Disaster in the Gulf: Public Health and Public Responsibility

By the time that this column is read in the pages of The American Journal of Bioethics, one can only hope that the Deepwater Horizon oil spill in the Gulf of Mexico will be out of the headlines, an environmental disaster well under control, and that my comments will be ones of hindsight. My best hope, I suppose, is to have 20/20 vision of a future I cannot see. But that, in essence, is the nature of disaster bioethics. As I write in late May 2010, it is hard to know whether major environmental and health catastrophes can be avoided and whether the tools potentially available to clean up what will likely turn out to be the worst oil spill in history will even be put to use, and if so, effectively. Unlike many previous catastrophes in which The American Journal of Bioethics has discussed disaster ethics, such as Hurricane Katrina, the explosive spills of Deepwater Horizon are neither a natural disaster nor malicious attack by a foreign enemy (unless you believe conspiracy theorists about cutting corners with subcontractors and British Petroleum's profit margins). No, this calamity was the result, it appears, of the hazards known to oil exploration: an unanticipated pressure surge on a nearly completed deep-sea oil well caused an explosion. It is, by all conventional description, an accident, followed by environmental disaster of inestimable proportions.

So how to approach this “accident” from a moral point of view. One might approach it the way one assesses a horrific case in the intensive care unit: survey the damage first. The southern United States’ wetlands and the Gulf of Mexico are both almost certain to be harmed at least as much by remediation efforts as by oil, and what is invisible damage in May of 2010 will be visible decimation of species unless a miracle occurs prior to press time. In a clinical ethics case though we recognize that a terrible clinical situation's being “accidental” does little to diminish the devastation for the people involved. Here, fishermen who rely upon the Gulf for their livelihoods, and the thousands of small business owners who depend upon the coast for their own, will simply go bankrupt. CPR doesn't work in hospitals, with very very few exceptions. It doesn't even exist in wetlands. DNR orders were not in place for the wetlands, but British Petroleum is honoring them anyway, subject to what seems to be our collective futility policy. So as in most clinical ethics dilemmas, at least one party if not all turn their heads eventually looking for someone or some group to hold responsible. In public health, there are no ethics consultants, for better or worse, but public health in disaster situations is as close as we get. And responsibility is not irrelevant nor is it a strictly legal matter. How this happened must be known as surely as one must know the chart and identify the primary diagnosis and etiology of disease or other health condition before one can assign the claim of iatrogenic actions. In this case in fact we can say of the disaster that it is essential that the body politic as it represents and surrounds those who live within the sphere of influence of the gulf must understand—understand it all: the implications of this crazy catastrophe for the human public's health, then acknowledge and handle that impact. And then the words every clinical ethicist hates to hear, but that in environmental disaster are essential, because everyone (much like malpractice) has already begun shuffling papers to demonstrate how they are not responsible: “Someone must pay, if not literally, then at least figuratively, for the environmental, public health, and social cost that this disaster has caused.” What kills ethics consults, or at least sets them back, will catalyze disaster ethics.

To understand the Deepwater Horizon catastrophe, we again have to call upon Van Renssalaer Potter's definition of bioethics as articulated by Jonathan Moreno in the wake of Hurricane Katrina: a “global bioethics to signify a broader understanding that encompassed medicine, environmentalism, public health and spirituality” (Moreno 2005). Because disasters on this scale are not limited simply to dealing with the environmental consequences or the spirits of the downtrodden shrimp fishermen or small business owners on the Coast, but also the literal and metaphorical ripple effect across our water-covered planet and throughout the interconnectedness of our human nation, there is more to consider than the short term assignment of responsibility or changing of practices. These ripples will last, quite possibly, for years to come. What will humanity learn? How will institutions from the corporate to the governmental respond to the idea of risk analysis that allows drilling without a plan to avert catastrophe? Will there be any call to hold responsible those who want to turn Alaska and the coasts of the U.S. into massive drilling fields? Will we pay more to drive the cars that require massive oil drilling? Will the British need to cough up some of the massive resources they harvest from our Gulf in order to make it a real Gulf again? Principles of social or collective responsibility, commitment to future generations, and stewardship of natural resources are all in place in such analysis, just as in microcosm, they govern good clinical ethics when disaster strikes families.

But handling public responsibility is a delicate proposition while the Gulf of Mexico fills up with oil. There are two obvious parties to hold accountable: the company who built the oil well-cum-environmental terror (British Petroleum in this case) or environmental agencies of the Federal governments whose waters are affected (the US). And others ask: what about all the aid we provide to other countries in their times of environmental disaster? Where are those nations now? These are neither questions of taking public responsibility for a nation's own public health, nor timely. But they fill the news networks’ airtime, in lieu of anything like the questions we've asked above.

Right now the question is what can disaster ethics mean: pragmatically, it means how to make a situation better rather than worse using a moral analysis of what “better” really means once the entire context of the matters at hand have been changed by the disaster. Some remedies resonate of being hung by a velvet rope. The use of chemical dispersants to prevent oil from coming ashore (now which is too late) can have long-term effects on the ecosystem, and in fact, the EPA forced British Petroleum to reduce its use in the Gulf in early May. Moreover, there are insufficient numbers of naturally occurring bacteria to consume the massive quantities of oil in the Gulf, thus taking months to occur naturally. Looks good, doesn't work. Not a good plan, not ethical, not the right way to implement bioethics in a disaster.

Rather than in the short term being concerned with who pays or who was in the wrong or how to get rid of the oil quickly at the expense of the Gulf Coast ecosystem, smart choices about the long term health of those who live along the Gulf Coast, as well as those who eat the fish and seafood that come out of those waters (that would be most Americans) must be ‘priority one’. A short term solution to stop the billowing of tens of thousands of barrels of oil now lapping up on the Gulf shores with harsh chemicals or untested mechanisms with unknown risk profiles will not benefit the long-term public health needs of anyone.

To ensure that the public's health will be protected for generations to come, public accountability is required. This accountability will require transparency on the part of governments, both domestic and international, as well as international corporations to understand how the Deepwater Horizon tragedy happened, how it can be curtailed and how it can be prevented in the future. Every resource, public and private, should be marshaled to limit the damage to the environment upon which millions of individuals depend.

And once the billowing oil geyser has stopped and the damage can be assessed, if we have learned anything from the world of medical errors, perhaps the most healing action that could be taken on the part of the corporate actors within BP would be to simply stand up and be counted and to say to the American public and in particular to the oil-soaked Gulf Coast, “I apologize.”

Perhaps then as the Gulf Coast has done many times before, it will begin its healing process, repairing itself from the water below.