Sufficiency of care in disasters: ventilation, ventilator triage, and the misconception of guideline-driven treatment

J Clin Ethics. Winter 2010;21(4):294-307.

Abstract

This essay examines the management of ventilatory failure in disaster settings where clinical needs overwhelm available resources. An ethically defensible approach in such settings will adopt a "sufficiency of care" perspective that is: (1) adaptive, (2) resource-driven, and (3) responsive to the values of populations being served. Detailed, generic, antecedently written guidelines for "ventilator triage" or other management issues typically are of limited value, and may even impede ethical disaster response if they result in rescuers' clumsily interpreting events through the lens of the guideline, rather than customizing tactics to the actual context. Especially concerning is the tendency of some expert planners to mistakenly assume that medical treatment of respiratory failure: (1) always requires full-feature mechanical ventilators, (2) will always occur in hospitals, and (3) can be planned in advance without sophisticated public consultation about likely ethical dilemmas.

MeSH terms

  • Aerosols
  • Botulinum Toxins / poisoning
  • Chemical Terrorism
  • Cyclonic Storms
  • Delivery of Health Care / ethics
  • Delivery of Health Care / standards*
  • Disaster Planning / trends
  • Disasters*
  • Health Resources / ethics
  • Health Resources / supply & distribution*
  • Humans
  • Influenza, Human / epidemiology
  • Pandemics
  • Relief Work
  • Respiration, Artificial* / ethics
  • Respiration, Artificial* / instrumentation
  • Respiratory Insufficiency / etiology
  • Respiratory Insufficiency / therapy
  • Standard of Care / ethics*
  • Standard of Care / standards
  • Triage / ethics*
  • Triage / standards
  • Ventilators, Mechanical* / ethics
  • Ventilators, Mechanical* / supply & distribution

Substances

  • Aerosols
  • Botulinum Toxins