AMA meeting: CEJA to study how ethics may shift during disasters

Chicago -- After disasters such as Hurricane Katrina and the tsunami following the Indian Ocean earthquake, physicians say they need ethical guidance on triage and other matters in catastrophic situations.

More than 20 delegates expressed their concerns to the Council on Ethical and Judicial Affairs at the AMA Annual Meeting last month.

Daniel P. Edney, MD, a Vicksburg, Miss., internist, said he had volunteered to serve in four world-class disasters but that Hurricane Katrina differed in that physicians also were victims of the catastrophe who had to choose between fleeing with their families and remaining behind.

"We have the dilemma of deciding, 'Do I stay irrespective of what help I can provide?' " Dr. Edney said. "Especially when we reach the point where staying is futile in terms of benefiting patients, yet when I leave I'm abandoning the patient."

Other delegates said public authorities, not necessarily physicians, manage disaster response operations and that any ethical guidance should take that into account.

CEJA member Dudley M. Stewart Jr., MD, said the council "would like to develop guidelines consistent with the basic principles of medical ethics but take into consideration some of the exigencies of emergency situations." A central conflict, he said, is between the doctor's traditional responsibility to individual patients versus the population-based medicine that takes priority during disasters.

Delegates at the forum also discussed expedited partner therapy, the practice of treating sex partners of patients with sexually transmitted diseases without examining or counseling them. The Centers for Disease Control and Prevention has recommended such therapy for adult heterosexual couples with chlamydia or gonorrhea. Randomized controlled trials have found that the practice, also known as patient-delivered partner therapy, has reduced reinfection rates.

But the practice raises ethical concerns, according to CEJA member Hilary Fairbrother, MD, because "it turns patients into pseudo-physicians and relies on them to explain things accurately to their partners." Many delegates said treating a patient without an examination increases the risk of adverse events. Others with public health backgrounds said asymptomatic partners often are very reluctant to seek treatment and that partner therapy is effective.

The day before CEJA held its open forum, about 25 disability activists from Chicago-based Feminist Response in Disability Activism and Not Dead Yet protested outside the Annual Meeting at the Hilton Chicago. The groups are upset about the medical ethics of the "Ashley X" case in Seattle. A CEJA report relevant to the Ashley case that deals with pediatric decision-making was withdrawn from consideration at the Annual Meeting because several late-arriving comments from specialty societies could not adequately be incorporated into the council's recommendations. The report likely will be presented for consideration at the AMA Interim Meeting in November.