Australia is not prepared for the ethical challenges of health care disasters

Australian health professionals are ill-prepared for the ethical challenges of public health care disasters, such as ultra pandemic flu, which could result in costly mistrust and confusion during a 'big event', according to a Deakin University health ethics expert.

Professor Megan-Jane Johnstone, of Deakin's School of Nursing, believes Australia, like many countries, has been slow to anticipate, plan and prepare for the ethical quandaries of major health care disasters.

"We need to move quickly to prepare our health care professionals for future scenarios where, for example, they would be required to treat and care for those most likely to survive rather than those who are the sickest," Professor Johnstone said.

The world is facing a series of converging and interconnected events poised to cause unimaginable chaos—namely climate change, peak petroleum production, solar storms, pandemics and the global financial crisis, Professor Johnstone explained.

"The health sector hasn't even begun to imagine, let alone prepare for the true nature and consequences of these events.

"For example, climate change will see a significant increase in illness and deaths from frequent and severe heat wave, vector-borne diseases, and other extreme weather events. Peak petroleum supplies will also affect health care in deleterious ways because health services are utterly dependent on petroleum products (eg medical supplies and equipment, pharmaceuticals, transportation and service delivery) without which they will come to a halt.

"These interconnected scenarios will give rise to unprecedented moral dilemmas in health care. As demand for health care services rapidly exceeds supply, doctors, nurses and allied health care professionals will quickly discover that, contrary to what they have become accustomed to, they will not be able to treat and care for everybody equally in every situation. Especially confronting will be the reality that what would ordinarily be regarded as unethical under normal circumstances will become ethical during a disaster situation."

Professor Johnstone believes there is an urgent need for a comprehensive national ethics framework to guide policy, planning and decision-making in health care disasters and public health emergencies.

"There is only a small window of opportunity to redress this oversight," Professor Johnstone said.

"The health care professionals and the community need to come together to explore and agree on the ethical values and ethical frames work that is necessary to guide a just response to disaster scenarios that lay ahead."