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Healthcare in Extreme and Austere Environments: Responding to the Ethical Challenges

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Abstract

Clinicians may increasingly find themselves practicing, by choice or necessity, in resource-poor or extreme environments. This often requires altering typical patterns of practice with a different set of medical and ethical considerations than are usually faced by clinicians practicing in hospitals in the United States and Europe. Practitioners may be required to alter their usual scope of practice or their standard ways of medically treating patients. Limited resources will also often place clinicians in the position of having to make decisions about fairly allocating healthcare, which will alter the physician–patient relationship. This does not absolve physicians and other healthcare practitioners of providing the best quality of care that can be given under the circumstances. In addition, the lack of a well-developed healthcare infrastructure and limited resources will require working with established providers to determine the needs of the community, and what types of healthcare are feasible given these limitations. The essays in this issue of HEC Forum encourage readers to reflect on the unique ethical challenges faced in the extreme or austere environment.

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Notes

  1. For insight into this debate see, e.g., Shea (2020), Trotter (2020), Garcia (2020), Veatch (2020), and Beckwith and Thornton (2020).

  2. Such circumstances also raise important questions regarding informed consent as well as understandings of health and disease. For insight into those ongoing debates see Heinrichs (2019), Walker and Lovat (2019), Mucker and Taylor (2020), and Wakefield and Conrad (2020).

References

  • Allhoff, F., & Golemon, L. (2020). Rural bioethics: The Alaska context. HEC Forum, 32(4). https://doi.org/10.1007/s10730-019-09385-5.

  • Bailey, R. (2010). The case of Dr. Anna Pou: Physician liability in emergency situations. Virtual Mentor, 12(9), 726–730.

    Google Scholar 

  • Battat, R., Seidman, G., Chadi, N., Chanda, M. Y., Nehme, J., Hulme, J., et al. (2010). Global health competencies and approaches in medical education: A literature review. BMC Medical Education, 10, 94.

    Article  Google Scholar 

  • Beauchamp, T. L., & Childress, J. F. (2013). Principles of biomedical ethics (7th ed.). New York: Oxford University Press.

    Google Scholar 

  • Beckwith, F., & Thornton, A. K. (2020). Moral status and the architects of principlism. The Journal of Medicine and Philosophy, 45(4–5), 504–520.

    Article  Google Scholar 

  • Crump, J. A., & Sugarman, J. (2008). Ethical considerations for short-term experiences by trainees in global health. Journal of the American Medical Association, 300(12), 1456–1458.

    Article  Google Scholar 

  • DeCamp, M. (2011). Ethical review of global short-term medical volunteerism. HEC Forum, 23(1), 91–103.

    Article  Google Scholar 

  • Donelan, K., DesRoches, C. M., Dittus, R. S., & Buerhaus, P. (2013). Perspectives of physicians and nurse practitioners on primary care practice. New England Journal of Medicine, 368(20), 1898–1906.

    Article  Google Scholar 

  • Engelhardt, H. T., Jr. (1996). The foundations of bioethics (2nd ed.). New York: Oxford University Press.

    Google Scholar 

  • Garcia, J. L. A. (2020). Virtues and principles in biomedical ethics. The Journal of Medicine and Philosophy, 45(4–5), 471–503.

    Article  Google Scholar 

  • Heinrichs, B. (2019). Myth or magic? Towards a revised theory of informed consent in medical research. The Journal of Medicine and Philosophy, 44(1), 33–49.

    Article  Google Scholar 

  • Iserson, K. V. (2020). Providing healthcare in resource-poor environments. HEC Forum 32(4). https://doi.org/10.1007/s10730-018-9346-7.

  • Klein, K. R., Pepe, P. E., Burkle, F. M., Nagel, N. E., & Swienton, R. E. (2008). Evolving need for alternative triage management in public health emergencies: A Hurricane Karina case study. Disaster Medicine and Public Health Preparedness, 2(suppl 1), S40–S44.

    Article  Google Scholar 

  • Langowski, M. K., & Iltis, A. (2011). Global health needs and the short-term medical volunteer: Ethical considerations. HEC Forum, 23(1), 71–78.

    Article  Google Scholar 

  • Mucker, D., & Taylor, J. S. (2020). The irrelevance of harm for a theory of disease. The Journal of Medicine and Philosophy, 45(3), 332–349.

    Article  Google Scholar 

  • O’Neil, E. O. (2006). The “ethical imperative” of global health service. Virtual Mentor, 8(12), 846–850.

    Google Scholar 

  • Pingree, C. S., Newberry, T. R., McMains, K. C., & Holt, G. R. (2020). Medical ethics in extreme and austere environments. HEC Forum 32(4). https://doi.org/10.1007/s10730-020-09405-9.

    Article  Google Scholar 

  • Shea, M. (2020). Principlism’s balancing act: Why the principles of biomedical ethics need a theory of the good. The Journal of Medicine and Philosophy, 45(4–5), 441–470.

    Article  Google Scholar 

  • State Bar of Texas. (2014). Texas Pattern Jury Charges. Austin: State Bar of Texas.

    Google Scholar 

  • Stokes, S., Koirala, P., Wallace, S., & Bhandari, S. (2015). Tragedy on Everest: The Khumbu icefall. Emergency Medicine Journal, 32(5), 418–420.

    Article  Google Scholar 

  • Stokes, S., Mackenzie, S., & Thomas, C. (2011). Medical ethics in mountain and wilderness medicine. BMJ Military Health, 157, 124–126.

    Google Scholar 

  • Trotter, G. (2020). The authority of the common morality. The Journal of Medicine and Philosophy, 45(4–5), 427–440.

    Article  Google Scholar 

  • Veatch, R. (2020). Reconciling lists of principles in bioethics. The Journal of Medicine and Philosophy, 45(4–5), 540–559.

    Article  Google Scholar 

  • Walker, P., & Lovat, T. (2019). Dialogic consensus in medicine—A justification claim. The Journal of Medicine and Philosophy, 44(1), 71–84.

    Article  Google Scholar 

  • Wakefield, J. C., & Conrad, J. A. (2020). Harm as a necessary component of the concept of medical disorder: Reply to Mucker and Taylor. The Journal of Medicine and Philosophy, 45(3), 350–370.

    Article  Google Scholar 

  • Welling, D. R., Ryan, J. M., Burris, D. G., & Rich, N. M. (2010). Seven sins of humanitarian medicine. World Journal of Surgery, 34(3), 466–470.

    Article  Google Scholar 

  • World Health Organization (2018). Climate change and health. https://www.who.int/mediacentre/factsheets/fs266/en/

  • Zafren, K., Brants, A., Tabner, K., Nyberg, A., Pun, M., Basnyat, B., et al. (2018). Wilderness mass casualty incident (MCI): Rescue chain after avalanche at Everest base camp (EBC) in 2015. Wilderness & Environmental Medicine, 29(3), 401–410.

    Article  Google Scholar 

  • Zientek, D., & Bonnell, R. (2020). When international humanitarian or medical missions go wrong: An ethical analysis. HEC Forum 32(4). https://doi.org/10.1007/s10730-019-09392-6.

    Article  Google Scholar 

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  1. Seton Heart Institute, and the University of Texas at Austin Dell, Medical School, 1301 W. 38th Street, suite 405, Austin, TX, 78705, USA

    David Zientek

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Zientek, D. Healthcare in Extreme and Austere Environments: Responding to the Ethical Challenges. HEC Forum 32, 283–291 (2020). https://doi.org/10.1007/s10730-020-09427-3

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