GS Paper 4 (Ethics)Ethics in emergency and disaster governanceUPSC CSE Mains 2023
A landslide occurred in the middle of the night on 20th July, 2023 in a remote mountain hamlet, approximately 60 kilometres from Uttarkashi. The landslide was caused by torrential rains and has resulted in large-scale destruction of property and life. You, as District Magistrate of that area, have rushed to the spot with a team of doctors, NGOs, media and police along with numerous support staff to oversee the rescue operations. A man came running to you with a request for urgent medical help for his pregnant wife who is in labour and is losing blood. You directed your medical team to examine his wife. They return and convey to you that this woman needs blood transfusion immediately. Upon enquiry, you come to know that a few blood collection bags and blood group test kits are available in the ambulance accompanying your team. Few people on your team have already volunteered to donate blood. Being a physician who has graduated from AIIMS, you know that blood for transfusion needs to be procured only through a recognized blood bank. Your team members are divided on this issue; some favour transfusing, while some others oppose it. The doctors in the team are ready to facilitate the delivery provided they are not penalised for transfusion. Now you are in a dilemma. Your professional training emphasizes prioritising service to humanity and saving lives of individuals. (a) What are the ethical issues involved in this case? (b) Evaluate the options available to you, being District Magistrate of the area. (20 marks, 250 words)
Based on 27 evaluated answers to this question on CollectorBabu: here is what aspirants most often missed, the mistakes that cost marks, and a model answer.
What most aspirants missed
- Parallel action: arranging immediate evacuation to the nearest medical facility while transfusion is prepared
- Time factor: postpartum haemorrhage can kill within minutes to hours, so each option must be judged by how long it takes
- DM powers under Sections 30 and 34 of the Disaster Management Act, 2005, and the doctrine of necessity as legal cover
- Safeguards: rapid blood grouping kit, cross-matching and donor screening for infection history before transfusion
- Written consent from the husband and a written direction protecting doctors from penalisation
- Post-action documentation, reporting to higher authorities and a health protocol review
Common mistakes
- Listing options without ranking them or stating a final decision with reasons
- Treating disaster management as an ethical issue instead of the context in which ethical issues arise
- Writing a vague conclusion such as desperate times need radical decisions without legal or procedural backing
- Including irrelevant material such as the case facts repeated, emotional narrative or unrelated examples, which wastes word limit
What the better answers did
- Clear statement of the conflict between blood bank rules and the duty to save life, framed as beneficence versus non-maleficence
- Options assessed against time sensitivity and risk, with consequences spelled out for each
- A middle path using on-site screening, telemedicine and evacuation before a final decision
- A stated recommendation with safeguards, documentation and accountability to higher authorities
Introduction
Open directly with the bleeding woman and the clash between the urgent need for blood and the rule that blood must come from a licensed bank, not with the landslide background.
Conclusion
End with a firm stand: transfuse only after rapid screening and written consent, under DM powers, with full documentation and reporting to health authorities.
Model answer
A woman in obstetric haemorrhage needs blood now, yet the law and professional training require blood from a licensed, screened source. The case tests the balance between the duty to save a life and rules meant to prevent harm.
Ethical issues
- Beneficence versus non-maleficence: transfusion saves life, but unscreened blood risks HIV, hepatitis and incompatibility reactions.
- Autonomy and consent: the husband speaks for an incapacitated patient, and the doctrine of necessity covers the consent gap in emergencies.
- Legal compliance versus humanitarian duty: blood bank rules under the Drugs and Cosmetics Act versus Article 21 and the Disaster Management Act.
- Accountability: the DM and doctors must be able to defend the decision later.
Options
- Option 1, refuse transfusion: avoids regulatory breach but likely leads to maternal death, violating the duty of care.
- Option 2, transfuse immediately from volunteers: saves time but exposes mother and child to infection and reactions.
- Option 3, parallel action: rapid on-site grouping and donor screening, telemedicine consultation with the nearest licensed blood bank, and evacuation to the nearest facility. Transfuse screened, compatible volunteer blood only if delay threatens life.
Recommended course
- Assess criticality first; if bleeding is uncontrolled, proceed with Option 3.
- Obtain written consent from the husband and record the reasons for the emergency.
- Invoke DM powers under Sections 30 and 34 of the Disaster Management Act, 2005, with a written direction protecting doctors from penalisation. The doctrine of necessity and good-faith provisions (BNS Section 26) support the action.
- Report to the state health department and blood transfusion council for protocol review.
Saving the woman comes first, but it must be done with screening, consent and documentation so that the decision is ethically sound and legally defensible.
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