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Informing the Gestalt: An Ethical Framework for Allocating Scarce Federal Public Health and Medical Resources to States During Disasters

Published online by Cambridge University Press:  10 March 2014

Ann R. Knebel ,
Virginia A. Sharpe ,
Marion Danis ,
Lauren M. Toomey  and
Deborah K. Knickerbocker
Ann R. Knebel*
Affiliation:
National Institute for Nursing Research, Bethesda, Maryland
Virginia A. Sharpe
Affiliation:
National Center for Ethics in Health Care, Veterans Health Administration, Washington, DC
Marion Danis
Affiliation:
Clinical Center Department of Bioethics, National Institutes of Health, Bethesda, Maryland
Lauren M. Toomey
Affiliation:
Office of the Assistant Secretary for Preparedness and Response, Office of Emergency Management, US Department of Health and Human Services, Washington, DC.
Deborah K. Knickerbocker
Affiliation:
Office of the Assistant Secretary for Preparedness and Response, Office of Emergency Management, US Department of Health and Human Services, Washington, DC.
*
Correspondence and reprint requests to Ann R. Knebel, PhD, RN, National Institutes of Health, National Institute for Nursing Research, 31 Center Dr, Bldg 31, Rm 5B05, Bethesda, MD 20892-2178 (e-mail ann.knebel@hhs.gov).
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Abstract

During catastrophic disasters, government leaders must decide how to efficiently and effectively allocate scarce public health and medical resources. The literature about triage decision making at the individual patient level is substantial, and the National Response Framework provides guidance about the distribution of responsibilities between federal and state governments. However, little has been written about the decision-making process of federal leaders in disaster situations when resources are not sufficient to meet the needs of several states simultaneously. We offer an ethical framework and logic model for decision making in such circumstances. We adapted medical triage and the federalism principle to the decision-making process for allocating scarce federal public health and medical resources. We believe that the logic model provides a values-based framework that can inform the gestalt during the iterative decision process used by federal leaders as they allocate scarce resources to states during catastrophic disasters. (Disaster Med Public Health Preparedness. 2014;0:1–10)

Keywords

ethical issuespoliticsstate/local issues
Type
Concepts in Disaster Medicine
Information
Disaster Medicine and Public Health Preparedness , Volume 8 , Issue 1 , February 2014 , pp. 79 - 88
Copyright
Copyright © Society for Disaster Medicine and Public Health, Inc. 2014 

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