Terrorism and the ethics of emergency medical care

The threat of domestic and international terrorism involving weapons of mas s destruction-terrorism (WMD-T) has become an increasing public health conc ern for US citizens. WMD-T events may have a major effect on many societal sectors but particularly on the health care delivery system. Anticipated me dical problems might include the need for large quantities of medical equip ment and supplies, as well as capable and unaffected health care providers. In the setting of WMD-T, triage may bear little resemblance to the standar d approach to civilian triage. To address these issues to the maximum benef it of our patients, we must first develop collective forethought and a broa d-based consensus that these decisions must reach beyond the hospital emerg ency department. Critical decisions like these should not be made on an ind ividual case-by-case basis. Physicians should never be placed in a position of individually deciding to deny treatment to patients without the guidanc e of a policy or protocol. Emergency physicians, however, may easily find t hemselves in a situation in which the demand for resources clearly exceeds supply. It is far this reason that emergency care providers, personnel, hos pital administrators, religious leaders, and medical ethics committees need to engage in bioethical decisionmaking before an acute bioterrorist event.