Ethics, Pandemics, and the Duty to Treat

Abstract

Numerous grounds have been offered for the view that healthcare workers have a duty to treat, including expressed consent, implied consent, special training, reciprocity (also called the social contract view), and professional oaths and codes. Quite often, however, these grounds are simply asserted without being adequately defended or without the defenses being critically evaluated. This essay aims to help remedy that problem by providing a critical examination of the strengths and weaknesses of each of these five grounds for asserting that healthcare workers have a duty to treat, especially as that duty would arise in the context of an infectious disease pandemic. Ultimately, it argues that none of the defenses is currently sufficient to ground the kind of duty that would be needed in a pandemic. It concludes by sketching some practical recommendations in that regard.

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

“…Rather, particular factors of disease process, availability of resources and training, countervailing responsibilities outside of the professional realm, and personal viewpoints on the virtues of courage and resilience as well as relational ethics perspectives and obligations imposed by professional status have guided the evaluations of the obligations of health care providers in the face of outbreaks of infectious disease. [28][29][30][31] For EDs, EPs, and emergency nurses, there is a need to weigh all of these considerations against the special role played by EDs in the U.S. health care system and the duties that accompany the professional status of EPs and emergency nurses.…”

Beyond Ebola Ethics: Do Nurses have a Duty to Treat?

“…Two themes that emerge related to DTT are social contract and moral obligation, as well as risk-benefit considerations. Codes of ethics for nurses mandate a duty to treat if the risk is low, but they are not legally binding (Brewer, 2010;Malm et al, 2008). Justice: applying fairness concepts to the distribution of benefits, risks and costs; treating everyone equitably.…”

“…Still, nurses do have an obligation to care for themselves first. And medicine is so specialized that it is not reasonable to view treating a (very) infectious disease as part of the job for all nurses (Malm et al, 2008). Perhaps an accepted risk level needs to be adopted in developing DTT mandates.…”

“…"(Nurses) paid a great deal of attention to the broader social context, with societal considerations playing a crucial role in promoting dialogue and education as well as providing compensation" (Bensimon et al, 2007). Malm et al (2008) proposed that they were going to provide five arguments supporting DTT in cases of pandemics. However, after extensive exploration and literature review they concluded that maybe there is none.…”

“…Perhaps a wiser approach may be to broaden the use of expressed consent…so that many more necessary workers acknowledge the duty to treat during a pandemic or other societal medical emergency as an explicit, voluntarily accepted, and compensated responsibility…this is not a novel idea. (Malm et al, 2008).…”