When a disaster strikes, normal thinking and routine procedures no longer apply. A disaster disrupts everything, including the triage system that is used successfully every day in the emergency department. This disruption applies both to clinical procedures and to the ethical foundation of those procedures. ED triage nurses traditionally practice using 4 ethical principles of autonomy, beneficence, nonmaleficence, and justice, along with the attendant moral rules of fidelity and
veracity, for example. Disaster triage operates according to a different ethical approach, the utilitarian ethical theory. A lack of standards and distinct guidelines in applying this theory adds to the moral distress felt by the triage nurse during a disaster. Making a life or death decision that a patient will consume too many resources and must go into the dead or dying category runs counter to the moral intuition of most people and most nurses, as well as counter to the typical ethical
principles that normally inform daily nursing practice. The nurse’s instinct is to help and nurture the patient. To ignore this instinct causes great consternation with extreme and potentially long-lasting moral distress for the triage nurse. An understanding of the ethical basis of disaster triage can help nurses reconcile the personal and professional difficulties, including moral distress, that can result from the decisions that must be made in such a situation. To read this article in full you will need to make a payment The Principle of Biomedical Ethics. Limits of autonomy in biomedical ethics? Conceptual clarifications. Autonomy, futility and the limits of medicine. Bioethics:
Principles, Issues, and Cases. Emergency department triage: an ethical analysis. Abbot Northwester patient left “writhing in pain” sues.References
- American Nurses Association
Code of Ethics for Nurses with Interpretive Statements.
American Nurses Association, Silver Spring, MD2001- Dahnke MD
The role of the American Nurses Association code in ethical decision making.
Holist Nurs Pract. 2009; 23: 112-119- Merin O
- Misken IN
- Lin G
- Wiser I
- Kreiss Y
Triage in mass-casualty events: the Haitian experience.
Prehosp Disaster Med. 2012; 26: 386-390- Challen K
- Walter D
Major incident triage, comparative validation using data from 7th July bombings.
Injury. 2012; 44: 629-633- Kahn CA
- Schultz CH
- Miller KT
- Anderson CL
Does START triage work?.
Ann Emerg Med. 2009; 54: 424-430- University Hospitals EMS Training & Disaster Preparedness Institute
S.T.A.R.T.: Simple Triage and Rapid Treatment.
[]- Leino-Kilpi H
The need to research the teaching of ethics and the outcomes of such teaching.
Nurs Ethics. 2001; 8: 297-298- Smart JCC
- Williams B
Utilitarianism: For and Against.
- Bentham J
- Mill JS
On liberty and other essays.
Oxford University Press, Oxford, UK1998- Hemingway M
- Ferguson J
Boston bombings: response to disaster.
AORN J. 2014; 99: 277-288- Hanna DR
- Romana M
Debriefing after a crisis: what’s the best way to resolve moral distress? Don’t suffer in silence.
Nurs Manag. 2007; 38: 38-47- Grimaldi ME
Ethical decisions in times of disaster: choices healthcare works must make.
J Trauma Nurs. 2007; 14: 163-164- White DB
- Katz MH
- Luce JM
- Lo B
Who should receive life support during a public health emergency? Using ethical principles to improve allocation decisions.
Ann Intern Med. 2009; 150: 132-138- Fink S
Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital.
Crown Publishers, New York, NY2013- Godley J
Not in my job description.
Am J Bioeth. 2008; 8: 25-26Biography
Jacqueline M. Wagner is Educator, Emergency Department, AtlantiCare Regional Medical Center, Pomona, NJ.
Biography
Michael D. Dahnke is Associate Teaching Professor, College of Nursing and Health Professions, Drexel University, Philadelphia, PA.
Article Info
Publication History
Published online: December 12, 2014
Identification
DOI: //doi.org/10.1016/j.jen.2014.11.001
Copyright
© 2015 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.