On pandemics and the duty to care: whose duty? who cares?

Abstract

BackgroundAs a number of commentators have noted, SARS exposed the vulnerabilities of our health care systems and governance structures. Health care professionals (HCPs) and hospital systems that bore the brunt of the SARS outbreak continue to struggle with the aftermath of the crisis. Indeed, HCPs – both in clinical care and in public health – were severely tested by SARS. Unprecedented demands were placed on their skills and expertise, and their personal commitment to their profession was severely tried. Many were exposed to serious risk of morbidity and mortality, as evidenced by the World Health Organization figures showing that approximately 30% of reported cases were among HCPs, some of whom died from the infection. Despite this challenge, professional codes of ethics are silent on the issue of duty to care during communicable disease outbreaks, thus providing no guidance on what is expected of HCPs or how they ought to approach their duty to care in the face of risk.DiscussionIn the aftermath of SARS and with the spectre of a pandemic avian influenza, it is imperative that we (re)consider the obligations of HCPs for patients with severe infectious diseases, particularly diseases that pose risks to those providing care. It is of pressing importance that organizations representing HCPs give clear indication of what standard of care is expected of their members in the event of a pandemic. In this paper, we address the issue of special obligations of HCPs during an infectious disease outbreak. We argue that there is a pressing need to clarify the rights and responsibilities of HCPs in the current context of pandemic flu preparedness, and that these rights and responsibilities ought to be codified in professional codes of ethics. Finally, we present a brief historical accounting of the treatment of the duty to care in professional health care codes of ethics.SummaryAn honest and critical examination of the role of HCPs during communicable disease outbreaks is needed in order to provide guidelines regarding professional rights and responsibilities, as well as ethical duties and obligations. With this paper, we hope to open the social dialogue and advance the public debate on this increasingly urgent issue.

Nurses’ preparedness for infectious disease outbreaks: A literature review and narrative synthesis of qualitative evidence

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Avian Flu Pandemic – Flight of the Healthcare Worker?

“…One of the four key ethical issues identified in response to a possible pandemic is healthcare workers' duty to provide care during a communicable disease outbreak (Clark, 2005;Chaffee, 2006;Ruderman, Tracy et al, 2006;Sokol, 2006;Rolls & Thompson, 2007;Gardiner, 2008). Although the answer may appear simple at first glance, this is a very complicated and value-laden issue.…”

Everyday Ethics and Ebola: Planning for the Unlikely

“…Ebola has raised questions, new and old, about which individual professionals and institutions have a duty to treat patients with communicable diseases, whether as a matter of professionalism or contract (Heidi et al 2008;Huber and Wynia 2004;Ruderman et al 2006). Literature on the ethical duty of individuals to treat has relied on concepts such as the social contract between the medical profession and the broader society, professionalism and oath-taking, the responsibility of individuals with special expertise to come to the assistance of others, and reciprocity for community support during training.…”