November , 2012
This paper considers some of the ethical dilemmas that occur during disasters and how the chaos and desperation of those situations effect decision making for nurse managers.
Dilemmas in Disaster. What's a Nurse Manager To Do?
In July of 2006, two nurses and a doctor were charged with murder as a result of their actions during Hurricane Katrina in 2005. This charge was related to their administration of iv pain medicine and iv sedation to critically ill elderly patients, who subsequently died before evacuation was possible Based on evidence from witnesses, Louisiana’s declared their actions to be homicide. ("The free library," December 2006) Due to the intense nature of their work, nurse managers face a variety of ethical dilemmas throughout the course of their careers. That process evolves to a new level in times of disaster. As nurse manager, it is incumbent upon you to use sound judgment and professional critical thinking to make those decisions at a time when your emotional responses are likely to be at their most pronounced state of your career. This can be extremely difficult due to the subjective nature of the concept of right and wrong. As a manager, you are not only responsible for your own decision making, but for observing and guiding your staff to appropriately make their own. Ethics in the field of medicine, or “bioethics” is founded on four basic principles; which are beneficence, non-maleficence, respect for autonomy, and justice. The priority of these principles may change with different circumstances, such as in disasters, which sometimes may lead to challenges that are quite different from usual medical practices. In addition, disaster situations are related with public health ethics and may require stronger effort to achieve a balance between individual and collective rights. In public health, there is usually a conflict between autonomy of the patient and the desire to protect and promote the health of all involved. This “dual loyalty” also exists in disaster situations and it stands in the middle of most ethical dilemmas.(Karadag & Hakan, 2012)
The events of Hurricane Katrina are some of the most tragic that I have known to occur in the U.S. during my career. Hospitals in New Orleans were flooded and without power or functioning water supply or sewer. In an interview regarding the event, Dr. Ben Deboisblanc said, “Inside the building it was pitch black, and condensation started to roll off the walls. The aromas became unbearable as the toilets backed up. People unable to find a place to use a bathroom were urinating in coffee cups and defecating in garbage cans, whatever they could find. The morgues were in the basement, and were flooded, so patients who passed away were kept in the rooms where they died and began to decay. The health care workers worked around the clock, standing at bedsides, squeezing bags hour after hour.”("Bilgrimage," 2009, para. 12) A family member of one of the patients reported that she heard the staff trying to coordinate rescue efforts. The first day, no one came, the second a few boats, and the third, some helicopters. It was going to require a massive evacuation at a time when the emergency resources were trying to save most of the city, and there was more than one health care facility in the same situation. It was clear that not all would be saved. It was reported that a triage approach was initiated, and it was decided that patients who had DNR orders and those on mechanical life support would be last meaning they would surely die. Allegedly, some of the terminally ill patients who were not going to be evacuated were euthanized by the hospital staff. The order to do so was reported to have been given by a well-respected surgeon, and was carried out by that Dr. and two nurses. The...