Lives on the line? Ethics and practicalities of duty of care in pandemics and disasters

Abstract

Pandemics and acute emergencies raise pressing medical, ethical and organisational challenges. These include global governance, priority setting, triaging of patients, allocation of scarce resources and restricting individual liberty in the interests of public health. We will focus particularly on an issue of direct relevance to all respiratory team members, i.e. what is the duty of the healthcare worker to continue working in the face of personal risk, and draw lessons from guidelines, ethical considerations, past pandemics and evolving experience with H1N1 swine influenza.

Healthcare Workers Emotions, Perceived Stressors and Coping Strategies During a MERS-CoV Outbreak

“…Some of these factors reflect what has been reported in other epidemics. 10,15 Our study has a few limitations. The sample size was not large enough to focus on HCWs by profession or distinguish their responses based on place of work.…”

“…15 These hospital staff are under huge stress not only during the epidemic, but they can also suffer from long-term psychological consequences. This was evident with the SARS outbreak and most recently with the Ebola virus outbreak.…”

“…Some specialties, like emergency room and critical care staff, are likely to be at a higher risk than those in unrelated or non-acute specialties. 15 For this reason, we targeted HCWs from these high risk areas in our study. We only included nurses, respiratory therapists, and physicians in our study and did not include other staff like housekeepers, unit clerks, etc., as they were not assigned to these high risk areas on a continuous basis.…”

Frente a la amenaza de la enfermedad del Ébola…¿por qué permanecer en servicio?: Algunas reflexiones

“…Actos que se verían fundamentados entre otras cosas: por el entrenamiento especial que otorga la profesión 3,8,10,11 , por las muestras de reciprocidad de la profesión hacia la sociedad en razón de las oportunidades y privilegios otorgados 3,10,12,13 , por el impacto en la salud pública que estas actuaciones conllevan, así como por las expectativas de la población 3 , etc. Otra de las razones que se declaran, es la creencia en un deber general de ayuda, el cual indica que por el simple hecho de que una persona esté en condiciones de ayudar a otra, aquel sería motivo suficiente para cubrir la necesidad de la segunda.…”

Public health management of pandemic (H1N1) 2009 infection in Australia: A failure!

“…The limited number of intensive care beds would have caused a catastrophic bottleneck were this disease more serious, and one of the crucial areas to revisit is the provision of intensive care services, as even with the relatively mild H1N1 and the sparing of the older population, intensive care beds were rapidly filled and life support facilities stretched. In some local contexts, there was conflicting advice to health‐care workers about coming to work if symptomatic, perhaps reflecting concerns that a seriously reduced workforce would be an unmanageable consequence 40 …”