Hostname: page-component-cd9895bd7-gbm5v Total loading time: 0 Render date: 2024-12-26T08:22:37.041Z Has data issue: false hasContentIssue false

Practical, Ethical, and Legal Challenges Underlying Crisis Standards of Care

Published online by Cambridge University Press:  01 January 2021

Extract

Public health emergencies invariably entail difficult decisions among medical and emergency first responders about how to allocate essential, scarce resources (e.g., medicines, supplies, personnel). To the extent that these critical choices can profoundly impact community and individual health outcomes, achieving consistency in how these decisions are executed is valuable. Since the terrorist attacks on September 11, 2001, however, public and private sector allocation plans and decisions have followed uncertain paths. Lacking empirical evidence and national input, various entities and actors have proffered multifarious approaches on how best to allocate scarce resources to protect the public's health. Though beneficial in some jurisdictions, these approaches fail to clarify how the type and amount of care delivered in major emergencies might be curtailed. This is due, in part, to a lack of meaningful guidance on shifting standards of care in major emergencies.

Type
Supplement
Copyright
Copyright © American Society of Law, Medicine and Ethics 2013

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Government Accountability Office, Emergency Preparedness: States Are Planning for Medical Surge, but Could Benefit from Shared Guidance for Allocating Scarce Medical Resources, 2008, GAO-08 668, available at <http://www.gao.gov/new.items/d08668.pdf> (last visited January 9, 2013).+(last+visited+January+9,+2013).>Google Scholar
Institute of Medicine, Crisis Standards of Care: A Systems Framework for Catastrophic Disaster Response (2012).Google Scholar
Quarantelli, E. L., University of Delaware Disaster Research Center, “Emergencies, Disaster and Catastrophes Are Different Phenomena,” Preliminary Paper no. 304, available at <http://dspace.udel.edu:8080/dspace/bitstream/handle/19716/674/PP304.pdf?sequence=1> (last visited January 9, 2013).+(last+visited+January+9,+2013).>Google Scholar
Hick, J. L. Barbera, J. A. and Kelen, G. D. “Refining Surge Capacity: Conventional, Contingency, and Crisis Capacity” Disaster Medicine and Public Health Preparedness 3, Supp. 2 (2009): S59S67.CrossRefGoogle Scholar
Agency for Healthcare Research and Quality, “Altered Standards of Care in Mass Casualty Events: Bioterrorism and Other Public Health Emergencies,” Publication no. 05-0043 (2005).Google Scholar
Institute of Medicine, Committee on Guidance for Establishing Standards of Care for Use in Disaster Situations, Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations: A Letter Report (September 24, 2009).Google Scholar
See Institute of Medicine, supra note 2.Google Scholar
Irvin, C. B. Cindrich, L. et al., “Survey of Hospital Healthcare Personnel Response During a Potential Avian Influenza Pandemic: Will They Come to Work?” Prehospital and Disaster Medicine 23, no. 4(2008): 328335.CrossRefGoogle Scholar
Antommaria, A. H. Powell, T. et al., “Ethical Issues in Pediatric Emergency Mass Critical Care” Pediatric Critical Care Medicine 12, Supp. 6 (2011): S163S168.CrossRefGoogle Scholar
See Institute of Medicine, supra note 2.Google Scholar
Hodge, J. G. Jr. “Legal Triage During Public Health Emergencies and Disasters” Administrative Law Review 58, no. 3(2006): 627644.Google Scholar
Hodge, J. G. Jr. and Anderson, E. D. “Principles and Practice of Legal Triage During Public Health Emergencies” New York University Annual Survey of American Law 64, no. 2(2008): 249291.Google Scholar
See Institute of Medicine, supra note 2.Google Scholar
Carpenter, M. Hodge, J. G. Jr. and Pepe, R. “Deploying and Using Volunteer Health Practitioners in Response to Emergencies: Proposed Uniform State Legislation Provides Liability Protections and Workers’ Compensation Coverage” American Journal of Disaster Medicine 3, no. 4(2008): 1723.CrossRefGoogle Scholar
Nossiter, A. and Dewan, S. “Patient Deaths in New Orleans Bring Arrests” New York Times, July 19, 2006, available at <http://www.nytimes.com/2006/07/19/us/19patients.html?pagewanted=all> (last visited January 9, 2013).Google Scholar
Hodge, J. G. Jr. and Brown, E. F. “Assessing Liability for Health Care Entities That Insufficiently Prepare for Catastrophic Emergencies” JAMA 306, no. 3(2011): 308309.CrossRefGoogle Scholar
Hoffman, S. Goodman, R. A. and Stier, D. D. “Law, Liability, and Public Health Emergencies” Disaster Medicine and Public Health Preparedness 3, no. 2(2009): 117125.CrossRefGoogle Scholar
42 U.S.C. § 247d-6d.Google Scholar
Hoffman, S. “Responders' Responsibility: Liability and Immunity in Public Health Emergencies” Georgetown Law Journal 96, (2008): 1913.Google Scholar
Annas, G. J. “Standard of Care - In Sickness and in Health and in Emergencies” New England Journal of Medicine 362 (2010): 2126.CrossRefGoogle Scholar
See Institute of Medicine, supra note 2.Google Scholar
Hodge, J. G. Jr. and Courtney, B. “Assessing the Legal Standard of Care in Public Health Emergencies” JAMA 303, no. 4(2010): 361362.CrossRefGoogle Scholar
Department of Health and Human Services, Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP): Legal and Regulatory Issues (2009).Google Scholar