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Book review of "The Ethics of Coercion in Mass Casualty Medicine" by Griffin Trotter MD, PhD

DOI: 10.1186/1747-5341-2-20

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Abstract:

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.The seven chapters logically explain the dynamics of coercion, the ethical basis of public health, public health legitimacy, the role of public health "experts", public deliberation prior to these events, the role of leadership, and decisions for particular coercive actions. The central argument is the optimal balance between security and liberty. The author argues that in Mass Casualty Medicine, the Clinical paradigm is replaced by the Rescue Paradigm in which it is necessary to save lives and minimize aggregate morbidity. Clinicians in the trenches might find exception to the argument, as it may be impossible to easily switch from one paradigm to another.Similar ethical and philosophical arguments throughout the book attempt to justify that public deliberation prior to mass casualty events, the use of the modus Vivendi approach (rather than rational consensus approach) which favors compromise rather than consensus, and decision-making at the local level are necessary in times of public health disasters. These arguments are somewhat logical and often supported by recent examples (eg decision-making during the events of September 11 to highlight tactical leadershi

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