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Project IV - Ethical challenges in disasters

The resource scarcity that defines disasters brings with it moral challenges beyond those in usual healthcare. In disaster response situations, personnel will be in new, sometimes threatening situations where they will need to make difficult decisions to prioritize the enormous needs. Available professional ethical guidelines are of limited use as they do not sufficiently capture the complexity of disasters and the pressure responders are working under. 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 confronted with moral challenges. Depending on the intensity, duration, and frequency of moral challenges, moral stress may give rise to “moral distress” which is the negative stress reaction. Moral stress includes feelings of anger, frustration and powerlessness in individuals when they are faced with moral challenges where they in different ways are hindered to act upon own moral values. 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 stress can help identify moral issues and ways for the situation to be improved. However, it assumes that there are mechanisms for transforming the stress into something constructive and that the individual get support in the situation. Moral stress can be viewed as a normative response to moral challenges which is separated from moral distress and from other psychological consequences.

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 moral challenges in disaster response is central to understanding the issues responders face. The link between moral distress and psychological consequences, such as burnout, is poorly explored but that moral distress is a problem intertwined with affected wellbeing seems clear. In collaboration with National Centre for Disaster Psychiatry at Uppsala University and the Department of Learning, Informatics, Management and Ethics (LIME) at KI, 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 moral challenges in disaster response

2. To explore how and to what extent these challenges affect wellbeing among responders

3. To systematically develop education materials to prepare responders

4. To assess the extent that a preparatory education improves the preparedness and the capacity of responders to handle moral stress