A mass casualty (MASCAL) event is different to a major incident. The crux of this difference is that in a major incident, by the adoption of special measures, normal or near-normal standards of care can be maintained. In a MASCAL, irrespective of what special measures are instituted, standards of care inevitably drop. This is a, currently unmet, challenge for medical planning and planning policy. Twenty-First century weaponry is capable of producing thousands of causalities a day over a period (...) of several days in peer-on-peer conflict. In this chapter, we propose that medical planning for military events on this scale should include the following: explicit acceptance that ‘gold standard’ care cannot be given to patients who are triaged for treatment, a better understanding how to identify those patients who will not be triaged for treatment, a focus on ensuring patient flow (which includes diversion, self-care and remote monitoring), and implementation of the principle that care should be given by the lowest capable provider. We attempt to begin to develop some principles for planners to consider drawing on historical precedents and explore some of the ethical implications of our proposals. (shrink)

This paper is going to explore the adverse effects of exposure to combat death on medics’ holistic well-being, which, if ignored could decrease individual readiness and negatively impact the mission. We rely on the experience of United States Air Force Special Operation Surgical Teams (AF SOST) whose exposure to mass casualty scenarios in austere environments could serve as approximations of conditions of future battlefields. Over the past two decades, the ability to deliver advanced medical care on and off (...) the battlefield along with a rapid casualty evacuation platform has allowed for unprecedented survival rates exceeding 90%. While laudable, these medical achievements have also set up a casualty management paradigm in which medical decision-making singularly focuses on life-saving care. Confronting peer-peer adversaries in large scale combat operations (LSCO) on a multi-domain battlefield will make casualty management frighteningly more complex by introducing major infrastructural, personnel, and resource constraints. When considering the high number of casualties expected in LSCO alongside enormous limitations in medical resource and resupply capability, the current casualty management paradigm will not be sustainable. The resource constrained environment in LSCO will shift medical decision-making away from a singular focus on life-saving care to triage, which hinges on the ability to determine futile medical interventions—a skill that has been lost in the past two generation of combat medics. As such, a broad ethical challenge that arises in preparation for LSCO is the need to set new expectations concerning dying and death. However, medical decision-making focused on death and dying has not been explicitly addressed in military medical training, research, or policy. Relying on a body of literature known as terror management theory (TMT) and ethnographic data from our study with AF SOST medics, we are going to argue that it is important to expose medics to death in mass casualty and triage training. (shrink)

The use of wireless, electronic, medical records and communications in the prehospital and disaster field is increasing. Objective: This study examines the role of wireless, electronic, medical records and com- munications technologies on the quality of patient documentation by emergency field responders during a mass-casualty exercise.

This qualitative study describes the lived experience of physicians who work in communities that have experienced a public mass shooting. Semi-structured interviews were conducted with seventeen physicians involved in eight separate mass casualty shooting incidents in the United States. Four major themes emerged from constant comparative analysis: The psychological toll on physicians: “I wonder if I'm broken”; the importance of and need for mass casualty shooting preparedness: “[We need to] recognize this as a public health (...) concern and train physicians to manage it”; massive media attention: “The media onslaught was unbelievable”; and commitment to advocacy for a public health approach to firearm violence: “I want to do whatever I can to prevent some of these terrible events.”. (shrink)

There is growing interest in the use of technology to enhance the tracking and quality of clinical information available for patients in disaster settings. This paper describes the design and evaluation of the Wireless Internet Information System for Medical Response in Disasters (WIISARD).

In emergencies and disasters, ethics are affected by both personal and organizational factors. Given the lack of organizational ethical guidelines in the disaster management system in Iran, the present study was conducted to explain the personal factors affecting ethics and ethical behaviors among disaster healthcare workers. The present qualitative inquiry was conducted using conventional content analysis to analyze the data collected from 21 in-depth unstructured interviews with healthcare workers with an experience of attending one or more fields of disaster. According (...) to the data collected, personal factors can be classified into five major categories, including personal characteristics such as age and gender, personal values, threshold of tolerance, personal knowledge and reflective thinking. Without ethical guidelines, healthcare workers are intensely affected by the emotional climate of the event and guided by their beliefs. A combination of personal characteristics, competences and expertise thus form the basis of ethical conduct in disaster healthcare workers. (shrink)

Public health ethics is neither taught widely in medical schools or schools of public health in the US or around the world. It is not surprising that health care professionals are particularly challenged when faced with ethical questions which extend beyond safeguarding the interests of their individual patients to matters that affect overall public good. The perceived threat of terror after September 11 2007, the anthrax attacks and the Katrina debacle are recent circumstances which may result in coercion. These have (...) piqued the interest of medical professionals and the general public on public health ethics. The Ethics of Coercion in Mass Casualty Medicine written by Griffin Trotter MD, PhD attempts to fill a timely void in this area by examining the ethics of coercion in times of public health disasters. (shrink)

Public health ethics is neither taught widely in medical schools or schools of public health in the US or around the world. It is not surprising that health care professionals are particularly challenged when faced with ethical questions which extend beyond safeguarding the interests of their individual patients to matters that affect overall public good. The perceived threat of terror after September 11 2007, the anthrax attacks and the Katrina debacle are recent circumstances which may result in coercion. These have (...) piqued the interest of medical professionals and the general public on public health ethics. The Ethics of Coercion in Mass Casualty Medicine written by Griffin Trotter MD, PhD attempts to fill a timely void in this area by examining the ethics of coercion in times of public health disasters. (shrink)

Introduction: Public health ethics addresses moral dilemmas arising from balancing individual healthcare needs with societal interests. Ethical considerations in public health during pandemics and disasters aim to reduce mortality rates and minimize social injustice through fair principles. Objective: This paper analyzes public health ethics and ethical values in allocating resources during mass casualty incidents. The intersection of public health ethics, applied bioethics, and ethics of social consequences (through non-utilitarian consequentialism) guides addressing serious public health challenges in catastrophic scenarios. (...) The application of the given interaction is significant for professional medical ethics. Methodology: The paper employs inductive, deductive, and normative methods of bioethics and the methodology of ethics of social consequences. Conclusion: The paradigmatic disparity between the bioethics of pandemics and disaster bioethics lies in the fluid application of bioethical principles and the accentuation of utilitarian demands depending on the severity and scale of mass casualty incidents. Applied bioethics in crisis situations respects the approaches of public health ethics and attempts to increase positive social outcomes. The application of (scarce) resource allocation criteria and triage of patients is derived from ethical decisions beneficial to public health and lege artis approaches of medical bioethics. The paper presents professional and ethical criteria for medically inappropriate treatment within the framework of patient triage; we approach crisis ethics from the perspective of maximization of benefit. Age is not an exclusion criterion of acute healthcare provision in crisis situations. Ethics of social consequences as a form of non-utilitarian consequentialism allowing for social consequences bridges public health ethics and applied bioethics. (shrink)

Health care providers (HCPs) are routinely placed into morally challenging situations that have the potential to cause moral distress. This is especially true for HCPs working in the military, whether they are on deployment outside their typical contexts of practice such as in disaster relief (e.g., Haiti and the Ebola missions in West Africa), or in more typically military settings such as peace keeping or armed conflicts (e.g., Afghanistan, Syria). Moral distress refers to “painful feelings and/or psychological disequilibrium” (Nilsson, Sjöberg, (...) Kallenberg, & Larsson, 2011, p. 50) that occur when an individual is aware of a morally appropriate action in a moral dilemma but obstruction prevents them from carrying it out, or when in a situation where they must choose between upholding equally treasured but conflicting moral values. Similarly, moral distress can occur when faced with a ‘tragic choice’ where all available courses of action require something of moral significance to be given up, such as surgical triage in a mass casualty event (Hunt, Sinding, & Schwartz, 2012). In the literature, moral distress has been connected to negative psychological effects and even stress related mental health issues including compassion fatigue, burnout, and post-traumatic stress disorder (Owen & Wanzer, 2014; Gustafsson, Eriksson, Strandberg, & Norberg, 2010; Litz, et al., 2009). (shrink)

Traditionally, hospital emergency readiness plans primarily addressed natural disasters, but because of preparations for year 2000, the arrival of terrorism in the United States, and the potential for mass casualties, hospitals were prompted to bring together new partners and create new emergency readiness plans. These new plans, however, give rise to a number of important issues hospitals must consider. First, hospitals must consider legal liability that might arise during an emergency. For example, what liability might arise when decision are (...) made regarding the provision of individual treatment versus mass triage? Second, hospitals must be cognizant of relevant privacy rules, such as the Health Insurance Portability and Accountability Act, as they apply to public health emergencies activities. Third, hospitals must be aware of the Emergency Medical Treatment and Active Labor Act which requires Medicarefunded hospitals to screen patients for emergency medical conditions and prohibits their transfer until they are stabilized. (shrink)

Traditionally, hospital emergency readiness plans primarily addressed natural disasters, but because of preparations for year 2000, the arrival of terrorism in the United States, and the potential for mass casualties, hospitals were prompted to bring together new partners and create new emergency readiness plans. These new plans, however, give rise to a number of important issues hospitals must consider. First, hospitals must consider legal liability that might arise during an emergency. For example, what liability might arise when decision are (...) made regarding the provision of individual treatment versus mass triage? Second, hospitals must be cognizant of relevant privacy rules, such as the Health Insurance Portability and Accountability Act, as they apply to public health emergencies activities. Third, hospitals must be aware of the Emergency Medical Treatment and Active Labor Act which requires Medicarefunded hospitals to screen patients for emergency medical conditions and prohibits their transfer until they are stabilized. (shrink)

This study examined more than 2,500 war images from U.S. television news, newspapers, news magazines, and online news sites during the first five weeks of the U.S.-led invasion of Iraq in 2003 and found that only 10% showed injury or death. The paper analyzes which media platforms were most willing to show casualties and offers insights on when journalists should use gruesome war images or keep them secret.

This study examined more than 2,500 war images from U.S. television news, newspapers, news magazines, and online news sites during the first five weeks of the U.S.-led invasion of Iraq in 2003 and found that only 10% showed injury or death. The paper analyzes which media platforms were most willing to show casualties and offers insights on when journalists should use gruesome war images or keep them secret.

Natural disasters in populated areas may result in massive casualties and extensive destruction of infrastructure. Humanitarian aid delegations may have to cope with the complicated issue of patient prioritization under conditions of severe resource scarcity. A triage model, consisting of five principles, is proposed for the prioritization of patients, and it is argued that rational and reasonable agents would agree upon them. The Israel Defense Force's humanitarian mission to Haiti following the 2010 earthquake serves as a case study for (...) the various considerations taken into account when designing the ethical-clinical policy of field hospitals. The discussion focuses on three applications: the decision to include an intensive care unit, the decision to include obstetrics and neonatal units, and the treatment policy for compound fractures. (shrink)

The well-known perception of war-hungry Muslims who had the Qur’an on the one hand and sword on the other offering a choice of either accepting Islam or losing one’s head has easily been created in the literature by the Orientalist scholars. Today the stress on the Jihad controversy by mass media in Europe and America is important and needs to be corrected. That jihad has usually been translated by the Western media as “holy war” is a greatly misunderstood principle (...) in Islam. There is no term in Arabic which means, “holy war”. War is not “holy” in Islam. I would like to divide this study into two parts: In the first part, the issue of conquest and its religious, ideological and theoretical references will be dealt with in reference to basic Islamic sources and the previous Islamic state’s practices. In particular, what are the limits of warfare and the position of civilians in the wars and wartimes according to the Islamic law will be looked for. In the second part, as a typical Islamic state, to what extend Ottoman conquests in the Balkans followed and practiced the legal way that opened up by Islamic law will be analyzed according to the available chronicles. (shrink)

A funny, touching look at the life of a social media influencer who starts to question the #goals life she has created for herself. Every day, Élie motivates her hundreds of thousands of followers to become the best versions of themselves by posting videos of exercise routines and high-protein breakfast recipes. Far from the shy teenager that she was, she is now in a very public relationship with singer Samuel Vanasse, and together they have become one of the most popular (...) influencer couples in the country. She has succeeded. She shines. And yet, Élie worries that her life is not as flawless as she makes it seem on YouTube and Instagram. Between her obsession with the "ideal weight," her growing attraction to another man, her family's disdain for her career as a content creator and a collaboration with another influencer who Élie can't stand, a thought haunts her. What if, by trying to become everything she wanted to be, she's lost herself along the way? Suck it In and Smile is an intimate exploration of our obsession with appearances and the hypocrisies that appear when you must craft the perfect online life. (shrink)

"Die Logik der Erfahrung" stellt eine Systematisierung der wissenschaftsphilosophischen Gedanken der klassischen Pragmatisten (Charles S. Peirce, William James, John Dewey) dar. Die pragmatistische Erfahrungstheorie sowie die Bestimmung des Verhältnisses von Theorie und Praxis bilden die Grundlage einer holistischen Wissenschaftsphilosophie, deren Aktualität durch die exemplarische Anwendung auf klassische wissenschaftstheoretische Fragestellungen gezeigt wird. Die AutorinTina Massing ist Akademische Rätin am Institut für Philosophie der Universität Koblenz. In ihrer Forschung beschäftigt sie sich insbesondere mit wissenschaftsphilosophischen Themen und dem Klassischen Pragmatismus.

‘From now on, I'll describe the cities to you’, the Khan had said, ‘in your journeys you will see if they exist.’ But the cities visited by Marco Polo were always different from those thought of by...

The dualism of knowledge and values as well as of the objective and the subjective views has accompanied the social work profession from its inception and presents a particular dilemma for the link between academia and practice. It is either that academia is split off from the practice of social work, or that these two fields of professional activity merge into each other. Either of these solutions impoverishes the profession. The key for the understanding of this dilemma as well as (...) its resolution rests with the particular ontological definitions adhered to by the profession. It is proposed that by fostering the moral ontology the dualism inherent in the nature of the profession may enrich it and a fruitful link between academia and the practice of social work will evolve. The arguments presented as well as the resolution proposed are illustrated by theoretical explanations, empirical studies and clinical practice in the area of the parent-infant relationship. (shrink)

Hallucinations do not originate in a single region of the brain, the thalamus, and cannot be traced back to a single pathological mechanism. They emerge from the complex interaction of several brain regions, and are not necessarily the result of sensory impairment or the effect of a defective filter. In the case of schizophrenia, hallucinations are accessory symptoms, in Bleuler's sense, and are thus not central to this disorder.

A conception of parental experience is proposed to enhance the move of the study of parenting into the interpersonal realm by describing parental subjectivity from the parent's point of view. Explanations are based on that which the parent can be accountable for, on parental dialogues with observers/clinicians about their dialogues with their infants. This conception of parental subjectivity is compared with other conceptions which define parental subjectivity as the mental apparatus of the parent and not as representing the evolving relation (...) of the parent with the infant, and with explanations which consider parental reports in terms of the parent's psychodynamics and cognitive abilities rather than in terms of the on-going dialogues between themselves and their infants. The paper introduces a typology of parental dialogues with observers/clinicians about their dialogues with their infants, within the context of the non-verbal nature of the infant's communication. The findings from empirical examinations of this typology are presented, and their implications for the proposal that the study of parental relations with their infants should consider the parent's accountability are discussed. (shrink)

Une tentative de rapprochement entre un certain nombre d'interrogations esthétiques et le contexte historique dans lequel elles s'inscrivent. Sortir les propositions artistiques contemporaines de leur histoire spécifique et les articuler sur les questions que posent certaines mutations récentes de nos sociétés.

The text confronts the elements of which Luhmann theorizes the educative system, from a critical form to center the suitable approach to know the multiplicity of elements from the educative system. Luhmann’s foundations are criticized and other levels are proposed, from a critical vision of social..

This article deals with a set of images which were probably the first in history to be reproduced on four continents: the Jesuit Jerome Nadal's Evangelicae Historiae Imagines, first published in Antwerp in 1593. It begins with a brief discussion of what we know about Nadal's life and the production history of his book, as well as its relationship to his Adnotationes et Meditationes in Evangelia quae in sacrosanto missae sacrificio toto anno leguntur, which acts as a commentary to the (...) Imagines. Then follows a description of the structure of the two books, and how they narrate and expound the significance of the Gospels. The remaining sections discuss the adaptations of Nadal's imagery. While his work has received much attention from scholars around the world in recent decades, the aim of the present article is to bring together research on the use and re-use of these images in Europe, the Americas, India, China, Japan, Iran and Ethiopia, and to make clear their global impact in a way that has not been attempted before. (shrink)

Qu'entend-on par enchantement et désenchantement du monde? Quelles seraient les voies à suivre pour susciter un réenchantement du monde qui sera le fait de l’humain lui-même? La raison et la rationalité sont-elles les causes des maux de nos errements ou des outils pour les contrer? Suffira-t-il d’avoir « foi en la raison » pour surmonter les défis que l’humanité s’est elle-même imposés par négligence et irresponsabilité.