Med Health Care and Philos (2017) 20:343–351
Personal factors aﬀecting ethical performance in healthcare
workers during disasters and mass casualty incidents in Iran:
a qualitative study
· Mohsen Fadavi
· Hamidreza Khankeh
· Fariba Borhani
Published online: 20 February 2017
© Springer Science+Business Media Dordrecht 2017
Disasters and mass casualty incidents aﬀect both public
health and socioeconomic development (Donner and Rod-
ríguez 2011). About three quarters of the world’s popula-
tion live in areas where at least one of the four main natural
disasters leading to death, including earthquake, ﬂood, hur-
ricane and drought, have occurred in the past few decades
(Hosseini 2008). Of the total of 41 types of natural disas-
ters existing in the world, 31 have been reported in Iran.
As a matter of fact, Iran ranks fourth among disaster-prone
countries of the region and sixth across the world (Khankeh
et al. 2007). Wars, terrorism, airplane crashes and nuclear
power plant accidents are also considered a disaster or mass
casualty incident, albeit man-made.
In disasters and mass casualty incidents, the priority is
always to provide healthcare services to all those aﬀected.
Apart from the wasting of resources and the destruction of
infrastructures, these incidents may lead to decisions that
are not based on conventional health principles and health-
care services framework (Rios et al. 2015).
The majority of disaster-prone countries are faced with
several ethical challenges in their provision of health-
care services, such as respect for the victims’ autonomy,
the importance of performing only useful medical proce-
dures, respect for the dignity of those aﬀected by the crisis
(including locals, rescue-workers, etc.), preventing further
harm to the aﬀected, ensuring the equitable and fair dis-
tribution of the available resources, triage of the wounded
and victims and making announcements and notiﬁcations.
According to Rios, processes contributing to equality, such
as transparency, stability, proportionality and accountabil-
ity, are also considered challenging.
Many of the medical guidelines used for providing
healthcare services in normal circumstances are not ﬁt for
Abstract In emergencies and disasters, ethics are aﬀected
by both personal and organizational factors. Given the lack
of organizational ethical guidelines in the disaster man-
agement system in Iran, the present study was conducted
to explain the personal factors aﬀecting ethics and ethical
behaviors among disaster healthcare workers. The pre-
sent qualitative inquiry was conducted using conventional
content analysis to analyze the data collected from 21 in-
depth unstructured interviews with healthcare workers with
an experience of attending one or more ﬁelds of disaster.
According to the data collected, personal factors can be
classiﬁed into ﬁve major categories, including personal
characteristics such as age and gender, personal values,
threshold of tolerance, personal knowledge and reﬂective
thinking. Without ethical guidelines, healthcare workers are
intensely aﬀected by the emotional climate of the event and
guided by their beliefs. A combination of personal charac-
teristics, competences and expertise thus form the basis of
ethical conduct in disaster healthcare workers.
Keywords Disasters · Mass casualty incidents · Ethical
performance · Healthcare workers
* Mohsen Fadavi
Shahid Beheshti University of Medical Sciences, Tehran,
University of Social Welfare and Rehabilitation Sciences,