This book intervenes in contemporary debates about the threat posed to democratic life by political emergencies. Must emergency necessarily enhance and centralize top-down forms of sovereignty? Those who oppose executive branch enhancement often turn instead to law, insisting on the sovereignty of the rule of law or demanding that law rather than force be used to resolve conflicts with enemies. But are these the only options? Or are there more democratic ways to respond to invocations of emergency politics? (...) Looking at how emergencies in the past and present have shaped the development of democracy, Bonnie Honig argues that democracies must resist emergency's pull to focus on life's necessities because these tend to privatize and isolate citizens rather than bring us together on behalf of hopeful futures. Emphasizing the connections between mere life and more life, emergence and emergency, Honig argues that emergencies call us to attend anew to a neglected paradox of democratic politics: that we need good citizens with aspirational ideals to make good politics while we need good politics to infuse citizens with idealism.Honig takes a broad approach to emergency, considering immigration politics, new rights claims, contemporary food politics and the infrastructure of consumption, and the limits of law during the Red Scare of the early twentieth century. Taking its bearings from Moses Mendelssohn, Franz Rosenzweig, and other Jewish thinkers, this is a major contribution to modern thought about the challenges and risks of democratic orientation and action in response to emergency. (shrink)

Emergency care providers regularly deal with ethical dilemmas that must be addressed. In comparison with in-hospital nurses, emergency medical service personnel are faced with more problems such as distance to resources including personnel, medico-technical aids, and information; the unpredictable atmosphere at the scene; arriving at the crime scene and providing emergency care for accident victims and patients at home. As a result of stressfulness, unpredictability, and often the life threatening nature of tasks that ambulance professionals have to (...) deal with every day, ethical decision-making has become an inevitable challenge. The content analysis approach was used to conduct the present qualitative study in Iran. The participants consisted of 14 EMS personnel selected through purposive sampling, which continued until the data became saturated. Data were collected using semi-structured interviews and analyzed concurrently with their collection through the constant comparison method. The process of data analysis resulted in the emergence of 3 main categories “respecting client’s values”, “performing tasks within the professional manner”, “personal characteristic”, and the emergence of eight sub-categories signifying participants’ experiences with regard to EDM. According to the results, when EMS personnel are faced with ethical dilemmas, they consider the client’s values and professional dignity, and perform the assigned tasks within the framework of the regulation. The findings also suggest that pre-hospital care providers assess legal consequences before making any decision. Further studies should be conducted regarding the experiences of the subordinates and other related parties. (shrink)

Abstract:The straightforward normative importance of emergencies suggests that empirically engaged political theorists and philosophers should study them. Indeed, many have done so. In this essay, however, I argue that scholars interested in the political and/or moral dimensions of large-scale emergencies should shift their focus from emergencies to emergency claims. Building on Michael Saward’s model of a “representative claim,” I develop an account of an emergency claim as a claim that a particular (kind of) situation is an emergency, (...) made by particular actors against particular background conditions to particular audiences, which in turn accept, ignore, or reject that claim. Emergency politics, in turn, consists of many different actors making and not making, accepting, and rejecting, a wide range of overlapping and competing emergency claims. I argue that scholars should shift their focus to emergency claims because doing so helps us see the fraught implications of emergency politics for marginalized groups. I examine three such implications: emergency claims are often “Janus-faced,” meaning that they function simultaneously as “weapons of the weak” and weapons of the strong; they are often regressive, including by discriminating against victims of chronic bad situations, and they often perpetuate and exacerbate existing social hierarchies. Noticing these troubling features of emergency politics raises a question that I do not address here: What might plausible alternatives to emergency politics look like? (shrink)

This paper focuses on an emergency basic income as a tool for avoiding financial insecurity during the time of pandemic. The authors argue that paying each resident a monthly cash amount for the duration of the crisis would serve to protect them from the economic fallout.They suggest three reasons why the EBI proposal is particularly well-suited to play an important role in a comprehensive public health response to COVID-19: it offers an immediate and agile response; it prioritizes the most (...) vulnerable in the affected population; and it promotes a solidaristic response to the pandemic crisis. To go beyond the need to shut down and restart an EBI assistance scheme each time a pandemic hits, the authors propose considering turning the program into a permanent feature. (shrink)

Background:Decision-making and assessment in emergency situations are complex and result many times in ethical conflicts between different healthcare professionals.Aim:To analyse and describe situations that can generate ethical conflict among nurses working in emergency situations.Methods:Qualitative analysis. A total of 16 emergency nurses took part in interviews and a focus group.Ethical considerations:Organisational approval by the University Hospital, and informed consent and confidentiality were ensured before conducting the research.Result/conclusion:Two categories emerged: one in ‘ethical issues’ and one in ‘emotions and feelings (...) in caring’. The four ethical subcategories are presented: Autonomy, the first sub category: first, the nurse’s ability to practise care on an emergency ward and, second, to support the patient and/or relatives in terms of care and medical treatment. The conflicts arise when the nurse ends up in the middle between the patient and the physician responsible for the diagnosis and treatment from a nature scientific perspective. Reification of injured body: patient was often reified and fragmented, becoming just a leg or arm. Different factors contributed in this perspective. Pain: pain relief was often inadequate but more effectively treated in the emergency medical services than at the emergency department. The nurses highlighted the phenomenon of suffering because they felt that pain was only an object, forgetting the patients’ care need, like separating mind from body. Death: the nurses felt that the emergency services are only prepared to save lives and not to take care of the needs of patients with ‘end-of-life’ care. Another issue was the lack of ethical guidelines during a cardiac arrest. Resuscitation often continues without asking about the patient’s ‘previous wishes’ in terms of resuscitation or not. In these situations, the nurses describe an ethical conflict with the physician in performing their role as the patient’s advocate. The nurses express feelings of distress, suffering, anger and helplessness. (shrink)

In this article, we discuss the ethics of research suspensions in animal research facilities and the consequent (mis)treatment of laboratory animals during emergencies. Through a case study from Switzerland during the COVID-19 pandemic, we articulate ethical principles and moral considerations that ought to guide the treatment and care of laboratory animals within animal research facilities during emergencies. They include a principle of preparedness, the importance of recognizing animal laboratory personnel as essential workers and conducting a Harm-Benefit Analysis in the case (...) of an emergency, assigning responsibilities in a clear way, and providing psychological support in the aftermath of an emergency. More generally, we suggest that the pandemic should be taken as a learning opportunity for critically re-evaluating and improving emergency planning within animal research institutions worldwide, in view of mitigating risks to both human and animal well-being in future emergencies. (shrink)

A lively and approachable meditation on how we can transform our digital lives if we let a little Nietzsche in. Who has not found themselves scrolling endlessly on screens and wondered: am I living or distracting myself from living? In Emergency, Break Glass adapts Friedrich Nietzsche's passionate quest for meaning into a world overwhelmed by "content." Written long before the advent of smartphones, Nietzsche's aphoristic philosophy advocated a fierce mastery of attention, a strict information diet, and a powerful connection (...) to the natural world. Drawing on Nietzsche's work, technology journalist Nate Anderson advocates for a life of goal-oriented, creative exertion as more meaningful than the "frictionless" leisure often promised by our devices. He rejects the simplicity of contemporary prescriptions like reducing screen time in favor of looking deeply at what truly matters to us, then finding ways to make our technological tools serve this vision. With a light touch suffused by humor, Anderson uncovers the impact of this "yes-saying" philosophy on his own life-and perhaps on yours. (shrink)

The 2018 constitutional crisis in Sri Lanka represents a critical turning point in the country’s post-1978 constitutional history, raising profound questions about the scope of executive emergency powers and the effectiveness of constitutional checks and balances. The study critically examines the legal and political dimensions of emergency – style executive action during the crisis, focusing on the interpretation of presidential powers, parliamentary sovereignty and judicial review. Research problem is to what extent did the exercise of presidential power during (...) Sri Lanka’s 2018 constitutional crisis expose structural weaknesses in constitutional checks and balance particularly regarding emergency style executive authority under the post 1978 constitutional framework? The research main objective of this study is to analyze how the 2018 constitutional crisis tested the constitutional safeguards introduced under the constitution of Sri Lanka, particularly after the 19th amendment to the constitution, and to evaluate whether Sri Lanka’s semi – presidential system provides sufficient institutional mechanisms to restrain emergency – style executive actions. Sub objectives are to examine the constitutional provisions governing presidential powers under the post 1978 framework, to analyze the legal and political developments during Sri Lanka’s 2018 constitutional crisis, to evaluate the role of parliament and the judiciary in checking executive actions during the crisis and to assess the effectiveness of the 19th amendment in limiting executive overreach. The writing of this article uses qualitative method. Under the qualitative method using literature resources for this. Specially analysis technique based on previous researchers’ findings. The findings contribute to ongoing debates on constitutional reform, democratic resilience and the recalibration of executive power in post-conflict societies. (shrink)

The paucity of research data to guide current paediatric practice has led to children being termed therapeutic orphans. This difficulty is especially pertinent to research in emergency situations, such as acute resuscitation or critical care, where accepted ethical standards for overall research, have historically created practical difficulties for researchers. The welcome establishment of organisations to support UK paediatric research is helping to ensure safer and more effective medications for children, however as the balance between protection and access at the (...) heart of the paediatric research ethical debate shifts to ever increasing access for researchers to children, it remains crucial to ensure the protection for these vulnerable participants. The fundamental protection for research subjects, namely their full informed consent before any recruitment, is not tenable in true emergency situations and so other approaches are warranted if standards are to be improved by human subjects research in such areas. Proxy, deferred and retrospective consent have all been advocated as solutions to this difficulty and this paper explores the ethical justification for these approaches and their utility in safeguarding children and families in emergency situations when traditional informed consent, as currently defined, cannot be obtained in the necessary time frame to enable research. (shrink)

The recent rapid development of information technology, such as sensing technology, communications technology, and database, allows us to use simulation experiments for analyzing serious accidents caused by hazardous chemicals. Due to the toxicity and diffusion of hazardous chemicals, these accidents often lead to not only severe consequences and economic losses, but also traffic jams at the same time. Emergency evacuation after hazardous chemical accidents is an effective means to reduce the loss of life and property and to smoothly resume (...) the transport network as soon as possible. This paper considers the dynamic changes of the hazardous chemicals’ concentration after their leakage and simulates the diffusion process. Based on the characteristics of emergency evacuation of hazardous chemical accidents, we build a mixed-integer programming model and design a heuristic algorithm using network optimization and diffusion simulation. We then verify the validity and feasibility of the algorithm using Jinan, China, as a computational example. In the end, we compare the results from different scenarios to explore the key factors affecting the effectiveness of the evacuation process. (shrink)

He describes this most private work of Heidegger's philosophy as "a dissonant symphony that imperfectly weaves together its moments into a vast fugue, under the ...

: On the grounds that rape is an act of violence, not a natural act of intercourse, Roman Catholic teaching traditionally has permitted women who have been raped to take steps to prevent pregnancy, while consistently prohibiting abortion even in the case of rape. Recent scientific evidence that emergency contraception (EC) works primarily by preventing ovulation, not by preventing implantation or by aborting implanted embryos, has led Church authorities to permit the use of EC drugs in the setting of (...) rape. Doubts about whether an abortifacient effect of EC drugs has been completely disproven have led to controversy within the Church about whether it is sufficient to determine that a woman is not pregnant before using EC drugs or whether one must establish that she has not recently ovulated. This article presents clinical, epidemiological, and ethical arguments why testing for pregnancy should be morally sufficient for a faith community that is strongly opposed to abortion. (shrink)

This article analyses and presents a survey of ethical conflicts in prehospital emergency care. The results are based on six focus group interviews with 29 registered nurses and paramedics working in prehospital emergency care at three different locations: a small town, a part of a major city and a sparsely populated area. Ethical conflict was found to arise in 10 different nodes of conflict: the patient/carer relationship, the patient’s self-determination, the patient’s best interest, the carer’s professional ideals, the (...) carer’s professional role and self-identity, significant others and bystanders, other care professionals, organizational structure and resource management, societal ideals, and other professionals. It is often argued that prehospital care is unique in comparison with other forms of care. However, in this article we do not find support for the idea that ethical conflicts occurring in prehospital care are unique, even if some may be more common in this context. (shrink)

Turning crises into opportunities for children and young people after traumatic events, helping them to overcome their traumas and avoiding trauma-related disorders—this is the mission of the ‘Emergency Pedagogy without Borders’ association founded in 2020.

The COVID-19 pandemic created a situation for the implementation of emergency remote learning. This meant that as a lecturer at a traditionalist University of contact sessions, the pandemic forced us to teach remotely through online methods of communication, using online lectures, narrated powerpoints, voice clips, podcasts, interviews and interactive videos. The assessments were conducted online from assignments to multiple choice questions, which forced the lecturers to think differently about the way the assessments were presented, in order to avoid easy (...) access to answers found in a textbook and online. This meant that more application questions of theory to practice were assessed in a more challenging way to prevent cheating and collaboration with peers. Formal assessments completed during emergency remote learning, have become the past practice, as innovative methods have been adopted for learning and for assessment purposes in order to preserve the integrity and attainment of the degree through online modes of learning. The aim of the paper investigates and explores the methods of teaching, together with the results obtained from the students of 2019 and 2020 in their final year relating to two final year modules against the literature relating to learning processes and methodologies. (shrink)

This article describes the main conceptual questions entailed in the doctrine of emergency powers, taking into account the theory and experience of their enforcement. It explains the constitutional aspects of emergency powers and evaluates the possibility of thinking about the position and force emergency powers play within a polyarchical constitution. It also discusses the epistemic dimension of emergency powers, constitutional dualism, and judicial control over emergency power.

The present study aims at proposing a time series-based network public opinion emergency management decision support algorithm for the problems of low decision accuracy and long decision time in traditional similar algorithms. In this proposed algorithm, after the time series data are preprocessed, the association rules of the original indicator data of network public opinion emergencies are mined, the original indicator data matrix of NPOEs will be constructed, and the improved local linear embedding approach will be employed to obtain (...) the original indicator data of NPOEs. After carrying out the preprocessing according to the preprocessing results, the objective weight of the emergency decision index is calculated through the interval value fuzzy information entropy measurement of the emergency decision index, the emergency management decision support model is constructed, and the emergency management decision support of the NPOE is realized. The simulation experiment results show that the proposed algorithm has a better effect on the decision-making effect of the management of NPOEs, and a higher decision-making efficiency is achieved. (shrink)

Background: Health systems globally face ncreasing challenges from health crises and epidemic threats, necessitating the pivotal role of epidemiological teams in emergency response. This study investigates the significance of collective competence within these teams, focusing on their ability to collect, analyze, and manage laboratory data effectively. Methods: A cross-sectional descriptive study design was used to survey epidemiological teams in Saudi Arabia. A structured questionnaire was developed based on existing literature and distributed electronically to participants. Data analysis was performed using (...) the Statistical Package for the Social Sciences (SPSS), using descriptive and inferential statistics to summarize participant characteristics and explore associations between variables. Results: A total of 208 epidemiological teams member completed the questionnaire, yielding insights into their The Role of Collective Competence in Epidemiological Teams. The findings reveal high levels of agreement regarding the effectiveness of management approaches, knowledge sharing, and team collaboration, with the average score exceeding 4.0 on a 5-point scale. Notably, team efficacy was found to significantly enhance the efficiency of laboratory data collection and analysis, accounting for approximately 25.9% of the variance in efficacy. Discussion: These findings underscore the need to invest in developing team competencies within epidemiological teams to improve emergency response capabilities. The study provides practical insights into enhancing team collaboration and coordination, ultimately contributing to more effective public health interventions in future health crises. (shrink)

This essay attempts to articulate three authors who have tried to think about the present time in its form of permanent crisis. Paulo Arantes with his theory of the age of emergency, Joshua Clover with his theory of the age of riots, and Wolfgang Streeck and the age of entropy. Arantes will serve as our theoretical foundation, while Clover will help us think about the informal masses that form in the riots while Streeck will help us think about the (...) excessive individualism of the present situation. It is in the latter that we recover the idea of the need to think about improvisation to conclude with what could be the general features of this. (shrink)

An estimated 6,500 undocumented immigrants in the United States have been diagnosed with end-stage renal disease. These individuals are ineligible for the federal insurance program that covers dialysis and/or transplantation for citizens, and consequently are subject to local or state policies regarding the provision of healthcare. In 76% of states, undocumented immigrants are ineligible to receive scheduled outpatient dialysis treatments, and typically receive dialysis only when presenting to the emergency center with severe life-threatening symptoms. ‘Emergency-only hemodialysis’ is associated (...) with higher healthcare costs, higher mortality, and longer hospitalizations. In this paper, we present an ethical critique of existing federal policy. We argue that EOHD represents a failure of fiduciary and professional obligations, contributes to moral distress, and undermines physician obligations to be good stewards of medical resources. We then explore potential avenues for reform based upon policies introduced at the state level. We argue that, while reform at the federal level would ultimately be a more sustainable longterm solution, state-based policy reforms can help mitigate the ethical shortcomings of EOHD. (shrink)

Since its establishment in 1948, Israel has been in a state of war and in extended periods of emergency. The Declaration of Independence founded Israel as a ‘Jewish and democratic’ state, but since the very beginning a ‘state of emergency’ was declared, which is permanent ever since. Furthermore, one-fifth of Israel’s citizens are Arab nationals (Palestinian Israelis) who wish to preserve their culture, religion and language, while sympathizing with the Palestinian nation and the Arab world, with which the (...) state of Israel is in a state of ongoing belligerency. In the 1967 war, Israel occupied populated territories, which created serious debates about the civil status and general fate of the Palestinian population of the West Bank and the Gaza Strip. The Supreme court of Israel allowed Palestinians to appeal against decisions made by the military commanders of the occupied regions, sharply defending the need to protect human rights even in times of emergency. War and terror acts have resulted in an almost daily examination of restrictions of human rights, pressing the need to find the right balance between defending those rights and protecting national security. This paper will present, first, the Israeli model of a state of emergency, the different types of power granted to the executive, its normative framework, and its uses in the past and present as well as parliamentary and judiciary control. Second, it will disclose the difficulties a permanent state of emergency poses: how the ongoing executive power may lead to the misuse of emergency rules by politicians, applying unusual methods and procedures in circumstances that have nothing to do with emergency; how parliamentary control tends to weaken, how power shifts from Parliament to the executive and how emergency legislative tools seem to ‘migrate’ even to constitutional amendments. The article will discuss the unique role of the Supreme court of Israel (sitting as the High court of Justice) as a powerful controller of emergency regulations, measures and decisions. The court’s activist rulings on military and security cases, coupled with its criticism of government powers, have played a most significant role in shaping Israel’s state of emergency. Last, it will analyse the new anti-terrorism law approved on 15 June 2016—a further step within the global war on terror—a law which creates new offences, significantly expands both the state’s counterterrorism powers and its definitions of terrorist organizations and terrorist acts. (shrink)

Introduction: Prehospital emergency medicine is a specific field of emergency medicine. The basic approach of prehospital emergency medicine is to provide patients with medical intervention at the scene of the incident. This special environment causes health professionals to encounter various problems. One of the most important problems in this field is ethics, in particular questions involving refusal of treatment and the processes associated with it. Objective: The objective of this study is to identify emergency health professionals’ (...) views regarding refusal of treatment. Methods: This study was conducted with 356 health professionals who were on active duty in prehospital emergency health services. The data were collected through a form which included 10 statements. The participants were asked to indicate their level of agreement with the statements given by rating them between 0 and 10. Ethical considerations: Before conducting the research, permission was received from the local ethics committee. Participants were given written information about the purpose of the study. Participants were assured that their participation was voluntary. Results: The healthcare professionals with fewer years of experience in the profession and female participants adopted an attitude of giving priority to providing care. Young participants, in general, respected patient autonomy. However, paradoxically, when it comes to emergency medical cases, they expressed an opinion closer to paternalism. Conclusions: This study has found that prehospital emergency health professionals generally respect the patient’s right to refuse treatment; however, they do not prioritize this right when there is a life-threatening situation or when the person does not have decision-making capacity. In these cases, prehospital emergency health professionals tended to adopt a more paternalistic approach. (shrink)

BackgroundEmergency separation of conjoined twins is performed when one twin is already dead or dying and threatens the survival of the other. The particular decision to perform an emergency separation of conjoined twins provides an ethical dilemma that needs special attention. Adding to the complexity of surgical and postsurgical management in emergency separation, ethical and sociocultural aspects further complicate decision-making.Case presentationFrom 1987 to 2022, 18 conjoined twin separations were performed in our centre. This paper describes three conjoined twin (...) emergency separations. In the first case of thoracoomphalopagus babies at nine days of age, one baby was diagnosed with necrotizing enterocolitis with frequent desaturation and seizures, and the other baby was healthy. Emergency separation was performed on the twelfth day of age; unfortunately, neither baby survived the surgery. In the second case, emergency separation was performed on the 110th day of life due to sepsis in one baby. The nonseptic twin passed away six hours after surgery, while the septic twin died 12 days after surgery due to wound dehiscence and abdominal sepsis. The third case was of an omphalopagus conjoined twin with a parasitic twin. The healthy baby was deemed nonviable but found to be healthy upon birth. Immediate emergency separation was performed at 2 h of age. The living baby survived the surgery but passed away two months later.ConclusionsWhen separation is deemed necessary to save one twin, it becomes difficult to apply standard ethical medical reasoning. The decision to separate results in most cases in very high-risk surgeries with poor outcomes during surgery and postsurgery. Compounded by the complexity of the case, sociocultural and religious aspects further add to the dynamics of decision-making. A multidisciplinary team must work together with a health ethics committee and navigate through this ethical conundrum with the patient and family at its decision-making centre to decide on the best plan of care. (shrink)

Effective communication and interpersonal skills have long been recognized as fundamental to the delivery of quality health care. However, there is mounting evidence that the pressures of communication in high stress work areas such as hospital emergency departments present particular challenges to the delivery of quality care. A recent report on incident management in the Australian health care system cites the main cause of critical incidents, as being poor and inadequate communication between clinicians and patients. This article presents research (...) that describes and analyses spoken interactions between health care practitioners and patients in one ED of a large, public teaching hospital in Sydney, Australia. The research aimed to address the challenges and critical incidents caused by breakdowns in communication that occur between health practitioners and patients and by refining and extending knowledge of discourse structures, to identify ways in which health care practitioners can enhance their communicative practices thereby improving the quality of the patient journey through the ED. The research used a qualitative ethnographic approach combined with discourse analysis of audio-recorded interactions. Some key findings from the analysis of data are outlined including how the absence of information about processes, the pressure of time within the ED, divergent goals of clinicians and patients, the delivery of diagnoses and professional roles impact on patient experiences. Finally, the article presents an in-depth linguistic analysis on interpersonal and experiential patterns in the discursive practices of patients, nurses and doctors. (shrink)

Background: Reliance on moral principles and professional codes has given nurses direction for ethical decision-making. However, rational models do not capture the emotion and reality of human choice. Intuitive response must be considered. Research purpose: Supporting intuition as an important ethical decision-making tool for nurses, the aim of this study was to determine relationships between intuition, years of worked nursing experience, and perceived ethical decision-making ability. A secondary aim explored the relationships between rational thought to years of worked nursing experience (...) and perceived ethical decision-making ability. Research design and context: A non-experimental, correlational research design was used. The Rational Experiential Inventory measured intuition and rational thought. The Clinical Decision Making in Nursing Scale measured perceived ethical decision-making ability. Pearson’s r was the statistical method used to analyze three primary and two secondary research questions. Participants: A sample of 182 emergency nurses was recruited electronically through the Emergency Nurses Association. Participants were self-selected. Ethical considerations: Approval to conduct this study was obtained by the Adelphi University Institutional Review Board. Findings: A relationship between intuition and perceived ethical decision-making ability ( r =.252, p =.001) was a significant finding in this study. Discussion: This study is one of the first of this nature to make a connection between intuition and nurses’ ethical decision-making ability. Conclusion: This investigation contributes to a broader understanding of the different thought processes used by emergency nurses to make ethical decisions. (shrink)

BackgroundHealth research often uses health information, a subcategory of personal information, collected during clinical encounters. Conditions under which such health information can be used for the secondary purpose of research are set out in state, national and international law. In Australia, consent is required or the relevant conditions for a waiver of consent must be met and approved by a human research ethics committee (HREC). Consent for use of health information for research is rarely sought at an emergency department (...) (ED) presentation. Research often occurs after the index visit and gaining consent can be difficult. Waiver of consent provisions are frequently used, but acceptability of this approach to patients is unclear.ObjectiveTo identify ED patients’ knowledge and attitudes towards the use of health information for research, consent preferences and acceptability of waiver of consent.MethodsAn online, anonymous survey of adult patients attending two large EDs in Melbourne, Australia.Results103 patients completed the survey. We found that 52% were unaware that health information might be used for research. A majority (77%) felt that HREC approval for use of health information without consent was acceptable. However, 36% would prefer to be contacted regarding consent.ConclusionThese findings suggest a lack of awareness that health information can be used for research and that waiver of consent is acceptable, but not necessarily preferred, in most of the ED patient population. Efforts to increase awareness and provide opportunities to express preferences about health information use for research are needed. (shrink)

The fight for public health primacy in U.S. emergency preparedness and response to COVID-19 centers on which level of government — federal or state — should “call the shots” to quell national emergencies?

Pharmacists with religious or ethical objections to prescribing emergency contraception won the latest round in the fight over conscience clauses in a case that could have broader implications for attempts to restrict access to contraception. In Stormans, Inc. v. Selecky, a federal District Court in Washington State granted an injunction to block the enforcement of regulations that would have forbidden pharmacists to refuse to dispense emergency contraception on the grounds of religious or ethical objections. In its decision, the (...) court applied Supreme Court abortion precedent without explicitly ruling whether emergency contraception should be legally categorized as a form of abortion or as contraception. However, the legal status of emergency contraception affects the strength of the defendants’ claims that the law was justified on the grounds of preventing sex discrimination. In neglecting to rule one way or the other, the court not only failed to adequately consider the sex discrimination claim but also may have opened the door to more restrictive regulation on contraceptives generally. (shrink)

This case study explores local North Carolina emergency manager perspectives on Defense Support (US Military) to Civil Authorities (DSCA). We ask a) How do county emergency managers integrate DSCA to prepare for disasters, and b) What factors do emergency managers consider when integrating DSCA into response and recovery activities. The reason why this study is important is that the results provide detailed and rich data for local emergency managers, and offers possibilities to improve collaborative emergency (...) responses between various local, state, and national emergency management agencies. Moreover, the study outcomes can help key leaders in emergency agencies to improve education and training to facilitate local emergency management through DSCA. (shrink)

Jones, Kate Wide spread media newsprint articles suggest our emergency medical departments are in a state of crisis. The purpose of this article is to examine a snapshot of emergency medicine performance data to provide some context in which to respond to this issue.

Firearm injuries are a significant public health problem. Prior studies have analyzed firearm death data or adult firearm injury data, but few studies have analyzed firearm injury data specifically among youth. To inform the current debate surrounding gun policy in the United States, this study aims to provide an estimate of the immense burden of youth firearm injury and its associated risk factors. Therefore, we performed a descriptive analysis of the Nationwide Emergency Department Sample, the largest all-payer emergency (...) department database in the United States, from January 2006 to September 2015. All patients age < 21 who presented with any diagnosis of firearm-related injuries were included. There were an estimated 198,839 incidents of firearm-related emergency department visits for patients age < 21 from 2006 through 2015. After presenting to the ED, an estimated 11,909 cases resulted in death. The population adjusted rate of firearm-related emergency department visits was highest in the South and Midwest. This study demonstrates the significant burden of firearm injury among youth. Having a reliable estimate of the number of children harmed by firearms each year is a critical tool for policymakers — and may make common-sense gun safety measures more politically possible. (shrink)

Democratic countries, such as Australia, face the dilemma of preserving public and national security without sacrificing fundamental freedoms. In the context where the rule of law is an underlying assumption of the constitutional framework, Emergency Powers in Australia provides a succinct analysis of the sorts of emergency which have been experienced in Australia and an evaluation of the legal weapons available to the authorities to cope with these emergencies. It analyses the scope of the defence power to determine (...) the constitutionality of federal legislation to deal with wartime crises and the 'war' on terrorism, the extent of the executive power and its relationship to the prerogative, the deployment of the defence forces in aid of the civil power, the statutory frameworks regulating the responses to civil unrest, and natural disasters. The role of the courts when faced with challenges to the invocation of emergency powers is explained and analysed. (shrink)

What is the meaning of Heidegger’s famous formula “the only emergency is the absence of emergency” in the 21st century? Interpreted as “opposition,” emergency becomes the paradigm through which politics, religion, and art must be practiced today. This practice takes place as an event which disrupts the imposed global order. The recent technocratic government in Italy has become an example of imposition which other countries must also submit to. This is why the absence of emergency can (...) only be felt inside the ruling world, as dysfunction, disturbance, and interruption. Art and religion return as realms where these disruptions take place. (shrink)

The essays selected for this volume focus on issues that arise when attempting to design, review and undertake research involving human participants who are experiencing a private or public emergency. The main themes discussed by the essays are: the distinctive and significant ethical questions as to how research participants can be treated during emergency settings; the ethical challenges raised by emergencies for researchers undertaking research and its effects on the nature of research pursued; and procedural obstacles raised by (...) emergencies which can affect the quality of good research ethics review. The volume is unique in that it is the first collection to exclusively deal with all of the central ethical aspects of conducting human subject research in the context of emergency. (shrink)

Excellent patient care within the emergency department requires interdisciplinary training, teamwork, and communication to manage the chaos of the environment. Specifically, invasive procedures required to manage airway, breathing, and circulation via intubation, chest compressions, and establishing intravenous access can provide a direct benefit to save lives but also have the potential to harm both patients and health care clinicians alike; emergency health care clinicians can be exposed to significant amounts of blood and body fluids as well as other (...) threats of physical and psychological harm. The ethical components of care in this environment are often under‐recognized due to the need for rapid patient assessment and immediate action. Moreover, challenges to practice that can include lack of qualified personnel, equipment, and other resources to provide safe care to a large volume of patients can lead to moral distress in ED staff. Because the ED is a high‐uncertainty, high‐acuity environment, continuing interprofessional communication, collaboration, and planning is critical. Opportunities for multidisciplinary policy dialogue and the development of professional guidelines can make the ED a safer environment for both patients and providers. (shrink)

Any plausible position in the ethics of war and political violence in general will include the requirement of protection of civilians (non-combatants, common citizens) against lethal violence. This requirement is particularly prominent, and particularly strong, in just war theory. Some adherents of the theory see civilian immunity as absolute, not to be overridden in any circumstances whatsoever. Others allow that it may be overridden, but only in extremis. The latter position has been advanced by Michael Walzer under the heading of (...) “supreme emergency.” In this paper, I look into some of the issues of interpretation and application of Walzer’s “supreme emergency” view and some of the criticisms that have been levelled against it. I argue that Walzer’s view is vague and unacceptable as it stands, but that the alternatives proposed by critics such as Brian Orend, C.A.J. Coady, and Stephen Nathanson are also unattractive. I go on to construct a position that is structurally similar to Walzer’s, but more specific and much less permissive, which I term the “moral disaster” view. According to this view, deliberate killing of civilians is almost absolutely wrong. (shrink)

The available choices of political responses to disruption in the global climatic system depend in part on how the problem is conceptualized. Researchers and policymakers often invoke a “climate crisis” or “climate emergency,” but such language fits poorly with current knowledge of the problem's physical causes and social impacts. This article argues that climate change is instead more like a political epic. It involves neither sudden onset, as in the concept of emergency, nor decisive resolution, as in the (...) concept of crisis, but rather a protracted ordeal of (temporally) obscure origins and uncertain outcomes. This alternative ontology of climate change highlights its novel temporal properties, including unusually slow-moving or time-lagged causal dynamics, with unsettling implications for academic research on the climatic-institutional nexus. Normatively, it undermines arguments for democracies’ environmental superiority over autocracies that rely on the former's general superiority at resolving crises and responding to emergencies. At the same time, some new arguments for democratic distributions of power become possible within the epic frame. More broadly, embracing the assumption of epic climate change may redirect attention from Promethean, managerial, or technocratic solutions to questions about which values or identities deserve preservation amid presumptively interminable and imperfectly remediable sources of disorder. (shrink)

States of emergency are declared frequently in all parts of the world. Their declaration routinely implies a suspension of basic constitutional rights. In the last half century, it has become the norm for constitutions to contain an explicit ‘emergency constitution’, i.e., the constitutionally safeguarded rules of operation for a state of emergency. In this paper, I ask whether inclusion of an emergency constitution can be legitimized by drawing on social contract theory. I argue that there are (...) important arguments, both against and in favor of constitutionalized emergency provisions, and that social contract theory—as applied by economists—can be of some help when deciding whether to have, or not to have an emergency constitution. This paper introduces a novel argument for justifying emergency constitutions. It argues that they can serve as a commitment mechanism protecting both citizens and politicians from overreacting to rare but significant threats. (shrink)

Background: Whenever there has been a worldwide contagious disease outbreak, there have been reports of infection and death of healthcare workers. Particularly because emergency nurses have contact with patients on the front line, they experience ethical problems in nursing while struggling with infectious diseases in an unfavorable environment. Objective: The objective of this study was to explore emergency nurses’ ethical problems and to identify factors influencing these problems during the outbreak of Middle East respiratory syndrome–coronavirus in Korea. Design (...) and sample: For this cross-sectional study, a questionnaire survey was conducted with emergency nurses working in six hospitals selected through convenience sampling from the hospitals designated for Middle East respiratory syndrome–coronavirus patients in the capital area. Methods: Data were collected from 169 emergency nurses in Korea during August 2015. Ethical considerations: This research was approved by the Institutional Review Board of G University in Korea. Results: The findings of this study suggest that during the Middle East respiratory syndrome–coronavirus outbreak, emergency nurses experienced ethical problems tied to a mind-set of avoiding patients. Three factors were found to influence emergency nurses’ ethical problems (in order of influence): cognition of social stigmatization, level of agreement with infection control measures, and perceived risk. Conclusion: Through this study, we obtained information on emergency nurses’ ethical problems during the Middle East respiratory syndrome–coronavirus outbreak and identified the factors that influence them. As found in this study, nurses’ ethical problems were influenced most by cognitions of social stigmatization. Accordingly, to support nurses confidently care for people during future health disasters, it is most urgent to promote appropriate public consciousness that encourages healthcare workers. (shrink)

BackgroundEach individual’s unique health-related beliefs can greatly impact the patient-clinician relationship. When there is a conflict between the patient’s preferences and recommended medical care, it can create a serious ethical dilemma, especially in an emergency setting, and dramatically alter this important relationship.Case presentationA 56-year-old man, who remained comatose after out-of-hospital cardiac arrest, was rushed to our hospital. The patient was scheduled for emergency coronary angiography when his adolescent daughter reported that she and her father held sincere beliefs against (...) radiation exposure. We were concerned that she did not fully understand the potential consequences if her father did not receive the recommended treatment. A physician provided her with in depth information regarding the risks and benefits of the treatment. While we did not want to disregard her statement, we opted to save the patient’s life due to concerns about the validity of her report.ConclusionsVariations in beliefs regarding medical care force clinicians to incorporate patient beliefs into medical practice. However, an emergency may require a completely different approach. When faced with a patient in a life-threatening condition and unconscious, we should take action to prioritize saving their life, unless we are highly certain about the validity of their advance directives. (shrink)

The paper proceeds in three steps. First, it addresses what urgency and emergency are in their simplest terms; then, it places this in the context of the now very popular metaphor of imprisonment, which supposedly describes what is happening to us today; and in the final steps, it presents the task of critical theory today. Starting from the distinction between urgency and emergency (the main difference being that in the latter case there is an immediate threat or danger (...) to life, health, property, or the environment, while in the case of urgency there is no such immediate threat or danger), the paper proposes the concept of Super-emergency as a name for a (contemporary) situation that is out of control and feeds on our own antagonisms and contradictions. The accompanying atmosphere or mood is the “mood of nightmare”, which also explains why it seems so natural for us today to speak of arrest, imprisonment, or entrapment. By pointing out some consequences of prison metaphors, we suggest in the last part of the paper that it is not only urgent to think about and deal with urgency and emergency per se, but also with their particular deviation – the Super-emergency. Even if we do not have time to think and act differently, as our leaders, the media, and propaganda keep claiming (“now we do not have time to listen, to discuss, to exchange opinions, to talk”), it is precisely urgent situations that provide time for reflection and radical action to reclaim our common future. In other words, what is really urgent and necessary for us now, today, is to free ourselves from this yoke of emergency in which we are trapped and which we call here the Super-emergency. (shrink)

Research is an integral part of evidence-based practice in the emergency department and critical care unit that improves patient management. It is important to understand the need and major obstacles for conducting research in emergency settings. Herein, we review the literature for the obligations, ethics and major implications of emergency research and the associated limiting factors influencing research activities in critical care and emergency settings. We reviewed research engines such as PubMed, MEDLINE, and EMBASE for the (...) last two decades using the key words “emergency department”, “critical care”, “research”, “consent”, and “ethics” as the search terms. Research within emergency settings is slow or non-existent due to time and financial constraints as well as the lack of a research tradition. There are several barriers to conducting research studies in emergency situations such as who, what, when, and how to obtain patient consent. The emergency environment is highly pressurized, emotional, and overburdened. The time taken for research is a particular risk that could delay the desired immediate interventions. Ethical issues abound, particularly relating to informed consent. Research in emergency settings is still in its infancy. Thus, there is a strong need for extensive research in the emergency setting through community awareness, resource management, ethics, collaborations, capacity building, and the development of a research interest for the improvement of patient care and outcomes. We need to establish a well-structured plan to assess and track the decision-making capacity, consider a multistep enrolment and consent strategy, and develop an integrated approach for recruitment into studies. (shrink)

This paper attempts to provide a broader view into the ethical issues surrounding the field of emergency medicine (EM) research. It starts from defining bioethically relevant features of EM and presents this field in the context of different models of health care provider–patient relationship. The paper also provides a short overview of the “post-Nuremberg” evolution of the main international research ethics guidelines relevant to EM research which demonstrates a tendency of liberalization of research on incapable persons. This tendency culminates (...) with the exceptions to informed consent for EM research which is supposed to be balanced by other research ethics principles, especially a careful rationing of risks and benefits. This finally brings us towards a critical analysis of the minimal risk standard which is one of the main fundamental safeguards in EM research. (shrink)

Background Professional ethics in nursing exist to guide care and allow for decision-making to be patient-centered. In the current medicolegal landscape post-Roe and in light of bans on gender-affirming care, the decision-making processes of emergency nurses in the clinical environment of care as informed by both professional and personal ethics are an important area of inquiry. Aim The aim of this study was to examine the contribution of moral courage to decision-making by emergency nurses. Research Design A mixed-methods (...) exploratory sequential approach was used, using a standard demographics form and the Nurses Moral Courage Scale to collect quantitative data. These data were used to inform an interview guide for qualitative data collection. Situational analysis was used to analyze the interview data. Ethical Considerations Prior to recruitment, this study was reviewed and approved by the University of Massachusetts IRB (#00003909). Participants were provided with an informed consent document at the time of registration and at the time of interview; participants provided both signed consent and verbal assent. Participants were assigned study codes to maintain anonymity and data were maintained in a secure University cloud. Participants and Research Context US-based emergency nurses working in environments with care limitations. Results 70% of respondents reported that they would speak up if they were aware of a situation that was ethically challenging. Respondents reported that it was fairly easy or very easy to defend their values when addressing ancillary staff, coworkers, authorities outside the organization, patients, and patient families. Respondents reported challenges in defending their professional values to charge nurses, physicians, or administrators. In response to a serious ethical problem, 65.8% of respondents answered that they would bring up the problem for discussion, 21.1% would file an internal report, and 13.2% would report externally. Interview participants reported significant social and professional barriers to acting in response to an ethical violation. Willingness to act centered on personal values and not professional codes of ethics. Conclusions While emergency nurses in this study reported high perceived levels of moral courage, they also reported low willingness to act directly, citing burnout and significant social and professional barriers. Adherence to professional codes of ethics is not the primary driver of moral courage. (shrink)

This article addresses the rise of faith-based emergency relief by examining the US President’s Emergency Plan for HIV/AIDS (PEPFAR), a public health intervention focused on the AIDS epidemic in sub-Saharan Africa. It argues that the theological turn in humanitarian aid serves to amplify ongoing dynamics in the domestic politics of sub-Saharan African states, where social services have assumed the form of chronic emergency relief and religious organizations have come to play an increasingly prominent role in the provision (...) of such services. In the context of an ongoing public health crisis, PEPFAR has institutionalized the social authority of the Pentecostal and charismatic churches, leading to a semantic confluence between the postcolonial politics of emergency and the Pentecostal/Pauline theology of kairos or event. Far from being confined to the space of foreign aid, however, the faith-based turn in humanitarianism is in keeping with ongoing reforms in domestic social policy in the United States. While on the one hand the sustained welfare programmes of the New Deal and Great Society have been dismantled in favour of a system of emergency relief, on the other hand the federal government has intensified its moral, pedagogical and punitive interventions into the lives of the poor. The wilful transfer of welfare services to overtly religious service providers has played a decisive role in this process. The article concludes with a critical appraisal of the links between African and North American Pentecostal-evangelical churches and questions the revolutionary mission ascribed to Pauline political theology in recent political theory. (shrink)