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15 Apr 2014

Doctors have been warned that during disasters they may face the agonising decision to withhold treatment from a gravely ill patient in order to treat someone with better survival prospects.

As climate scientists warn of the risk of increasingly severe bushfires, floods, cyclones and other natural calamities, the AMA has advised doctors they need to consider the ethical dilemmas they are likely to confront in the event they are called on to help treat people injured or made ill by natural or man-made disasters.

In an update to the 2008 Position Statement Ethical considerations for medical practitioners in disaster response in Australia, the Association said that, in addition to causing mass deaths, injuries and serious disruption to community life, disasters can also confront medical practitioners with situations and decisions that challenge strongly-held ethical principles and can bring the multiple responsibilities of doctors into conflict.

In the normal course of practice, the duty of care for a doctor to look after the health of a patient does not generally compete with other responsibilities, such as seeing to the wellbeing of themselves, their family, other patients, staff, colleagues and the general public.

“During a disaster, however, these multiple duties may come into conflict,” the Position Statement said.

“For example, in ordinary clinical circumstances, those who are sickest or most severely injured generally receive treatment first. During a disaster, there may be limited resources immediately available large number of sick and injured individuals.

“The doctor has to prioritise which individuals receive treatment over others. This may involve a decision not to actively treat a gravely ill or injured individual who cannot be saved in the specific circumstances…in order to treat others who can be saved.”

AMA President Dr Steve Hambleton acknowledged this was a tough decision, and said the Position Statement provided a guide to a doctor’s duty of care in emergency situations.

Dr Hambleton said doctors and other medical professionals were regularly called upon to help out when disaster struck, and most responded willingly and with great commitment.

But he said the Position Statement pointed out that, while helping others, doctors also had a duty to look after themselves and their families, colleagues and other health workers.

“In these situations, doctors have a duty to protect themselves from significant harm, so they should not be expected to exceed the bounds of reasonable personal risk,” the AMA President said.

Among the issues and challenges confronting doctors in responding to emergencies and disasters were the assumption of greater professional duties, increased occupational risk, physical and emotional stress, loss of income, risk of professional liability, and the possible exposure of their family to risk.

To ensure the medical profession’s readiness to respond, Dr Hambleton said it was important that it be included in the development, implementation and review of disaster response protocols.

This should include the development of standards for triage, the allocation of resources, treatment, quarantine, the giving of consent, and the protection of privacy and confidentiality.

In addition, the Position Statement said, employers, governments, and the community must acknowledge and act on a reciprocal obligation to protect and support doctors and other health workers who respond in times of disaster and emergency.

The Position Statement Ethical considerations for medical practitioners in disaster response in Australia can be viewed at:

Adrian Rollins

Published: 15 Apr 2014