Ethical Issues in the Response to Ebola Virus Disease in United States Emergency Departments: A Position Paper of the American College of Emergency Physicians, the Emergency Nurses Association, and the Society for Academic Emergency Medicine

Abstract

The 2014 outbreak of Ebola virus disease (EVD) in West Africa has presented a significant public health crisis to the international health community and challenged U.S. emergency departments (EDs) to prepare for patients with a disease of exceeding rarity in developed nations. With the presentation of patients with Ebola to U.S. acute care facilities, ethical questions have been raised in both the press and medical literature as to how U.S. EDs, emergency physicians (EPs), emergency nurses, and other stakeholders in the health care system should approach the current epidemic and its potential for spread in the domestic environment. To address these concerns, the American College of Emergency Physicians, the Emergency Nurses Association, and the Society for Academic Emergency Medicine developed this joint position paper to provide guidance to U.S. EPs, emergency nurses, and other stakeholders in the health care system on how to approach the ethical dilemmas posed by the outbreak of EVD. This paper will address areas of immediate and potential ethical concern to U.S. EDs in how they approach preparation for and management of potential patients with EVD.ACADEMIC EMERGENCY MEDICINE 2015;22:605-615

The ability of the emergency medical service personnel to take patients’ medical history

“…But attention to patients' request causes positive psychological reactions and higher satisfaction. This effect is created because when patients' personal features and requests are heard, the patients themselves and their companions cooperate more (18). As a result, personnel can communicate better and the quality of examining patients improves.…”

Clinical and ethical challenges for emergency departments during communicable disease outbreaks: Can lessons from Ebola Virus Disease be applied to the COVID‐19 pandemic?

“…They are the primary access point for patients with acute and undifferentiated illness, and bridge gaps in care for vulnerable patient groups. These roles are maintained during PHEs, when EDs fulfil surveillance, triage and clinical care functions …”

“…Historical examples of relevance include the emergence of human immunodeficiency virus and severe acute respiratory syndrome (SARS). PHEs of this nature have highlighted tensions between a healthcare worker's right to protection and a duty to provide treatment …”

Patients Under Investigation for Ebola Virus Disease in the United States: Hospital Preparedness Planning and Alternate Care Facilities

“…The position paper jointly developed by the American College of Emergency Physicians, the Emergency Nurses Association, and the Society for Academic Emergency Medicine, on "Ethical Issues in the Response to Ebola Virus Disease in United States Emergency Departments," appearing in this issue of Academic Emergency Medicine, 18 outlines important ethical responsibilities of all hospitals in support of such networks. The article points out that the principle of reciprocity should apply to appropriately credentialed staff, sharing equipment and supplies and "reputational" support, i.e., publicly endorsing the safety and quality of care offered at institutions caring for EVD patients and PUIs.…”

“…Neither scarcity of resources nor medical futility would be viable arguments against providing mechanical ventilation, central pressure monitoring, transfusion, renal dialysis, or other aggressive care of these patients. 18 Availability of more rapid diagnostic testing for Ebola infection should shorten the duration of the assessment phase of care of PUI and facilitate more rapid transfer of critically ill patients to regular intensive care units or transport to Ebola treatment hospitals. Meanwhile, as appeared to be true of the isolation unit in Sugalski's facility, Ebola assessment hospitals must be prepared to manage such patients for a period of time.…”