A mass casualty incident is a situation where the number of casualties overwhelms the emergency medical resources mostly in times of a disaster. During times of disasters, the medical care providers have to make ethical decision. This poses ethical challenges since there is no clear code of conduct applied globally at times like these. States generate their code of ethics to govern medical practitioners in times of emergencies (Born et al., 2007). An ethics code has its basis on best practice standards, which are set to the values and principles of a specific profession. For medical practitioners, they have a code never to deny medical help to those in need. However, in times of mass casualty the rescuers have to make decisions in limited time and resources.

There are three primary challenges faced by health care providers in times of emergencies including restrictions, rationing, and responsibility. Restrictions are the isolation and quarantine implemented during disease outbreaks or biological weapons. Rationing is the specific allocation of resources based on rapid diagnosis for each patient. Responsibility is the duty that health care providers have to patients. Among the three responsibilities poses a high ethical challenge. In times of mass casualty, healthcare providers have to make responsible decisions. Given that health care providers have a duty of care to all citizens during mass-casualty, then it is hard to know what one will do in times of mass casualty (Kathleen, 2012). It is clear by the definition of mass casualty that not all patients will receive medical care given the idea of limited responsibility. The decision the health providers make should be ethical and safe as many people as possible based on the available resource.

The most vulnerable people in mass casualty are the pregnant women, children and the elderly. The effects of a disaster affect those most, and it is upon the rescuers to decide whom to save. Addressing the needs of these vulnerable groups can reduce the aftermath effects of a disaster (Chen et al., 2009). These groups acquire emotional effects from disasters, and if their needs fulfilled, the effects will last for long.  In addition, these groups have a lower chance of survival in during mass casualties and the rescuers have to decide which of the three groups will require more resources.

Utilitarian Approach

The Utilitarian Approach to mass casualty calls for the attaining a greater good for the greatest number of casualties. This involves sorting the patients into groups based on their condition. This can lead to many situations in which decision-making has to occur which can mean life and death to casualties. The health care providers have to decide who will receive the available resources and who will not. However, the decision has its basis on saving as many casualties as possible with limited resources (Iserson & Moskop, 2007).  The ethical consideration lies in making the decision of who to receive the limited resource. After categorizing the patients, then the rescuers have to decide which group to receive the resources. The decision does not have its basis solely on the best outcome but also on the obligations vested on the health care providers.

The utilitarian approach is effective in that it generates an action with the greatest good and least harm. The goal of rescuers in mass casualties is to save as many casualties as possible and utilitarian approach enables the achievement of this goal.  However, the sense of humanitarian responsibility often allows the health care providers not to ignore any group based on policies or procedures.

Rights Approach

Human beings have equal rights regardless of gender or religious beliefs or ethnicity. In mass casualty decision making, this approach considers whether the decision made respects the rights of all human beings. Human beings are different from other things in that they have moral rights to choose what to do with their lives and freedom freely. In addition, human beings have a right to the truth. They have a right to know of the decisions made. This poses a challenge to the health care providers for one will not approach a group and inform them they will not receive health care (White et al., 2009). This will contradict with the right to what is agreed.  All affected people in mass casualties have equal rights, and ethical considerations in such a case depend on respecting the rights of all.

Using this approach in making decisions in mass casualties can be challenging. All the casualties have an equal right, but the available resources are overwhelmed. In making an ethical decision in this approach, it calls for the respecting of the rights for all (Born et al., 2007). Its effectiveness in mass casualties’ situations will have its basis on the choices made by the casualties themselves. Human beings have a right to have their choices respected.

Fairness or Justice Approach

The Greek philosopher Aristotle said that equals are equally treated and unequal unequally treated. This is the basis of the fairness approach. The idea of favoritism benefits some people with a reason to justify the favor. In addition, discrimination imposes burdens on people who are equal to those who have no burdens. In this sense, both favoritism and discrimination are wrong. The Utilitarian approach calls for the grouping of the patients and then deciding who to receive resources and who not to receive (White et al., 2009). This results in favoritism and discrimination. It is not fair for some people to receive treatment while others do not, and all people are equal. The fairness or justice approach ensures that the decision made is fair meaning it shows no favoritism or discrimination.

This approach is effective in that it respects the constitutional and universal human rights. All people are equal in the eyes of the constitution, and unfair treatment of any kind is unjustifiable even in times of mass casualty. However, given the limited resources in mass casualty situations, using this approach may not lead to best results regarding saving lives.

Common-Good Approach                                

This approach assumes that the society is comprised of individuals whose individual good has its basis on the good of the whole society. The approach focuses on ensuring that the social policies are beneficial to all members of the society. For the society to thrive, the sustainability of the society has to be safeguarded for the good of all (Iserson & Moskop, 2007).  The approach weighs whether a decision erodes the good common element. It encourages the recognition of the how the support people enjoy as individuals in pursuit of happiness and freedom is made possible by the sustenance of their community. It considers whether the action taken furthers common goals while at the same time respecting individual freedoms.

In mass casualty situations, the common good approach is not effective. Furthering the common good will mean saving as many people as possible, which with limited resources will call for doing away with some casualties. Doing away with some casualties will thus not be respecting their individual freedoms. Such a policy will be beneficial to some people and not to all.

Virtues Approach

Virtues are habits, attitudes, and traits, which enable human beings to behave in a way that develops their highest potential. The virtues approach assumes there are certain ideals that provide for the full development of humanity in human beings. To discover the ideals, we have to reflect on what kind of human beings we have the latent to become. Once acquired, virtues become characteristics of a person. A virtues person is in principle expected to act in a way consistent with the moral principles (Iserson & Moskop, 2007). Thus, a virtuous person is an ethical person. The virtuous approach focuses on the development of personal traits. Particular virtues such as cooperation, sharing, generosity can contribute to good results in mass casualty’s situations.

The approach can be every effective in mass casualties decision making. It calls for cooperation and sharing which are key attributes in mass casualties. If the health care providers decide to apply this ethical approach, they will cooperate and share the limited resources between the casualties. That way, they will have developed the traits of cooperation and sharing.

Conclusion

Making decisions in mass casualty’s situations is very challenging. Issues such as human rights, ethics, the common good and responsibility will collide with each other. A health provider, however, has to make a decision given the limited time and resources. The justification of the decision made will depend on how ethical is the approach used given the prevailing situation.

References

Born, C. T., Briggs, S. M., Ciraulo, D. L., Frykberg, E. R., Hammond, J. S., Hirshberg, A., … & O’Neill, P. A. (2007). Disasters and mass casualties: I. General principles of response and management. Journal of the American Academy of Orthopaedic Surgeons, 15(7), 388-396.

Chen, J., Wilkinson, D., Richardson, R. B., & Waruszynski, B. (2009). Issues, considerations and recommendations on emergency preparedness for vulnerable population groups. Radiation protection dosimetry, ncp083.

Iserson, K. V., & Moskop, J. C. (2007). Triage in medicine, part I: concept, history, and types. Annals of emergency medicine, 49(3), 275-281.

Kathleen Geale, S. (2012). The ethics of disaster management. Disaster Prevention and Management: an international journal, 21(4), 445-462.

White, D. B., Katz, M. H., Luce, J. M., & Lo, B. (2009). Who should receive life support during a public health emergency? Using ethical principles to improve allocation decisions. Annals of Internal Medicine, 150(2), 132-138.

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