GESTIÓN EN SALUD PÚBLICA: BioEdge: Terrorism and triage

Terrorism and triage

by Michael Cook | 25 Feb 2017 |

Imagine that you are a doctor responding to an emergency in Israel. A terrorist has attacked people in a shopping mall with a knife, stabbing some old women and children. A policeman has shot and seriously wounded the terrorist. Whom should you treat first?

This is a classical triage situation in which the worst are to be treated first. The conventional view is that doctors must be “colour-blind” in treating victims. If the terrorist is the worst injured, he should be treated first.

In an article in the Journal of Medical Ethics, two Israeli doctors question this. Value-neutrality can lead to injustice, they contend, even if “ the virtuous euphoria that accompanies the subjective neutrality-maintenance effort” seems ethically pure.

In any case, “value-neutrality” is a myth, they claim. Deciding which organ to treat is a neutral decision; deciding which person to treat always involves the invocation of values. In fact, a strict “no exceptions” rule could easily be “a manifestation of conservative stagnation, induced by fear of change, or even masked political-correctness.”

In their analysis they argue that on three counts, victims deserve to be treated first:

• “Terrorists do not deserve the right of higher priority in the terror-triage dilemma (retributive justice).

• “The higher societal merit of the victims makes them eligible for higher priority (distributive justice).

• “The terrorist, who intentionally caused the victims' injury, should be of lower priority than the victims (corrective justice).

In a commentary on this controversial view, Michael Ardagh, of Christchurch Hospital, in New Zealand, disagreed with the Israelis’ analysis. His point is simple: there is too much uncertainty in an emergency:

to make a judgement about relative worthiness for care is a moral stab in a dark uncertainty. In the shadows of that darkness are rumours about what happened and who did what, opinions about why and what for, and impressions in the patients' dress, appearance and speech which might be consistent with a certain stereotype. Even if the moral arguments for triaging terrorists lower than victims were to be accepted, the potential for getting it wrong is enormous.

We’ve often blamed the pharmaceutical industry for medicalising the normal ups and downs of life. But journalists are not above disease-mongering. I’ve just noticed a promising new ailment to which members of the Fourth Estate themselves are particularly susceptible: post-election stress disorder.

According to columnist in Psychology Today, “Countless Americans are reporting feeling triggered, traumatized, on edge, anxious, sleepless, angry, hopeless, avoidant of connection, alone, and suddenly haunted by past traumas they believed they had buried” because of the Trump election.

As of now, no pharmaceutical company is marketing a drug to cure these anxieties. Instead, therapists are recommending a range of behavioural strategies for dealing with the stress. “I advise my clients and friends affected by the election and its aftermath to reach out, connect, affiliate and show compassion for those similarly affected,” wrote Steven Stosny in the Washington Post.

Some people are indignant that Post-Traumatic Stress Disorder after battle is being compared to discouragement after an election loss. Republican Congressman Brian Mast lost both legs in Iraq because of a roadside bomb. Let him have the last word:

There was a big missed opportunity in naming it ‘Post-Election Stress Disorder,'” he says. “I would have preferred they name it ‘Post-Inauguration Stress Disorder,’ that way they could have called it ‘PISD.’ There’s a big difference between being pissed off about things and what happens on the battlefield.”