Bioterrorism poses a persistent threat to public health and national security, and clinical preparedness activities—including education and competency testing, tabletop exercises and simulation-based training—are essential for enabling front-line clinicians to recognise and respond to high-consequence pathogens. However, the ethical dimensions of these preparedness activities have received limited attention. This article provides an ethical analysis of clinical preparedness activities for bioterrorism, identifying seven categories of concern: overtriggering and patient harms arising from disproportionate clinical responses; false reassurance when confidence gains are poorly calibrated to actual competence; patient confidentiality risks in teaching materials derived from rare cases; psychological safety and moral distress among simulation participants; opportunity costs diverting resources from higher-burden emergencies; information hazards from publishing preparedness assessments that could inform adversarial planning; and scope creep toward the securitisation of healthcare, potentially undermining therapeutic trust. For each concern, mitigation strategies are proposed, including probabilistic reasoning in curricula, objective competency assessment, composite case development, psychological safety protocols, aggregated reporting of results and explicit reflection on professional role boundaries. The analysis concludes that while clinical preparedness for bioterrorism remains essential, activities must be designed and implemented in ethically defensible ways that attend to their potential for unintended harm.
Richard Armitage (Wed,) studied this question.