I teach a seminar on ethics in health care in the newly-launched Doctor of Nursing Practice (DNP) program at Yale. My students include advanced practice registered nurses (nurse practitioners), senior administrators, and health policymakers. Because the typical DNP student is a working professional, the program combines traditional,face-to-face teaching with online discussion and other distance-learning methods. Friday, November 2, was our first seminar at Yale in several weeks.
As I drove to New Haven from my apartment in a high-and-dry section of Manhattan far from the “power-less” areas hit by the Hurricane Sandy storm surge on Monday, October 29, I encountered pre-dawn
traffic jams that turned out to be gas lines stretching down the highway. I wondered how many of my 14 students would make it to class. The email traffic suggested that nearly all were affected by the storm, either because they live and work in the affected states or because their travel arrangements had fallen apart.
Everyone made it. Three were patched in remotely (any port in a storm). The lesson plan had called for us to begin work on justice theory and its application to health and health care, via Amartya Sen’s The Idea of Justice. Instead, we talked about the storm, and about doing ethics in the midst of disasters that do not work quite like tabletop exercises.
One student, who came to class on no sleep after three straight nights at work, described her institution receiving intensive-care patients evacuated from a hospital whose back-up generators had failed, and then scrambling to find places for the evacuated staff to eat and sleep. Another student, part of the essential staff keeping a hospital’s emergency services functioning on back-up power, described the daily huddles with colleagues to figure out how best to allocate their limited resources, including the power needed to complete procedures safely.
Several students raised intriguing questions about the resilience of health care professionals. Is it easier to respond to a disaster if you don’t feel your personal safety to be at risk? (Yes.) Can growing up in a place with extreme weather conditions – typhoons, blizzards, floods – make you more resilient? (Yes.) Can it also make you less likely to comply with evacuation orders? (It depends – where did you grow up, and what was the local, national, or historical story about how to respond to orders?) What is owed to those who elected not to show up for disaster duty, as well as to those who did? (It depends, but you can be sure that are-we-getting-paid-for-this? questions are on everyone’s minds.)
I asked the student who had phoned in from a borrowed office in the hospital on back-up power, so, has anything in this course been . . . helpful to you in the thick of it? (I braced myself for “Not really.”) Yes, he said. I’ve found that relying on one theory or principle – for example, giving priority, on grounds of utility, to procedures that allow us to treat a larger number of patients– may not work in practice. Every decision about serving patients also has to factor in how much of our generator power an option would use or conserve. And, he added, I’ve learned to come to meetings with more questions than answers.
Nancy Berlinger is a research scholar at The Hastings Center. Leonid Gorelik, RN, MSN, and Bonnie Tong, NP, of the Yale University School of Nursing, contributed to this commentary.