Hippocratic Oath (Modern Version)  I swear to fulfill, to the best of my ability and judgment, this covenant:  I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.  I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.  I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.  I will not be ashamed to say "I know not," nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery.  I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.  I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.  I will prevent disease whenever I can, for prevention is preferable to cure.  I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.  If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help. Mass casualty events always pose ethical dilemmas, but especially in Haiti. Why so?  Patients admitted before they built their field hospital.  Saw 1100 patients in 10 days.  Already poor facilities.  Millions left homeless.  Hundreds of thousands needing medical aid.  No functioning authority coordinating the distribution of available medical resources.  60 beds, 4 ICU beds, 1 operating table => 72 beds, 2 operating tables Normal: Triage decisions are usually about which patients to prioritize knowing that all will eventually receive care – vs. -- Haiti: Denying care to some so as to benefit others. Opposite of what doctors are ethically required to do.          Patients with urgent need ➔ Lots of resources expended. In a resource-limited environment, they were forced to determine if they expend the scarce resources, will the patient survive? Broken limbs, open wounds, gangrene, death. If received treatment earlier, then better chance of survival. Where the cutoff between early and late arrivals for care? Crush injuries sometimes led to renal (kidney) failure. But no dialysis machines, what do? Brain or paralysis injuries moved elsewhere since they did not feel they could expend resources on those who might not experience full rehabilitation. Survivors under rubble. Cannot decline medical aid to those had survived for days under rubble. One patient under rubble for a week, admitted, surgery, did not survive. When to use ICU beds: 1 for post-surgery, others for severe conditions they believed they could stabilize in 24 hours. Patients with small chances of survival, not admitted to ICU. Created ad-hoc ethics committee of three senior physicians to relieve on-site physicians of responsibility. Created one-to-one admittance and discharge. One in, one out. Discharge issues: No community health centers, family members displaced, homeless, orphans, and so on.
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