1. Through her experiences during Katrina Dr. Evans learned the importance of having a committee make the difficult decisions necessary and not just one doctor. While the doctor could advocate for the patient the committee of ethics and other professionals could take a broader view of the situation with the idea being that, together, they could come up with the best plan. Ultimately decisions had to be made as to what patients would be given access to the six power outlets and decision-by-committee seemed to be the best approach, even though some would disagree with the committee’s conclusions.

2. Given her extensive knowledge of what had taken place at Memorial I am sure Shari Fink was appalled by how little the authorities in NY had learned from Katrina. While the hospitals were smart enough to evacuate patients earlier in the aftermath of Katrina, Ms. Fink points out that many of the personnel seemed unprepared for the possibility that all power could be lost. That lack of preparedness leads me to the conclusion that the AMA really hasn’t done enough to implement the lessons they learned as a result of the disaster at Memorial. The possibility of being left with only six power outlets in this day and age seems incomprehensible and better disaster planning seems to be necessary.

3. I think Maryland takes a very interesting approach to the ethical dilemmas involved with disaster relief care. Unlike the majority of places where these decisions are left only to doctors and other health care professionals, Maryland has decided to base their disaster-relief policies based up the attitudes and perspective of the community as a whole. By eliciting opinions from all segments of societies they seek to formulate the most well-rounded approach to these difficult decisions and I think that idea has merit. While it may be difficult to generate those conversations in a cohesive and helpful way I think the notion of having open, community-wide discussion on the issue should be applauded. Shari Fink tells us that triage choices are more about values than they are about science and she is right because the science involved is pretty much universally accepted. The doctors at all of the hospitals are using the same methods and machinery, but during disasters like Katrina a person’s ethical compass will control the decisions they make.

4. I am not so sure the story has had am impact on my feelings about the AMA. I have always had the impression that large government agencies are too bureaucratic to ever be really effective and if anything this book has underscored that view. I also think this book demonstrates that the justice system ultimately did work. The disaster at Memorial created unprecedented times and, while I disagree with the fact that Dr. Pou was charged in this case, the fact that she ultimately prevailed shows that justice was done in the end.

5. I think I do agree with Roger Bernier when he questions whether or not we believe in democracy here in America. Obviously this country was founded on democratic principles but in reality the real decision making is left to a very small percentage of our population. Such a small percentage of Americans even take advantage of the right to vote and many who blidnly do do over party lines. I think the political divide that is present in the country today demonstrates that democracy is or more of a romantic notion than a reality.

6. I don’t know if anyone can ever be fully prepared to respond to a crisis like this but clearly advanced planning and preparation are the keys. Like anything in history, this book has provided a learning tool. Unfortunately, however, it best illustrates what not to do under such circumstances. Learning from the mistakes of others and ensuring that history will not repeat itself is really the best we can do in the aftermath of a disaster like this. We know that two situations are never alike but what happened at Memorial taught us that there are things we can do to help better navigate these situations. Written response guidelines, early evacuations, clear chains of command and adequate infrastructure are all critical parts of the planning process but Shari Fink is right when she says the quality of the response will ultimately depend on the performance and decision making of the individuals on the scene.