The surgeon and acts of civilian terrorism: Biologic agents
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ABSTRACT: Terrorists' use of explosive, biologic, chemical, and nuclear agents constitutes the potential for catastrophic events. Understanding the unique aspects of these agents can help in preparing for such disasters with the intent of mitigating injury and loss of life. Explosive agents continue to be the most common weapons of terrorists and the most prevalent cause of injuries and fatalities. Knowledge of blast pathomechanics and patterns of injury allows for improved diagnostic and treatment strategies. A practical understanding of potential biologic, chemical, and nuclear agents, their attendant clinical symptoms, and recommended management strategies is an important prerequisite for optimal preparation and response to these less frequently used agents of mass casualty. Orthopaedic surgeons should be aware of the principles of management of catastrophic events. Stress is less an issue when one is adequately prepared. Decontamination is essential both to manage victims and prevent further spread of toxic agents to first responders and medical personnel. It is important to assess the risk of potential threats, thereby allowing disaster planning and preparation to be proportional and aligned with the actual casualty event.
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ABSTRACT: A well-known thought experiment has us ponder a lottery system that selects one person as the source of transplantable organs
for two others. The organs are forcibly harvested and the “donor” dies, whereas the other two patients live. The Survival
Lottery is supposed to get at the distinction between killing and letting die, but it is also a challenge to beliefs about
moral duties: what are my obligations if my life could be used to save yours and another person's as well? A less extreme
version of this thought experiment might have us imagining that officials of the public healthcare system would devise a similar
lottery in the aftermath of a large-scale medical emergency. We could imagine that a natural disaster or an attack using biological
weapons, for example, has so diminished the ability to provide public health care that in some communities, officials might
consider implementing a lottery. To avoid the concerns about outright killing of selectees, officials might offer a wide range
of participation in medical practice and research, not just organ allocation. Officials could ensure that no significant risks
are involved, and selectees could in various ways be compensated. Would it be possible to ethically justify this “Healthcare
Lottery” on the grounds that it was a temporary, yet necessary, infringement on autonomy?
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