Ethics and Disaster Medicine
This domain tests consent, capacity, confidentiality, resuscitation decisions, resource allocation, and mass-casualty triage. The exam expects ethical reasoning under emergency conditions.
Core rules
- Emergency treatment may proceed without consent when immediate life-saving intervention is needed and the patient lacks capacity.
- Assess capacity: understand, retain, weigh, and communicate a decision. If capacity is absent, use best interests and advance directives where available.
- Respect confidentiality, but disclose information when required to protect others or by law.
- In disaster triage, prioritise patients who can benefit most from immediate treatment, not those likely to die or those with minor injuries.
- Use a recognised mass-casualty system and reassess as resources change.
Worked example
At a bus crash, four casualties arrive: an apnoeic patient with no pulse, a patient with severe respiratory distress, a walking patient with an ankle injury, and a patient with a tension pneumothorax. Treat the tension pneumothorax and severe distress first; the walking patient is delayed, and the deceased is not prioritised during the immediate response.
Traps
- Do not use ordinary first-come, first-served triage in a mass-casualty incident.
- Do not withhold emergency treatment solely because consent cannot be obtained.
- Do not assume incapacity from disagreement alone.
- Do not let family pressure override a valid advance directive.