Healthcare in Extreme and Austere Environments: Responding to the Ethical Challenges
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Healthcare in Extreme and Austere Environments: Responding to the Ethical Challenges David Zientek1 Accepted: 30 September 2020 © Springer Nature B.V. 2020
Abstract Clinicians may increasingly find themselves practicing, by choice or necessity, in resource-poor or extreme environments. This often requires altering typical patterns of practice with a different set of medical and ethical considerations than are usually faced by clinicians practicing in hospitals in the United States and Europe. Practitioners may be required to alter their usual scope of practice or their standard ways of medically treating patients. Limited resources will also often place clinicians in the position of having to make decisions about fairly allocating healthcare, which will alter the physician–patient relationship. This does not absolve physicians and other healthcare practitioners of providing the best quality of care that can be given under the circumstances. In addition, the lack of a well-developed healthcare infrastructure and limited resources will require working with established providers to determine the needs of the community, and what types of healthcare are feasible given these limitations. The essays in this issue of HEC Forum encourage readers to reflect on the unique ethical challenges faced in the extreme or austere environment. Keywords Ethics of extreme or austere environments · Medical ethics in resourcepoor environments · Ethics of short-term medical and humanitarian missions · Ethics of natural or man-made disasters
Introduction The concept for this special issue of Health Care Ethics Committee (HEC) Forum began with two recent experiences that led me to reflect on ethical issues distinct from those typically encountered in routine hospital ethics consultation. In 2014, I participated in a trek to Mount Everest basecamp with the Wilderness Medical Society. The expedition focused on helping clinicians gain knowledge and experience in * David Zientek [email protected] 1
Seton Heart Institute, and the University of Texas at Austin Dell, Medical School, 1301 W. 38th Street, suite 405, Austin, TX 78705, USA
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high altitude medicine and the injuries and illnesses that may occur on mountaineering expeditions. Three members of the group typically remain at basecamp to staff a temporary clinic supported by the Himalayan Rescue Association. During our time together, many questions arose about the ethical obligations of physicians in such a remote environment, both those serving as expedition doctors and those attempting to summit the mountain themselves. What sort of training and expertise should expedition physicians have, and when is it permissible in an emergency situation to function outside of their usual scope of practice? Similarly, what obligation does a physician, present only for the purpose of climbing the mountain, have to an injured or ill climber, especially when this may place the physician at risk of personal injury or loss of opportunity to achieve a life goal
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