PPN Disaster Handbook

Ethics in Disasters

Ethics

Ethics help us figure out what’s right and wrong. In disaster medicine, ethics can help guide us when we make hard choices and it’s not always clear what the “right” answer is.

There are four basic principles:

Beneficence: Do good
Non-Maleficence: Avoid harm
Respect for Autonomy: Respect peoples’ choices:
Justice: Be fair

Ethics and Disaster Settings

We often have to make tough decisions in all phases of a disaster. These decisions should try to balance the needs of individuals and the community, especially when resources are limited. We may not be able to save everyone. But with a plan, we can make decisions that are thoughtful, fair, and focused on doing the most good.

Pediatric Ethical Considerations

Children tend to be left out of disaster planning, and that is a problem. Children need special attention in disaster planning due to their unique considerations.

Ethically, we should include children in disaster plans. That means setting aside the right resources:

child-size equipment
pediatric medications
staff trained to care for kids

It also means planning for their mental health, which is often affected long after the event.The World Health Organization and other relief organizations in the Sphere Project recommend psychological first aid as a first-line intervention in disaster settings.

Useful Resources:

Before the Disaster

Doing the right thing starts with good planning and preparation. Preparation improves ethical decision-making and reduces conflicts during disaster responses.

Before the disaster hits:

Review local laws and regulations
Create ethical guidelines and protocols
Set up an on-call ethics committees
Train staff to handle tough decisions

Disaster Response Ethics Trainings:

Ethical training in disaster preparation helps prevent harm in the field, aids in decision-making / conflict resolution, and helps manage moral stress.

Training should cover cultural contexts, teamwork, conflict resolution, and communication skills.
Case studies are especially helpful because they allow responders to discuss and reflect on ethical issues in a practical context4. They show how real decisions play out under pressure.

During the Disaster

Topic	Considerations
Resource Allocation	During disasters, standards of care may change and resources can be scarce. We want to maximize benefits while conserving precious resources. Some strategies include: Using supplies from stockpiles Calling in volunteers Reusing or repurposing materials Expanding existing roles and responsibilities
Triage	Triage helps us prioritize which patients need care first and who can be saved. Recommended Practices for Ethical Triage Use a designated and trained triage team Re-triage and reassess frequently Always offer respect, privacy and dignity, even if saving a life is not possible Ethical Triage: What’s Fair? Ethics helps guide how we fairly prioritize who gets treated and the other that they are treated. The World Medical Association (WMA) says triage should be based only on medical needs. But others ask if things like age or social status should factor in. These debates are ongoing. The utilitarian approach to triage prioritizes saving the most lives and helping those who are most likely to survive (WMA recommendation) Other approaches to triage include: lotteries, first-come-first-serve, prioritization of medical staff, prioritization based on age. Watch Out for Bias Bias can sneak in even when we try to be fair. Some groups (children, elderly, those with chronic illnesses, people in marginalized communities) may be unintentionally deprioritized. Know your community, plan ahead, and work to close these gaps.
Informed Consent	Things move fast in a disaster. There might not be time for full informed consent. Respect and transparency is important. Explain decisions as clearly as possible and get consent if possible.
Individual vs. Community Rights	Sometimes what’s best for the community may conflict with personal freedom. Quarantines, mandatory vaccinations, and lockdowns raise tough questions. Review and update these policies and recommendations often and to make sure they stay fair.
Communication	Clear, honest communication builds trust and reduces fear. Acknowledge when there is uncertainty. Be wary of misinformation or disinformation. Use social media responsibly. Some teams now train media staff in ethical reporting during disasters.

After the Disaster Research

Disasters are opportunities to learn from mistakes and improve existing systems. Research must still follow ethical rules:

Get community support
Ensure participant and research team safety (physical and psychological)
Get consent whenever possible
Make sure research doesn’t get in the way of treatment

References

Ciottone GR, ed. Ciottone’s Disaster Medicine. Third edition. Elsevier; 2023.
Kathleen Geale S. The ethics of disaster management. Disaster prevention and management. 2012;21(4):445-462. doi:10.1108/09653561211256152
Ozge Karadag C, Kerim Hakan A. Ethical dilemmas in disaster medicine. Iranian red crescent medical journal. 2012;14(10):602-612.
Simm K. Ethical Decision-Making in Humanitarian Medicine: How Best to Prepare? Disaster medicine and public health preparedness. 2021;15(4):499-503. doi:10.1017/dmp.2020.85
Leider JP, DeBruin D, Reynolds N, Koch A, Seaberg J. Ethical Guidance for Disaster Response, Specifically Around Crisis Standards of Care: A Systematic Review. American journal of public health (1971). 2017;107(9):e1-e9. doi:10.2105/AJPH.2017.303882
Antommaria AHM, Powell T, Miller JE, Christian MD. Ethical issues in pediatric emergency mass critical care. Pediatric critical care medicine. 2011;12(6 Suppl):S163-S168. doi:10.1097/PCC.0b013e318234a88b
Reid C, Hillman C. Children in a disaster: health protection and intervention. BMJ Mil Health. 2022;168(6):473-477. doi:10.1136/bmjmilitary-2021-002010

Written by Allison Etcheverry

Last updated: 5/30/2025

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