Emerging Ethical Issues in Palliative Care: Grand Rounds from the Dept. of Pain Medicine and Palliative Care, Beth Israel Medical Center

Tia Powell, MD

Director
Montefiore-Einstein Center for Bioethics
Bronx, NY

During catastrophic public health emergencies or disasters, existing surge capacity plans may not allow healthcare providers to continue to follow normal treatment procedures and adhere to usual standards of care. This is exemplified by the response to Hurricane Katrina, which initiated a public policy debate on end-of-life care in the face of large-scale emergencies. Expert panels from the Institutes of Medicine and have recognized the importance of incorporating palliative care considerations—including appropriate pain management—into disaster planning. Identified issues that need to be evaluated in planning include the skill sets of responders, available services and basic supplies, and codified policies for mass casualty events. Clinicians must focus on saving lives, while simultaneously decreasing pain and suffering in surviving patients and those who will not survive due to either pre-existing illness or disaster-related injury. Yet how to prioritize patients for care remains a matter of debate among experts.

References

Downar J, Seccareccia D; Associated Medical Services Inc. Educational Fellows in Care at the End of Life. Palliating a pandemic: "all patients must be cared for". J Pain Symptom Manage. 2010;39(2):291-295.
Bogucki S, Jubanyik K. Triage, rationing, and palliative care in disaster planning. Biosecur Bioterror. 2009;7(2):221-224.
Matzo M, Wilkinson A, Lynn J, Gatto M, Phillips S. Palliative care considerations in mass casualty events with scarce resources. Biosecur Bioterror. 2009;7(2):199-210.
Institute of Medicine. Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations: A Letter Report. 2009. Washington, DC: The National Academies Press.

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