Considerazioni bioetiche applicate alla medicina dei disastri. Studio osservazionale inerente la conoscenza e la percezione riguardo i dilemmi etici da parte di studenti partecipanti a corsi post-laurea di medicina dei disastri.

Disasters, like earthquakes, epidemics and wide and complex emergencies raise many ethical issues for the people involved, who include responders, health specialists, educators and policy-makers. A disaster is defined by the United Nations Office for Disaster Risk Reduction as a “serious disruption of the functioning of a community or a society involving widespread human, material, economic or environmental losses and impacts, which exceeds the ability of the affected community or society to cope using its own resources”. A Disaster is a result of interactions between hazards and manifold community elements, with differing vulnerability and capacity to cope with such situations. The disaster dynamics depict the various phases like a circle: disaster preparedness, response, rehabilitation, reconstruction, development, disaster prevention, mitigation. The requirements of the community for patient care and for research and surveillance vary case by case and are influenced by how risks are managed before, during and after events and by the type and magnitude of the consequences of emergencies when they occur. Disaster Medicine is concerned with the comprehensive response management and application of various health disciplines, from military and emergency to public health medicines, dealing with human-made and natural catastrophes by the “disaster pillars” of prevention, planning response recovery and mitigation. Such events often result in a large number of victims, who have undergone both physical and mental insults, that temporarily disrupts the ability of the local health response system invalidating the ordinariness socio-economic and public health of the affected resulting in an imbalance between the relief response and the resources immediately available in the area. In these scenarios rescuers have to cope with an imbalance between the relief response and the resources, operate with different standards and specific recommendations out of the ordinary clinical practice. The wide range of potential types of disasters is also reflected in the field of bioethics that underlie the decisions of planners and those involved in a disaster. The lack of time and the complexity of the operational performance of disaster operations require an ethical reflection process to enable the health operators to take advantage of clear behavioral recommendations to recalibrate on spot their ethical decisions because medical professionals have to face with uncommon and dramatic ethical dilemmas. In the last decades the scientific community began to wonder about the issues posed by this recent branch of medicine through an embryonic production of both clinical and organizational recommendations for bioethical debates applied to research, training and management of such topics. Triage, Allocation of resources, vulnerability of those involved, risks and benefits of participation in research, informed consent, training represent only some of this thematic. Health professional preparedness is one of the imperative key element of disaster response focused on clinical and organizational conducts. Worldwide training programs in disaster medicine are usually structured to create emergency preparedness core competencies in this matter. But if we focus on bioethics declined to this discipline, create ethical competencies in the field of disaster medicine represent one of the new challenges. The ability to analyze the boundaries between public health practice, including surveillance, and research and their ethical implications in emergencies, to define adequate processes for ethics review or to define ethically relevant criteria for standards of care in emergency response and the expertise to discuss the professional duties of health care workers during clinical performances, public health surveillance, research and management in disasters and complex humanitarian emergencies, as reported by the WHO “Ethics in epidemics, emergencies and disasters: research, surveillance and patient care” training manual, represent the core competences sum of relief workers, researchers and ethical consultants involved in each phases of disaster events. According to the third world conference on disaster risk reduction recommendations is fundamental to promote and enhance the training capacities to cope disasters and create resilience. If clinical and managerial educational topics in disaster medicine are strongly depicted, this discipline still reveals a complexity of concerns about several ethical topics. Most of the latest international core curriculum education proposals in disaster medicine embody ethics competency. The purposes of the present pilot study, co-realized by the Center for Clinical Ethics of the University of Insubria (Italy) were to investigate the interest and cognition on ethical issues by a cohort of health operators, mostly medical doctors, attending two disaster medicine international programs delivered by the Research Center in Emergency and Disaster Medicine (CRIMEDIM) of the University of Eastern Piedmont (Italy). An anonymous questionnaire was proposed to the students attending the European Master Degree in Disaster Medicine and the Humanitarian Medic Program in three academic sessions (2015-2017). 128 questionnaires were received. The interest about ethical issues is robust for the 96% of the respondents. As assumed disasters ethical dilemmas are perceived dissimilar to the ordinary medicine practice (χ2 0,916, p=0,011). About the importance of sixteen main topics proposed, like disaster triage, allocation of resources, informed consent, palliative care for non-salvageables or disaster research the range of acceptance was demonstrated (χ2 0,984, p=0,031). A significant portion of attendees consider useful the contribution of an ethical consultant to draft a mass casualty protocol (84%) or in case of debriefing (81%), less into operational phases (59%). The results have depicted a strong involvement in disaster ethics by the participants and various learning needs too that educators has to take in account to frame ethical contents into disaster medical educational programs.