Abstract
First responders to chemical, biological, radiological, or nuclear (CBRN) events face decisions having significant human consequences. Some operational decisions are supported by standard operating procedures, yet these may not suffice for ethical decisions. Responders will be forced to weigh their options, factoring-in contextual peculiarities; they will require guidance on how they can approach novel (indeed unique) ethical problems: they need strategies for “on the spot” ethical decision making. The primary aim of this paper is to examine how first responders should approach on the spot ethical decision-making amid the stress and uncertainty of a CBRN event. Drawing on the long-term professional CBRN experience of one of the authors, this paper sets out a series of practical ethical dilemmas potentially arising in the context of a large-scale chemical incident. We propose a broadly consequentialist approach to on the spot ethical decision-making, but one which incorporates ethical values and rights as “side-constraints”.
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The international community has sought to counter the proliferation and trafficking of WMDs and CBRN materials through measures such as United Nations Security Council Resolution 1540 (2004), reiterated in Resolutions 1673 (2006), 1810 (2008), and 1977 (2011).
The literature on role improvisation (i.e. the way disaster and emergency responders improvise and innovate their roles in novel situations) gives empirically-based insight into decision-making processes for first responders facing extreme circumstances. See: Webb et al (1999), Webb (2004). Though the focus is not specifically on ethical decision-making, the taxonomy of role improvisations includes “normative order changes” (Webb 2004, 54–55), which include improvisations affecting fundamental rights (property seizure, restrictions on movement, etc.). Kowalski-Trakofler et al. (2003) examines the impact of stress on emergency managers' decision-making capacities; their focus is more general than ethical decision-making alone, as is that of Cohn et al (1998) in their analysis of the role of emotion in emergency response. Examinations of stress, cognitive load, and time on specifically moral judgements include: Greene et al (2008), Suter and Hertwig (2011) and Starcke et al. (2012). These are not specifically addressed to disaster response. More general reviews of ethical issues in CBRN include Singer et al (2003), though this is not dedicated to on the spot decision-making.
There are many varieties of consequentialism. Here we generalise and simplify. See Sinnott-Armstrong (2011).
And of course if consequentialism is true, then the chances are even higher.
A key premise of that defence is that an act may be moral even if motivated by a false moral theory.
Mr Chaim Rafalowski MA has been the national CBRN officer of Magen David Adom in Israel for more than 15 years. In that period Chaim Rafalowski has been a member of several national steering committees and international task forces on the subject.
Chemical incidents are likely to be marked by large numbers of victims over a very short period of time and in a defined territory. In a biological incident signs and symptoms will likely be delayed. In radiological incidents there will be no casualties on the scene suffering from acute radiation syndrome, but huge numbers of “worried well”, which is a different type of problem.
See the United Nations Mission to Investigate Allegations of the Use of Chemical Weapons in the Syrian Arab Republic, “Report on the Alleged Use of Chemical Weapons in the Ghouta Area of Damascus on 21 August 2013” (http://www.un.org/disarmament/content/slideshow/Secretary_General_Report_of_CW_Investigation.pdf).
This is not to say that the public should not have a say in disaster planning more generally.
Methods of encouraging participation may range from an appeal to responders' vocational duty to care, to linking benefits to participation (financial incentives, holiday allowance, etc.), to explicit sanctions for non-participation (e.g. fines, disciplinary action, dismissal and, ultimately, legal measures). We will not discuss which measures are most effective or ethically acceptable.
The question of which agencies’ staff are “public safety personnel” (as opposed to, say, “civil servants”) is directly relevant to questions of acceptable exposure to risk, compensation for injury or death, and so on. The matter is complex and controversial.
The working group on ethical issues arising from the 2003 SARS outbreak around Toronto reached no consensus on healthcare workers' obligations to risk their lives to deliver care (Singer et al. 2003).
Such as hallucinations or increased heart rate or blood pressure.
A further issue is that, in many countries, the kinds of drugs used in auto-injectors only have approval for use in military settings. Since large-scale nerve agent intoxications are extremely rare, the pharmaceutical industry does not invest in the trials required to secure approval for civilian use. An incident commander may therefore encounter a situation where lifesaving drugs are available, but not officially authorised for use. This is even more problematic in countries where those drugs are authorised for civilians members of response forces, but not the general public (e.g. in most US states auto-injectors are authorised as “self-treatment” for responders and military personnel, but are not to be used on the general public). On what basis should commanders decide whether to use these measures?
Perhaps ideally responders would simply know (in some sense of that word)—or see (if that is different)—the right thing to do; and perhaps “ethical training” could promote this. But it is plausible that, in at least some situations, at least two courses of action have a plausible claim to be the (or a) a right thing to do.
What counts as a “rational” justification is open to debate (a debate we will not join here).
The complete framework for such decisions will clearly be more encompassing than only those aspects discussed in this paper. It will include all other implicit and explicit supports and constraints to decision-making (e.g. technological decision support systems, extant organisational SOPs and heuristics, codes of conduct, guidelines, legal requirements, hierarchical command structures, and so forth).
Cf. Eyal and Firth (2012, 3).
We do not assume that predicting and evaluating the consequences of actions is simple, but do contend that identifying and balancing the ethical principles and values motivating an action is harder.
“Autonomy” is not univocal. Its use in, say, Kant’s moral philosophy (roughly, the capacity of an agent to be subject to a moral law she herself prescribes) differs from its use in contemporary bioethics (where it is bound up with decisional capacity and consent). It can make sense to distinguish autonomy from the related concept freedom: autonomy concerns the ability to choose one’s goals or actions, freedom the ability to practically pursue them. This distinction appeals to the difference between an action and the maxim motivating it; yet accounts of autonomy rarely make fully clear the line between the two.
Recall that we are not advocating any particular course of action in the dilemmas.
See also Parfit (1978) for response.
As non-committally as possible: rather than proposing an account of what (ultimately) is the moral course of action, we are proposing an account of how best to arrive at a course of action consistent with morality's demands. A non-consequentialist could entertain our position if willing to accept that an act may be moral even though motivated by a false moral theory (a claim we cannot defend here). A related complication concerns the ethical significance of the interrelations—whatever they may be—between motivation, decision, and action.
Stress impedes competence in judgement and decision-making (Kowalski-Trakofler et al. 2003).
Morton (2007) offers insightful related discussion of difficulties in ranking risks and “choosing how to choose”.
An important issue—into which we cannot enter here—concerns “moral framing”. The way in which courses of action are evaluated will very often vary with the way in which they are presented. In particular, since people tend to be loss averse, framing choices in terms of “lives saved” or “lives lost” is likely to be extremely significant (Sunstein 2007).
These important philosophical and ethical matters are discussed, in different ways, in the papers collected in Lewens (2007).
Or whether one person (as opposed to any other) could have “agent relative” (Parfit 1984) reasons for acting.
Necessitating a secondary (… n-ary) criterion, beyond saving lives.
Though we do not discuss them here, alternative forms of deontological approach could be suggested. Kant's categorical imperative could be formulated as a deliberative decisional procedure (cf. Cranor 2007, 42f), for example. Alternatively, it might be suggested that a deontological approach which takes the principle “save as many lives as possible” as outranking all others is equivalent to the consequentialist approach. The two would likely result in similar decisions in similar circumstances. Consider however that, to the extent that the deontological version adopts “save lives” as an ethical principle outranking all others, it is (a) implausible and (b) differs from the consequentialist view in the way it motivates action. If both views motivate an action A, the deontological view advocates it on the grounds that A is, in and of itself, “maximally life-saving”; the consequentialist view advocates A only insofar as it results in the most lives saved. Whereas, to the extent that the deontological version adopts the “save lives” principle as an expedient, it is (a) not genuinely deontological and thus (b) collapses into its rival.
This is obviously to beg the question, for we assume that a life lost is worse than an (almost certainly temporary) affront to dignity. It seems a reasonable assumption though.
As mentioned in the “Consequentialism and on the Spot Decision-Making” section, decisions may not always be the best possible; but the approach should provide a defensible rationale for any decision taken.
A response to this objection is discussed below.
Kinslaw et al. (2009) make a similar proposal—utilitarianism tempered by other ethical principles as side-constraints—in the related field of pandemic influenza planning.
The phrase “core values” is from Baldwin (1997), who uses it in a slightly different context.
That the deontological approach could be so taken does not imply that it should be so taken.
Punctuation modified.
It would be interesting to investigate whether the training methods and technological decision support systems designed to encourage and improve creativity, flexibility, and improvisation in operational aspects of disaster and emergency response can be straightforwardly adapted to improve ethical decision-making.
Further study is required to begin to understand how the heuristical approaches discussed in this paper can be aligned with the recognised need for creativity and innovation. Sunstein (2007) suggests that heuristical moral judgements about risks are often questionable. Can such judgements be conceived of as failures of creativity? In disaster response, failures of creativity can result in responders forcing unique situations into forms with which they are more comfortable, but which simplify and blunt sharp details (Mendonca et al. 2001; Weick 1993). Discussing risk, Morton (2007) argues for the importance of certain—frequently underrated—creative virtues implicated in our capacities to judge well: “we often frame questions about decision-making as if people were faced with a set of options, over whose composition they have no control, from which they must choose. But in fact we search for options, digging out facts and using our imaginations” (p. 97). This is highly resonant with the disaster management literature on creativity, innovation, and role improvisation (Kreps 1991; Mendonca et al. 2001; Kendra and Wachtendorf 2002, 2006; Webb et al. 1999; Webb 2004; Mendonca and Fiedrich 2006). Morton (2007, p. 97) continues: “The main focus of advice concerning risk should be not how to compare the options that you have but what sorts of options to search out before comparing them.” A question to be addressed is whether this is feasible amid the extreme urgency of disaster situations.
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Acknowledgments
We would like to thank Dr Bruno Turnheim (one of the guest editors of this special edition) and two anonymous reviewers for their feedback and several suggestions for improvement. The work that enabled this paper was partially funded by the CATO project. CATO—“CBRN Crisis Management: Architecture, Technologies, and Operational Procedures”, Grant Agreement no. 261693—is funded by the 7th Framework program (FP7) of the European Commission.
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Rebera, A.P., Rafalowski, C. On the Spot Ethical Decision-Making in CBRN (Chemical, Biological, Radiological or Nuclear Event) Response. Sci Eng Ethics 20, 735–752 (2014). https://doi.org/10.1007/s11948-014-9520-5
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DOI: https://doi.org/10.1007/s11948-014-9520-5