Portal de Periódicos da CAPES

Altering the Standard of Care in Disasters—Unnecessary and Dangerous

2011; Elsevier BV; Volume: 59; Issue: 3 Linguagem: Inglês

10.1016/j.annemergmed.2011.07.037

1097-6760

Carl H. Schultz, George J. Annas,

Disaster Management and Resilience

After September 11, 2001, the United States began examining approaches to the delivery of medical care during disasters when demand exceeds available resources. One seemingly popular option is the creation of "crisis" or "altered" care standards meant to reduce the legal standard or duty of care for medical responders. However, evidence supporting the need for reduced care standards is lacking. Concern for liability exists but it is not evidence based. The actual risk for litigation is minimal, according to experience with multiple disasters during the last 15 years. Even if a lower legal standard or duty of care were to be adopted, it is unlikely this would reduce the risk of liability because violation of this lower standard could still result in an allegation of malpractice. Creating algorithms to equitably and rationally allocate scarce resources is necessary and appropriate, but altering the legal standard of care will not contribute to this process. Rather than inhibiting the creation of these protocols, the current legal standard of care helps guarantee that disaster policies are created in an ethical and transparent manner. Adoption of a lower legal care standard would encourage implementation of less effective approaches and could undermine the impetus to constantly improve the care of disaster victims. Once lowering the legal standard of care becomes accepted practice, it becomes unclear what will prevent this process from moving downward indefinitely. The most rational approach buttressed by evidence to date supports maintaining the current legal standard of care defined by the actions of reasonably prudent physicians under the same or similar circumstances. After September 11, 2001, the United States began examining approaches to the delivery of medical care during disasters when demand exceeds available resources. One seemingly popular option is the creation of "crisis" or "altered" care standards meant to reduce the legal standard or duty of care for medical responders. However, evidence supporting the need for reduced care standards is lacking. Concern for liability exists but it is not evidence based. The actual risk for litigation is minimal, according to experience with multiple disasters during the last 15 years. Even if a lower legal standard or duty of care were to be adopted, it is unlikely this would reduce the risk of liability because violation of this lower standard could still result in an allegation of malpractice. Creating algorithms to equitably and rationally allocate scarce resources is necessary and appropriate, but altering the legal standard of care will not contribute to this process. Rather than inhibiting the creation of these protocols, the current legal standard of care helps guarantee that disaster policies are created in an ethical and transparent manner. Adoption of a lower legal care standard would encourage implementation of less effective approaches and could undermine the impetus to constantly improve the care of disaster victims. Once lowering the legal standard of care becomes accepted practice, it becomes unclear what will prevent this process from moving downward indefinitely. The most rational approach buttressed by evidence to date supports maintaining the current legal standard of care defined by the actions of reasonably prudent physicians under the same or similar circumstances. Crisis Standard of Care Is Altered Care, Not an Altered StandardAnnals of Emergency MedicineVol. 59Issue 3PreviewDrs. Schultz and Annas1 spark debate on a critical issue. As the originator of the term "crisis standard of care" in 20082,3 (before the Institute of Medicine established guidance, renaming it crisis standards of care4), I would like to correct some misperceptions. Full-Text PDF In replyAnnals of Emergency MedicineVol. 59Issue 5PreviewWe thank Dr. Koenig for her comments. Rather than clarifying the issue, however, her comments may confuse the debate further. Full-Text PDF Crisis Standard of Care Is Altered Care, Not an Altered StandardAnnals of Emergency MedicineVol. 59Issue 5PreviewDrs. Schultz and Annas1 spark debate on a critical issue. As the originator of the term "crisis standard of care" in 20082,3 (before the Institute of Medicine established guidance, renaming it crisis standards of care4), I would like to correct some misperceptions. Full-Text PDF Understanding the Role for Crisis Standards of CareAnnals of Emergency MedicineVol. 60Issue 5PreviewThe argument by Schultz and Annas1 claiming that planning for crisis standard of care implementation during disaster response is "unnecessary and dangerous" represents a minority viewpoint on this issue and serves to potentially confuse health care providers whose response to such events is quintessential to the successful treatment and care of the victims of major disasters. The authors observed that efforts to create a clinical, legal, and ethical framework for catastrophic event response2,3 are "diversionary." Indeed, what is diversionary is their incorrect assertion that our efforts call for "reducing the current level of accountability" and that we advocate "lowering the standard of care" in response to disaster situations. Full-Text PDF