Hostname: page-component-586b7cd67f-vdxz6 Total loading time: 0 Render date: 2024-11-26T02:44:03.910Z Has data issue: false hasContentIssue false

Should I Stay or Should I Go? A Bioethical Analysis of Healthcare Professionals' and Healthcare Institutions' Moral Obligations During Active Shooter Incidents in Hospitals — A Narrative Review of the Literature

Published online by Cambridge University Press:  01 January 2021

Abstract

Active shooter incidents (ASI) have unfortunately become a common occurrence the world over. There is no country, city, or venue that is safe from these tragedies, and healthcare institutions are no exception. Healthcare facilities have been the targets of active shooters over the last several decades, with increasing incidents occurring over the last decade. People who work in healthcare have a professional and moral obligation to help patients. As concerns about the possibility of such incidents increase, how should healthcare institutions and healthcare professionals understand their responsibilities in preparation for and during ASI?

Type
Independent Articles
Copyright
Copyright © American Society of Law, Medicine & Ethics 2020

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Federal Bureau of Investigation, “Active Shooter Resources,” available at <https://www.fbi.gov/about/partnerships/office-of-partner-engagement/active-shooter-resources> (last visited May 6, 2020).+(last+visited+May+6,+2020).>Google Scholar
“Soft Target,” OED Online, available at <https://en.oxforddictionaries.com/definition/soft_target> (last visited May 6, 2020).+(last+visited+May+6,+2020).>Google Scholar
Coss, D.J. and Rennie, K.D., Valuation of Hospital Employee Perception of Interventions and Programs used to Deter Active Shooter Events (New Jersey City University, ProQuest Dissertations Publishing, 2016), 10259625; “Experts Advise Hospitals to Heed Warning Signs, Leverage Security to Prepare Against Shootings,” ED Management:T he Monthly Update on Emergency Department Management 26, no. 9 (2014): 97-101; Kelen, G.D., Catlett, C.L., Kubit, J. G., and Hsieh, Y. H., “Hospital-Based Shootings in the United States: 2000 to 2011,” Annals of Emergency Medicine 60, no. 6 (2012): 790-798. e791.Google Scholar
Kelen et al., id.Google Scholar
Foley, C. and Phillips, F., “Combating Healthcare Workplace Violence: A Dose of Prevention is Good Medicine,” ABA Health eSource, February 22, 2019.Google Scholar
Silver, J., Simons, A., and Craun, S., “Pre-Attack Behaviors of Active Shooters,” available at <https://www.fbi.gov/file-repository/pre-attack-behaviors-of-active-shooters-inus-2000-2013.pdf/view> (last visited May 6, 2020).+(last+visited+May+6,+2020).>Google Scholar
Federal Bureau of Investigation, supra note 1; Maryniak, K., “Active Shooter: Know the Facts: AMN Healthcare Education Services,” RN.com, available at <https://www.rn.com/nursing-news-active-shooter-know-the-facts/> (last visited May 6, 2020).+(last+visited+May+6,+2020).>Google Scholar
Beauchamp, T.L. and Childress, J.F., Principles of Biomedical Ethics (USA: Oxford University Press, 2001).Google Scholar
Jacobs, L.M. and Burns, K. J., “The Hartford Consensus: Survey of the Public and Healthcare Professionals on Active Shooter Events in Hospitals,” Journal of the American College of Surgeons 225, no. 3 (2017): 435442; Emergency Medical Treatment & Labor Act (EMTALA), available at <https://www.cms.gov/Regulations-and-Guidance/Legislation/EMTALA/> (last visited May 6, 2020); Maryniak, supra note 9.CrossRefGoogle Scholar
EMTALA, supra note 11; American Academy of Emergency Medicine, Code of Ethics, available at <https://www.aaem.org/about-us/our-values/code-of-ethics> (last visited May 6, 2020); American College of Emergency Physicians, Code of Ethics for Emergency Physicians, available at <https://www.acep.org/globalassets/new-pdfs/policy-statements/code-of-ethics-for-emergency-physicians.pdf> (last visited May 6, 2020).+(last+visited+May+6,+2020);+American+College+of+Emergency+Physicians,+Code+of+Ethics+for+Emergency+Physicians,+available+at++(last+visited+May+6,+2020).>Google Scholar
Jacobs, supra note 11.Google Scholar
Eckenwiler, L.A., “Ethical Issues in Emergency Preparedness and Response for Health Professionals,” Virtual Mentor 6, no. 5 (2004): 235-241.Google Scholar
Coss, supra note 3; Jacobs, supra note 11; Inaba, K., Eastman, A. L., Jacobs, L. M., and Mattox, K. L., “Active-Shooter Response at a Health Care Facility,” The New England Journal of Medicine 379, no. 6 (2018): 583-586.CrossRefGoogle Scholar
U.S. Department of Health and Human Services, U.S. Department of Homeland Security, U.S. Department of Justice, Federal Bureau of Investigation, Federal Emergency Management Agency Incorporating Active Shooter Incident Planning into Health Care Facility Emergency Operations Plans (2014), available at <https://www.phe.gov/Preparedness/planning/Documents/active-shooter-planning-eop2014.pdf> (last visited May 6, 2020).+(last+visited+May+6,+2020).>Google Scholar
The Joint Commission Division of Health Care Improvement, “Preparing for active shooter situations,” Quick Safety 4 (July 2014).Google Scholar
Maryniak, supra note 9.Google Scholar
Maryniak, supra note 9.Google Scholar
American Medical Association, AMA Code of Medical Ethics, available at <https://www.ama-assn.org/delivering-care/ama-code-medical-ethics> (last visited May 7, 2020); American Medical Association, Declaration of Professional Responsibility: Medicine's Social Contract with Humanity (September 2001).+(last+visited+May+7,+2020);+American+Medical+Association,+Declaration+of+Professional+Responsibility:+Medicine's+Social+Contract+with+Humanity+(September+2001).>Google Scholar
Eckenwiler, supra note 14.Google Scholar
Id.; American Medical Association, supra note 20.Google Scholar
American Academy of Emergency Medicine, supra note 12.Google Scholar
American College of Emergency Physicians, supra note 12.Google Scholar
American College of Surgeons, Statements on Principles, available at <https://www.facs.org/about-acs/statements/stonprin> (last visited May 7, 2020).+(last+visited+May+7,+2020).>Google Scholar
Supra note 16.Google Scholar
Rallo Daniels, C. A., Legal Issues and Operational Risk Management for Workplace Violence and Active Shooter Situations, Everbridge, available at <http://go.everbridge.com/rs/004-QSK-624/images/LegalIssuesandOperationalRiskManagementforWorkplaceViolenceandActiveShooterSituations.pdf> (last visited May 7, 2020).+(last+visited+May+7,+2020).>Google Scholar
Eckenwiler, supra note 14; National Association of Emergency Medical Services Physicians, “Ethics Committee. Ethical Challenges in Emergency Medical Services,” Prehospital Disaster Medicine 8, no. 2 (1993): 179-182.CrossRefGoogle Scholar
Baker, R., The American Medical Ethics Revolution: How the AMA's Code of Ethics Has Transformed Physicians' Relationships to Patients, Professionals and Society (Baltimore, MD: Johns Hopkins University Press; 1999): 1.Google Scholar
Palmer, J., “Protecting your Patients: Violence and Active Shooters,” available at <https://www.psqh.com/analysis/protecting-patients-violence-active-shooters/> (last visited May 7, 2020).+(last+visited+May+7,+2020).>Google Scholar
Isserson, K. V. et al., “Fight or Flight: The Ethics of Emergency Physician Disaster Response,” Annals of Emergency Medicine 51, no. 4 (2008): 345-353.Google Scholar
Beauchamp and Childress, supra note 10.Google Scholar
Isserson, supra note 31.Google Scholar
American Academy of Emergency Medicine, supra note 12; American College of Emergency Physicians, supra note 12; American Medical Association, supra note 20; American College of Surgeons, supra note 25.Google Scholar
Pellegrino, E.D., “Altruism, Self-interest, and Medical Ethics,” JAMA 258, no. 14 (1987): 19391940.CrossRefGoogle Scholar
US Legal, Oaths Law and Legal Definition, available at <https://definitions.uslegal.com/o/oaths/> (last visited May 7, 2020).+(last+visited+May+7,+2020).>Google Scholar
K. Inaba, supra note 15.Google Scholar
McKenzie, N. et al., “Active Shooter: What Would Health Care Students Do While Caring for Their Patients? Run? Hide? Or Fight?” Disaster Medicine Public Health Preparedness (2019): 1-5.Google Scholar
Braun, T., Violence Prevention Agency (VPA), Active Shooter Prevention and Response: A Community Preparedness Approach, 2016 Preparedness Summit, Dallas Hilton Anatole, April 19-22, 2016; ED management, supra note 3; Palmer, supra note 30; “Anti-Violence Program Cuts Incidents Sharply at VA Med Center,” Hospital Security and Safety Management 17, no. 8 (1996): 1-3; Special report, “After Shooting Incidents: Hospitals Take Different Security Measures to Deal with ED Violence.” Hospital Security and Safety Management 14, no. 11 (1994): 5-10; Special report, “The Los Angeles ER shootings, Part I: What Happened–Before, During, After,” Hospital Security and Safety Management 14, no. 1 (1993): 5-9; Special report, “The Los Angeles ER shootings, Part II: What hospitals in other parts of the country are doing,” Hospital Security and Safety Management 14, no. 2 (1993): 5-8; Special report, “Violence in Hospitals: New Facts and Approaches to a Growing Threat,” Hospital Security and Safety Management 15, no. 10 (1995): 5-9; Special report, “Violence in Hospitals: What are the Causes? Why is it Increasing? How is it Being Confronted?” Hospital Security and Safety Management 13, no. 9 (1993): 5-10; “ED physicians take action to promote firearm safety, curtail gun violence,” ED Management: The Monthly Update on Emergency Department Management 10, no. 5 (1998): 57-60.Google Scholar
Eckenwiler, supra note 14.Google Scholar
Pellegrino, supra note 35.Google Scholar
Yakubu, A. et al., “The Ebola outbreak in Western Africa: Ethical Obligations for Care,” Journal of Medical Ethics 42, no. 4 (2016): 209210.CrossRefGoogle Scholar
Pellegrino, supra note 35.Google Scholar
B. Baker, Email discussion about the comparative moral obligations of healthcare professionals during a disaster and an active shooter incident, July 2019.Google Scholar
Davies, C.E. and Shaul, R.Z., “Physicians' Legal Duty of Care and Legal Right to Refuse to Work During a Pandemic,” Canadian Medical Association Journal 182, no. 2 (2009): 167-170; US Department of Health & Human Services, Public Readiness and Emergency Preparedness Act (2005), available at <https://www.phe.gov/Preparedness/legal/prepact/Pages/default.aspx> (last visited May 7, 2020).Google Scholar
Rosenbaum, J.D., Harty, M.B., and Sheer, J., “Law and the Public's Health,” Public Health Reports 123, no. 2 (2009): 238-241.Google Scholar
Bensimon, C.M. et al., “The Duty to Care in an Influenza Pandemic: A Qualitative Study of Canadian Public Perspectives,” Social Science & Medicine 75, no. 12 (2012): 2425-2430; American Bar Association (2011), Report on the duty of care to the house of delegates (2011), available at <https://www.americanbar.org/content/dam/aba/directories/policy/2011_am_125.pdf> (last visited April 4, 2019).CrossRefGoogle Scholar
Davies et al., supra note 46.Google Scholar
Occupational Safety and Health Administration (OSHA), United States Department of Labor, Workplace Violence, available at <https://www.osha.gov/SLTC/workplaceviolence/standards.html> (last visited May 7, 2020).+(last+visited+May+7,+2020).>Google Scholar
Occupational Safety and Health Administration (OSHA), United States Department of Labor, Workers' Right to Refuse Dangerous Work, available at <https://www.osha.gov/right-to-refuse.html> (last visited May 7, 2020); Simonds, A.K. and Sokol, D.K., “Lives on the Line? Ethics and Practicalities of Duty of Care in Pandemics and Disasters,” The European Respiratory Journal 34 (2009): 303-309.Google Scholar
Occupational Safety and Health Act of 1970, Section 12(b)(2), 38 FR 4577 (1977).Google Scholar
Isserson, supra note 29.Google Scholar
Bruce Goldfeder is a Florida based Emergency Room physician who while working, distracted and disarmed an armed intruder. “Goldfeder, who was shot in the back of his neck confronting and disarming the shooter, described those moments to The Palm Beach Post on Thursday night from his home, where he was recovering from his wound; ‘I heard gunshots go off, and they seemed to become louder and closer to me,’ Gold-feder recalled. ‘So I turned around from my hidden position, and I saw a man with a gun in his hand. He looked at me and he was close-range to the other doctors.’” “VA Center shooting: ‘I've been shot’; Doctor describes confrontation with gunman,” J. Whigham, II, The Palm Beach Post, March 1, 2019, available at <https://www.palmbeachpost.com/news/20190301/va-center-shooting-ive-been-shot-doctor-describes-confrontation-with-gunman> (last visited May 7, 2020). (last visited May 7, 2020).' href=https://scholar.google.com/scholar?q=Bruce+Goldfeder+is+a+Florida+based+Emergency+Room+physician+who+while+working,+distracted+and+disarmed+an+armed+intruder.+“Goldfeder,+who+was+shot+in+the+back+of+his+neck+confronting+and+disarming+the+shooter,+described+those+moments+to+The+Palm+Beach+Post+on+Thursday+night+from+his+home,+where+he+was+recovering+from+his+wound;+‘I+heard+gunshots+go+off,+and+they+seemed+to+become+louder+and+closer+to+me,’+Gold-feder+recalled.+‘So+I+turned+around+from+my+hidden+position,+and+I+saw+a+man+with+a+gun+in+his+hand.+He+looked+at+me+and+he+was+close-range+to+the+other+doctors.’”+“VA+Center+shooting:+‘I've+been+shot’;+Doctor+describes+confrontation+with+gunman,”+J.+Whigham,+II,+The+Palm+Beach+Post,+March+1,+2019,+available+at++(last+visited+May+7,+2020).>Google Scholar
Stanford Hospital & Clinics Risk Consulting, The Active Shooter: The New Threat in Healthcare?, available at <https://www.urmc.rochester.edu/MediaLibraries/URMCMedia/flrtc/documents/SRC_Active_Shooter_White_Paper_Apr_2011.pdf> (last visited May 7, 2020). Table 2: Specific Recommendations of Included Studies excluding Agency Recommendations.+(last+visited+May+7,+2020).+Table+2:+Specific+Recommendations+of+Included+Studies+excluding+Agency+Recommendations.>Google Scholar