In an essay published in the Journal of the American Medical Association, a Johns Hopkins emergency physician outlines how he and other physicians who worked in Haiti after the earthquake had to make emotionally difficult ethical decisions daily in the face of a crushing wave of patients and inadequate medical resources.
Thomas D. Kirsch, M.D., M.P.H., writes in the essay that the team of Johns Hopkins physicians that he lead in Haiti for two weeks soon after the earthquake had to quickly adjust standards of care that are common in the United States due to the sheer volume of patients, the wide range of injuries and complaints, and inadequate medical resources that had to be allocated to those most likely to benefit from them.
Kirsch and his six-member team worked at University Hospital in Port-au-Prince, where they saw on average 350 to 450 patients per day. In the JAMA essay, Kirsch dubs this daily march of the suffering "The Line."
This tide of battered humanity, which began forming some days at 5:30 a.m., Kirsch writes, was "unrelenting in numbers, in illness, in injury, and in heartbreak."
"The Line is a force that never stops its pressure. It is the pressure of the massive imbalance of needs and resources," writes Kirsch and his co-author and wife Margaret Moon, M.D., M.P.H.
As a result of these problems, the authors note, "The standards have to change … The standards get lower, must be lower than anything these clinicians have ever imagined before. We worry about the slippery slope toward inhumane medicine."
The intense experience in Haiti, Kirsch writes, raises many troubling and difficult ethical and moral questions, none of which have easy answers. Kirsch, deputy director of the Johns Hopkins Office of Critical Event Preparedness and Response, is now working with the Johns Hopkins Berman Institute of Bioethics, to host a symposium this fall to explore the ethics of triage and resource-allocation during mass disasters.
The Berman Institute is an independent, interdisciplinary center dedicated to the study of complex moral and medical issues.
Kirsch, a trained medical disaster expert who assisted with medical responses to Hurricane Katrina and the Sept. 11 terrorist attacks in New York, was among the first medical staff sent to Haiti by Johns Hopkins Medicine. He deployed to the country soon after the massive January 12 earthquake, which killed an estimated 230,000 people, as part of the Johns Hopkins Go Team. The multidisciplinary group of approximately of 185 is trained to respond to natural and manmade catastrophes. Moon, a Johns Hopkins pediatrician, did not deploy to Haiti.
Kirsch has been tapped by the nonprofit Earthquake Engineering Research Institute to help assess earthquake building damage in Chile. Kirsch will be looking into how building damage contributed to injuries, deaths and hospital closings in the February 27 earthquake.
- Thomas D. Kirsch; Margaret R. Moon. The Line. JAMA, 2010; 303 (10): 921-922
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