Thanks to Guernica for the chance to speak with Sheri Fink, a Pulitzer Prize-winning journalist and author of Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital. We talked about disaster preparedness, impossible health care choices, and the notion of journalistic objectivity. I’ve pasted an excerpt below. You can read the entire piece here.
Ann Neumann: In Five Days at Memorial, you too track a decision-making process, one developed in the days of disaster and not set out beforehand—because Memorial had no appropriate plan in place. When comparing disaster triage and organ donation, you write, “Although no allocation method could ever enlist universal agreement, the process of devising a method, at least, can be made more just.” The great tragedy of Memorial is, of course, the number of lives lost. But the lack of an explicit triage plan to guide the staff seems to throw heightened doubt onto the decisions they made. Do you think that even the absence of a plan can create the impression of injustice and unethical behavior?
Sheri Fink: Yes, that’s right. If the staff and leadership at this hospital could have pointed to a plan and a process by which they made the decisions they did—whom to rescue first, and how to care for those patients who appeared to have little chance of surviving—it stands to reason that there would have been fewer questions and more trust after the disaster. And those plans and processes could have helped keep decisions in line with ethical principles and the best possible standards of care. It would also have lifted some of the decision-making burden off the shoulders of exhausted, scared, unprepared individuals. There’s also the issue of inclusiveness—for example, now some states and localities are bringing representatives with diverse perspectives into the disaster planning process for hospitals, because the question of who gets scarce medical resources during a disaster has a lot to do with values, not just medicine. On the other hand, some of the plans that have been drawn up for rationing scarce medical resources in a disaster have their own hazards. They can discourage flexibility, which is one of the key principles of disaster response. You need to be frequently re-assessing and re-matching resources and needs throughout a period of crisis. If you blindly follow a piece of paper that says take away the ventilators from everyone over age 65 in a mass emergency, say, and it turns out you actually can get enough ventilators and staff to care for everyone, it would be a tragedy not to change the plan. Also, let’s say that a reasonable goal in allocating resources in a disaster is to save the greatest number of lives, or greatest number of years of life. There are not really good data or studies showing how to direct resources to accomplish that.