[Ethical considerations of psychiatric treatment in chronic post traumatic stress following multiple casualty...

Israeli society has been repeatedly exposed to traumatic stress following terrorist attacks with multiple casualties. Individuals who are subjected to these incidents experience various mental reactions, including traumatism, fear, loss and bereavement. Unfortunately, evidence based medical knowledge is lacking regarding natural methods for dealing with incidents that may precipitate traumatic stress, ways of identifying people who are more likely to develop post traumatic symptoms, or suggestions on early interventions that may avert the onset of these symptoms. Ethical problems may arise, especially in situations involving mass traumatic stress, when there are insufficient therapeutic resources. In such cases, the issues of whether to intervene, who to treat, and how, will often be influenced by conflicting personal and social interests. Another concern involves the principle of autonomy - the individual's right to decide whether he/she wants treatment. Should "latent" victims be identified in the community and referred to therapy? Diverse ethical issues emerge in situations of traumatic stress, and may potentially evoke dilemmas among health policy makers and among the therapists who work in the field. This type of discussion may enhance the understanding, help formulate key principles and assist in making reasonable and appropriate decisions when dealing with such difficult and complex situations.