The Shifting Ethical Responsibilities of Healthcare Delivery in an Age of Terror


C. C. Hook, R. J. Vetter


The prevailing medical ethic in the United States is fundamentally focused on patient autonomy. Even the classic principles of beneficence, non-malfeasance and justice are interpreted and employed through the lens of the individual patient's perspective. Appropriate responses of communities and medical institutions to acts of radiological terrorism, however, may best occur in the context of a communitarian ethic that focuses on community values and survival. These values may become paramount over the goals and desires of individual patients. As medical institutions are charged with protecting the health of whole regions in the event of terrorism, the ethic may of necessity become even more focused toward mission objectives. For instance, in a radiological event involving mass casualties, hospitals may be forced to delay or exclude patients contaminated with large levels of radioactivity to protect the staff, facilities, and mission of the institution. Similarly the principles of triage may move the priority selection of patients to be treated from those in most urgent need of attention to those most likely to survive or to mission critical colleagues. These shifts in operational ethic and triage principles may be very difficult for staff and members of the public to understand and adjust to, and thus must become a focus of education and preparation of institutional terrorism response plans.


This abstract was presented at the 36th Annual Midyear Meeting, "Radiation Safety Aspects of Homeland Security and Emergency Response", Emerging Technologies, Part 1 Session, 1/26/2003 - 1/29/2003, held in San Antonio, TX.

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