Medical Vulnerability in Natural Disasters: The Ethics of Responsibility and Response

Disaster relief organizations and workers often exhibit some of the most noble of human qualities, including concern for others, generosity, dedication, and even bravery in the face of extreme circumstances. Perhaps because of our admiration, disaster relief activities have largely escaped the scrutiny of bioethics; there are relatively few publications dealing with the ethics of disaster relief. Recent experiences, however, indicate that there is a need to evaluate disaster relief efforts from an ethical perspective. The thousands of “excess deaths” in Puerto Rico in the months following Hurricane Maria in 2017 demonstrate that generosity is not helpful if the aid that is provided does not match the actual needs of affected communities. In addition, the persistent cholera epidemic in Haiti, caused by United Nations personnel after a 2010 earthquake, illustrates that well-intentioned interventions can have serious adverse consequences. Based on analyses of these and other natural disasters, I argue that a key concept in disaster ethics is that of medical vulnerability. Both specific populations and health systems are vulnerable to natural disasters, and addressing these vulnerabilities is essential for effective and ethical disaster relief. I draw from published ethical considerations in three other contexts – clinical care, public health, and medical volunteerism – to propose a set of six ethical considerations that are essential in disaster relief. These are (1) Community-level beneficence and nonmaleficence, (2) Respect for communal autonomy, (3) Collaboration, (4) Evidence-based prevention, (5) Need-based response, and (6) Sustainability. Application of these considerations requires detailed planning by disaster relief organizations – planning that should occur well in advance of the disaster and be tailored to the resources and vulnerabilities of the specific affected communities. To illustrate that type of planning, I develop and present a predictive model that can be used to estimate the amounts of particular medications needed to provide care for one exemplary vulnerable population – those with heart failure. The ethical framework and approach to preparation described in this thesis can be used by disaster relief organizations and workers to ensure that responses to future natural disasters are more effective in caring for the medically vulnerable.

Grantor dc:publisher

Wake Forest University

Year dc:date.issued

2018

Author dc:creator

• Croxton, Rachel Dare

• Bioethics

Language dc:language.iso

en

Handle dc:identifier.uri

http://hdl.handle.net/10339/93057

OAI identifier oai:identifier

oai:wakespace.lib.wfu.edu:10339/93057