Just-in-Time Disaster Planning Does Not Work
Margaret McLean
Just-in-time disaster planning does not work. Witness South Korea, where officials are scrambling to contain the largest outbreak of Middle East Respiratory Syndrome (MERS) outside its homeland in Saudi Arabia. More than 3,000 people are under mandatory quarantine after sharp criticism erupted in the wake of a slow response by health officials to this fast-moving disease. A recent editorial in The Korea Times accuses officials of “wasting away the ‘golden time’” — the first days of MERS—through “incompetence and irresponsibility.”
The virus arrived in South Korea with a businessman returning home from the Middle East. Since the confirmation of his diagnosis on May 20, at least 100 MERS infections have been confirmed. There have been nine deaths.
One can certainly understand why South Korea is in a panic as citizens don fashionable face masks, and hand sanitizer evaporates from store shelves in an effort to stave off this incurable infection with close to 40% mortality. But, most of the permeating fear is not the fault of the virus but the result of palpable distrust of a government that refuses to share information or even to pick up the phone at the Health Ministry.
Reminiscent of the SARS epidemic a decade ago, MERS brings our attention to the importance of developing a value-based framework for decision making ahead of medical disaster. Panicked responses are rarely well-reasoned responses. We must urge our health officials to maximize preparedness in an effort to minimize harm. And to be open and up front about it. We must be operationally prepared — where do we go; what do we do — and ethically prepared — why must we go; why must we do what we must do.
Post-SARS, researchers at the University of Toronto Joint Centre for Bioethics concluded that, as the virus spread and people faced increasing restrictions, they became increasingly concerned about whose values were guiding such decisions.
This response suggests that being transparent and developing a value-based decision-making framework can help public-health officials and government leaders make better-informed, defensible decisions in a public-health crisis.
Disaster challenges our everyday ethical thinking as the unimaginable becomes reality. A rapidly spreading incurable infectious disease, such as MERS, swings our ethical focus from protecting individual rights to caring for the community. Respect for individual autonomy may be temporarily replaced by concern for the common good.
In a health disaster, concern for the public’s health may trump the interests and rights of individuals— movement restricted, people quarantined, access to supportive interventions and experimental treatments limited. Before MERS or SARS or Ebola or avian flu or an as-yet-unknown virus gets a foothold here, we would be well served by thinking through matters such as access to supportive medicine, IVs or ventilators for example, and who is quarantined, where, and how. We have a responsibility to plan.
An effective response to disaster cannot be worked out once the disaster strikes. Now is not the time for us to panic, but it is the time for us to plan: develop vaccines, discover treatments, be ethically and medically prepared. Once in disaster mode, difficult decisions need to be made without the luxury of time — thinking through possible scenarios and responses today creates the opportunity to keep our ethical heads about us tomorrow. Explicitly identifying the values and ethical perspectives inherent in preparedness planning provokes public commitment to and trust in the resulting plan. Value-based disaster planning should include:
•Transparency
•Attention to the tradeoffs between individual autonomy and the common good
•Explicit consideration of fairness and the building of trust
• Opportunities for collaboration among public officials and citizens
•Concern for the disadvantaged and those disproportionately affected by medical disaster
Perhaps most importantly, ethical preparedness requires creativity and courage — both of which must be developed and nurtured today so that we can be ready in time.
Margaret R. McLean is the associate director of the Markkula Center for Applied Ethics at Santa Clara University. This article originally appeared in Marketwatch.