The Ethics of Coercion in Mass Casualty Medicine

Contents

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pp. v-

Preface

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pp. vii-xv

This book inquires about coercion in mass casualty medicine: What are its proposed uses? How are these justified? Which justifications are adequate? The term coercion here denotes the intentional use of a credible and severe threat of harm or force to control others. Mass casualty medicine denotes preparation for and provision of medical treatment or other health-preserving actions in mass casualty events or in situations in which large numbers of casualties will result unless there is quick ...

Acknowledgments

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pp. xvii-

Much of the groundwork for this book was laid during visits to specialized libraries and academic centers in the northeastern United States. Many of these visits occurred in the fall of 2004. I am grateful to Saint Louis University for a faculty research leave award that provided time and money for these travels and to Gerard Magill for facilitating the process. I also deeply appreciate the hospitality and expert ...

1. The Dynamics of Coercion in Mass Casualty Medicine

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pp. 1-14

Three days later, dozens of persons from the building present to Dover clinics and emergency departments with severe pneumonia. The rapid influx of patients is identified by public health authorities, and suspicions of terrorism are aroused. Fluorescent antibody testing of several patients for tularemia (which takes about 2–3 hours) is positive, but strict confirmation by culture will require at least three to five days, perhaps even weeks. Epidemiologists ...

2. Public Health and Its Ethical Basis

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pp. 15-27

Several factors related to this conception of public health bear mention. First, as I have observed, the conditions for good health are often established through coercion. This chapter will investigate general approaches to justifying coercive measures in public health. Second, conditions for good health are not equivalent to good health itself, and some thinkers believe that the latter is actually the primary aim ...

3. Legitimacy

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pp. 28-52

Five years into the First World War, sailors and soldiers started dying en masse in Boston and at Fort Devens, Massachusetts. Initially, the Germans were blamed, since—so the thinking went—if Germans introduced lethal chemicals such as chlorine and phosgene gas into battlefields, they were capable of seeding cities with killer microbes.¹ Now they had imported a killer virus in Bayer aspirin bottles. Or perhaps ...

4. Public Policy and the Role of Experts

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pp. 53-66

Feelings of self-importance blossom in many settings, but disaster seems to beget an exceptional profusion. Consider the Muncie, Indiana, smallpox epidemic of 1893, in which twenty citizens died, a public health official was shot, and vainglorious experts caused more harm than good. Almost from the beginning, in August of that year, there was dispute over both the source of the epidemic and how best to ...

5> Public Deliberation and Strategic Leadership

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pp. 67-83

Politically legitimate decisions about the use of coercion require not only the right kind of deliberation but also deliberation by the right people. Simply designating an amorphous “public” will hardly do. Where coercion is considered, it is important to determine who should have a right to input, where the authority for a final decision should lie, and what sorts of constraints should apply to this authority. ...

6. Tactical Leadership

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pp. 84-103

After these final words to her husband, Sandy Bradshaw presumably joined the battle for United Airlines Flight 93. The cockpit voice recorder captured loud thumps, crashes, breaking glass, and shouting voices as passengers stormed past the fallen flight crew in an attempt to wrest control from their terrorist captors. Terrorists in the cockpit quickly realized they were losing the battle and were about to lose the plane. ...

7. Decisions for Particular Coercive Actions

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pp. 104-118

Perhaps the most salient general advice one can give high-level tacticians about coercion in mass casualty medicine is that it can be avoided by delegating some of their decisional authority to frontline personnel—including a degree of latitude even for private-sector experts and untrained civilians. Coercive decisions themselves and their enforcement, however, typically remain within the purview of designated ...

Notes

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pp. 119-148

Index

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pp. 149-154