Question A: With respect to history and political issues, Haiti had special problems that could have made coordinating and managing decisions about treatment very difficult. What special political situation(s) may have influenced how they riage patients?
Haiti has had a long history of corrupt governments, violence and dysfunctional political system (Hoppes). By continuing to abuse country's resources, few as are, Haiti's successive presidents and governments have made catering for healthcare needs of Haiti's broad, poor population not only unsustainable but also increasingly difficult, particularly during crises and emergencies. Thus, when Haiti's earthquake hit on January 12, 2010, Haiti was unable to respond to a big-scale natural disaster further complicated by an ensuing cholera epidemic (Hoppes). True, Haiti has had few, international healthcare assistance initiatives such as Partners in Health (PIH) and Project Medishare (Hoppes). However, disaster's scale required much more assistance, largely an outside one.
Question B: Since many of Haiti's residents are extremely poor, what ethical issues would need to be considered when patients are helped?
Given Haiti's extreme poverty – 75% of country's population lives in extreme poverty, i.e. on less than $1 a day (Hoppes) – and political corruption, first responders could – if not actually did – adopt a paternalistic approach to providing assistance. That is, given scale of disaster and lack of resources, first responders had nothing but to respond on own initiative by providing assistance to whom each responder believed should receive immediate rescue and help. Moreover, in opting for providing assistance, first responders could adopt a more utilitarian approach, weighing options for greater benefits for more persons. As well, since first responders did not have adequate resources at hand, choosing to help persons or group of persons who were, more or less, affiliated to a responder, could be an ethical issue at stake. Specifically, in weighing options for assistance, responders could have a situation when an "affiliated" (e.g. a relative, friend, co-worker or an acquaintance) person is at risk in a far area and another, unaffiliated person in a close by area. This situation could, if anything, pose a great ethical dilemma for responders as "greater benefit" principle in catering help comes under considerable ethical examination.
Question C: Since Haiti's life expectancy is lower that it is in other countries, what ethical issues would need to be considered when patients are helped?
Life expectancy in Haiti is comparatively low at 60 years (Hoppes). This low life expectancy represents a significant factor in providing assistance, particularly during emergencies. Based on a needs-based approach, younger persons need more assistance compared to older ones (Hoppes). Thus, in weighing options of providing emergency assistance, assistance providers are more likely to prioritize assistance provision based on age. Moreover, in weighing options between an HIV-infected person and a non-infected person, assistance providers are more likely to help non-infected persons based on a utilitarian approach as non-infected persons are more likely to be of greater benefit (and less burden) for community compared to infected persons.
Based on World Medical Association's utilitarian principle (Hoppes), a principle paper's author endorses as most effective, given groups in need of assistance can be prioritized in order as follows: (1) Rich Kids, (2) 65 Workers, (3) Tent City Leaders and Families, and (4) Prison Inmates, and (5) 34 Injured.
The Rich Kids assume highest priority, notwithstanding an apparent negative connotation of "rich". If anything, kids, rich or poor, remain kids: helpless and are unable to seek help independently. If left unassisted, all kids could die of suffocation. Moreover, based on adopted approach, i.e. utilitarian approach, kids are young persons who, albeit of no benefit history for broader community, but by whose loss could cause greater harm to own families compared to other groups. Unsurprisingly, kids, of all war casualties, are most lamented. The loss of a kid is not only symbolic of a community's future but, probably more significantly, an indication of a community's ability to protect community's weakest and most helpless. (In an insightful, recent example, one would ask: why did U.S. President Barak Obama cry during a speech on gun control after a series of mass shootings in which kids were shot down?)
The 65 Workers assume second place (only next to kids) because of a greater benefit offered to community namely, being an only communication channel between makeshift hospital and outlying areas. By saving 65 workers, more lives are saved for broader good.
The Tent City Leaders and Families have a history of greater benefit for community by being first responders and, not least, by being able to mobilize and organize people. This ability combined by a lack of any emergency in addition to a spreading cholera makes saving Tent City Leaders and Families less urgent compared to more at-risk or of greater benefits groups in (1) and (2) respectively. True, Tent City Leaders and Families contributed immensely to community as first responders. However, priorities do shift. In weighing 65 Workers against Tent City Leaders and Families, 65 Workers now assume higher priority.
The Prison Inmates come in a delayed priority order not because of being inmates per se but because helping others after being assisted is not guaranteed. Indeed, compared to 65 Workers, for example, Prison Inmates should assume a lower priority since 65 Workers have already contributed to community in past incidences and possibilities of more contributions is more guaranteed.
The 34 Injured group is already on makeshift hospital grounds. They are, compared to other groups, are at immediate and close watch of assistance providers. Moreover, having been hit in an after-shock, one would assume injuries for 34 Injured group are much milder compared to persons in different groups hit immediately during earthquake's outbreak.
Hoppes, Emily. "In the Wake of Tragedy: Medical Ethics and the Haiti Earthquake." Center for Bioethics, Health & Society. Wake Forest University, 2011. PDF file.