Faculty members from the Johns Hopkins Berman Institute of Bioethics stress the need for more targeted care management after a disaster for those with pre-existing mental health challenges. In a recent article, they emphasize that this segment of the population should receive as much consideration for disaster preparedness as those with physical limitations, and even more regard should be taken for people with anxiety issues or post-traumatic stress. The authors state that people with conditions such as dementia, bipolar, schizophrenia, and addictions are far more vulnerable to declined health and impairment, long before a disaster occurs.
“Disasters limit the availability of resources, and these groups are especially vulnerable because they cannot advocate for themselves,” says faculty member Peter Rabins, M.D., M.P.H. “But little attention has been given to the ethical challenges that arise when resources are limited, to the importance of identifying these ethical issues ahead of time, and for establishing mechanisms to address these moral dilemmas.” Rabins and others insist that many people with mental issues rely on others for their care, and are not able to make their own decisions in emergency situations. They urge emergency response plan administrators to be ethically responsible and plan for the necessary mental health care needed by these people.
“Disaster-response managers and those on the front line are well aware that survivors may succumb to PTSD and other mental disorders,” says Rabins. “But sudden devastation also puts people with both lifelong and acquired intellectual disabilities in grave danger as well.” Although many people with addictions are seen as less than deserving of immediate treatment, these people are at risk also, many of whom are on strong sedatives and cessation of treatment could cause serious physical and psychological impairment. Additionally, the authors remind planners that determining if a person’s condition is worthy of care or under one’s own control, “is neither practical nor ethically justifiable, and in emergencies becomes wholly impractical.”
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