Ethical Considerations for Emergency Care Providers during Pandemic Influenza–Ready or Not…

Abstract

When an infectious pandemic occurs in the United States, emergency care providers (ECPs) will be on the frontlines caring for infected, potentially infected, and non-infected patients. Logistically, the current emergency care system is not ready for a pandemic, but are the providers ethically ready? Some of the most difficult and challenging issues that will be raised during a pandemic will be ethical in nature. An ECP likely will be confronted with ethical values and value conflicts underlying restriction of liberty, duty to care, and resource allocation.This report summarizes the ethical concerns and challenges that ECPs face during an infectious pandemic, and raises ethical questions that may arise related to the role of an ECP as a healthcare provider and stakeholder.

A Rapid Review of Pandemic Studies in Paramedicine

“…There was one report and two articles discussing relevant ethical concerns; the report included paramedic services implicitly (Table 1) (29)(30)(31). Two closely related sub-themes emerged: duty; and resource allocation ( Figure 2).…”

Must I Stay?

“…To the best of my knowledge, there are no published papers that discuss a physician's duty to care in the midst of a nuclear disaster. The issues described previously are akin to other ethical ques-tions in medicine, such as whether it is acceptable to refuse to treat patients with highly infectious and fatal diseases like avian flu or SARS, 4,5 or whether a surgeon can refuse to perform open surgery on HIV positive patients. 6 How far does the physician's duty to treat reach when the cost is personal danger?…”

Pandemic Influenza

“…The ethical value of reciprocity implies that a health care worker’s duty to care 50,56,108–112 should be reciprocated with the health care facility’s duty to provide a safe working environment. 56,109,110,112-114 Duty of care is neither a fixed nor an absolute concept but is heavily dependent on context.…”

“…56, 109–110, 112–114 Duty of care is neither a fixed nor absolute concept but is heavily dependent on context. Hospitals should inform prospective staff members of what is expected in crisis situations before, rather than in the midst of, an emergency”.…”

“…47, 59, 72, 82, 108, 111, 175, 208, 211, 218, 225–227 Examples of ethical principles include justice, 56, 111, 175, 208 transparency, 56, 58, 63, 72, 76, 78, 82–83, 111, 176, 194, 208, 213, 226–227 distributive justice, 111–112, 226, 228 beneficence, 175 equity, 56, 112, 208, 218, 225, 228 utility, 56 fairness, 72, 76, 208, 213, 226 duty of compassion and care, 72, 111, 208, 225 and duty to steward resources. 72, 111, 225 …”