EKAMED - Ethics in disaster medicine

The comprehensive and fair provision of health services for all members of a society is not only a core task of governmental action but a value to pursue for every society. In everyday life, this is guaranteed by the health care system, which is based on medical standards of individual and needs-based care. Such care is materially as well as personnel resource-intensive and requires stable and reliable infrastructures.

In the context of extreme events, when the material or human resources are not sufficient to ensure the individual care of all injured or affected persons, this medical approach might need to be adjusted towards the maintenance of adequate basic care of the population becomes necessary; a change to disaster medicine. Whether such an adjustment is appropriate or not depends not only on cost-benefit analyses of concrete measures, but also refers to fundamental questions of professional ethics of medical personnel, social ideas of a good life and aspects of a fair distribution of limited resources. Therefore, the turn to disaster medicine is thus not only a structural and logistical but also an ethical issue.

A special situation in which this disaster medicine approach is applied is the Zivilschutzfall (protection of civil population in a national conflict situation according to art. 73, German constitution). With the creation of the Civil Defence Concept 2016, the Federal Ministry of the Interior has suggested the development of various framework concepts to address the very problems this case of civil protection raises. The basis for this is the assumption that precaution and planning preparation for such an event are basically possible. Although this civil defence guideline provides a framework for this case and ethical questions are raised in various regards, there is not yet an ethics guideline to support emergency forces.

The EKAMED project addresses this blind spot and develops both a guideline for dealing with ethical issues of medical and care personnel in the context of disaster medicine, as well as teaching material for the use of this guideline. Due to the variety of possible questions, EKAMED focuses on ethical issues of disaster medicine by medical and care personnel. On the one hand, this guideline is intended to provide support for emergency personnel who are confronted with various ethical problems in their actions. On the other hand, this guideline is intended to make the ethical implications of disaster medical action visible to emergency services and the population and thus promote a conscious approach to associated challenges. In this way, not only the adherence to central ethical values of our society should be supported even in times of crisis, but also the legitimacy of changing priorities should be explained and thus promote an acceptance that is both justified and justifiable.

Despite the research scenario of civil protection, as a situation of armed conflict on German territory, at no time research for military purposes is carried out.