additional harm to the research subjects, those who need the most immediate help and support, thus endangering rather than saving lives.

Obtaining a more nuanced and objective view of “disaster research” is complicated. Disasters are multiple and unpredictable; they each have their own peculiar dynamics. As the March 2011 earthquake-tsunami disaster in Japan illustrates, disasters are “uncharted territory” and cannot be effectively managed through traditional survival strategies, routine procedures and stockpiled resources. They create formidable challenges to the community of nations, and nongovernmental organisations (NGOs) that come to the rescue. Even countries like Japan, which are best prepared to manage disasters and boast to be among the nations with the most towering seawalls and the sturdiest buildings in the world, are not immune from the chaos of disasters. Mismanagement in the evacuation process, miscommunication between private and public agencies, and irresponsible conduct of those in charge of the rescue are not uncommon. For example, the rescuers in Japan in the aftermath of the 2011 earthquake and tsunami disaster abandoned survivors to die of starvation (Tabuchi 2012) , and allegations were made that doctors in New Orleans euthanized patients during the 2005 Hurricane Katrina (Fink 2009) .

Facts on the ground (number of deaths, nature of injuries, and the extent of destruction) rarely fall in line with predictions based on theories. Not all health hazards exacerbate human misery or create health problems; not all disasters are catastrophic or equally tragic. And there is the question of logistics , the day to day, hour to hour, even minute to minute disaster relief responses. Choices must be made between competing evils and be flexible. Disaster victims may qualify as a vulnerable population, although they have not been explicitly recognised as such in any research guidelines or regulations. We must therefore ask whether current research guidelines are applicable to research on victims of disasters.

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