Project IV - Ethical challenges in disasters

The resource scarcity that defines disasters brings with it ethical challenges beyond those in usual healthcare. In disaster respons situations, personnel will be in new, sometimes threatening situations where they will need to make difficult decisions to prioritize the enormous needs. Frequently, existing biomedical ethics and guidelines cannot adequately capture the complexity of disaster responses and the time pressure. New circumstances, cultural considerations, values and limitations must be considered and taken into account. 

The term "moral stress" is a concept that captures the stress responding personnel experience when they end up in ethically difficult settings. Moral stress includes feelings of anger, frustration and powerlessness in individuals when they are faced with moral dilemmas with all alternatives perceived as morally wrong. Often, individuals have questioned the idea of what they believe should be done, but it is not possible due to lack of resources or other external or institutional barriers. The moral distress can help identify moral issues and ways for the situation to be improved. It assumes that there are mechanisms for transforming the stress into something constructive. 

In addition, one psychological consequence of responding to a disaster can be secondary trauma, or the development of post-traumatic stress reactions by indirect exposure to a serious incident. This has been observed by psychotherapists who treat traumatized responders. Although it is clear that the phenomenon occurs, what increase the risk of secondary trauma and the concepts are not yet clearly defined or studied. 

Defining and determining the extent of the ethical challenges in disaster response is central to understanding the issues responders face. The link between moral distress and mental illness is poorly explored but that stress is a problem intertwined with mental illness seems clear.  In collaboration with National Centre for Disaster Psychiatry at Uppsala University, we will work to better understand what determinants are crucial to moral stress and what can be done to prevent illness and suffering.

Objectives 2019

  1. To identify and categorize ethical challenges in disaster response
  2. To explore how and to what extent these challenges create ill-health among responders
  3. To develop education materials to prepare responders
  4. To assess the extent that education improves the preparedness of responders to handle moral stress
Disaster MedicineEthics