Virulent Epidemics and Scope of Healthcare Workers' Duty of Care

Abstract

The phrase "duty of care" is, at best, too vague and, at worst, ethically dangerous. The nature and scope of the duty need to be determined, and conflicting duties must be recognized and acknowledged. Duty of care is neither fixed nor absolute but heavily dependent on context. The normal risk level of the working environment, the healthcare worker's specialty, the likely harm and benefits of treatment, and the competing obligations deriving from the worker's multiple roles will all influence the limits of the duty of care. As experts anticipate the arrival of an avian influenza pandemic in humans, discussion of this matter is urgently needed.

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.…”

“…Nebulous "calls to duty" based upon oaths and codes or draconian measures of punishment are simply insufficient. Institutions must encourage both active participation and open debate about the practical implications of the purported "duty to treat" (Sokol, 2006;Bailey, Rosychuk et al, 2008;Sokol, 2008). In fact, by one analysis, duty to treat is replaced by a duty to care, a more encompassing concept that addresses the obligations of all relevant occupational groups as well as members of the public (Joint Centre for Bioethics Pandemic Ethics Working Group, 2008).…”

Ethical Issues in the Response to Ebola Virus Disease in US 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, 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 healthcare providers in the face of outbreaks of infectious disease. [28][29][30][31] For emergency departments, emergency physicians and emergency nurses, there is a need to weigh all of these considerations against the special role played by emergency departments in the US healthcare system and the duties that accompany the professional status of emergency physicians and emergency nurses.…”

“…54 But there is no consensus on the specific limits of this duty. 30,55 Emergency nurses and physicians are front line in an outbreak and, implicit in their specialty choice, accept additional risk beyond what is typical for many of their colleagues. As noted above, this is acknowledged in professional codes of ethics and statutory mandates (e.g., EMTALA).…”

“…29 Emergency nurses and physicians, therefore, have a duty to care for Ebola-infected patients and, in most instances, accept the associated risks. 30,60 But the duty is not unlimited. An "abstract limitless duty" obscures the discussion about reasonable risk acceptance among nurses and physicians.…”