When Pestilence Prevails … Physician Responsibilities in Epidemics

Abstract

The threat of bioterrorism, the emergence of the SARS epidemic, and a recent focus on professionalism among physicians, present a timely opportunity for a review of, and renewed commitment to, physician obligations to care for patients during epidemics. The professional obligation to care for contagious patients is part of a larger "duty to treat," which historically became accepted when 1) a risk of nosocomial infection was perceived, 2) an organized professional body existed to promote the duty, and 3) the public came to rely on the duty. Physicians' responses to epidemics from the Hippocratic era to the present suggests an evolving acceptance of the professional duty to treat contagious patients, reaching a long-held peak between 1847 and the 1950's. There has been some professional retrenchment against this duty to treat in the last 40 years but, we argue, conditions favoring acceptance of the duty are met today. A renewed embrace of physicians' duty to treat patients during epidemics, despite conditions of personal risk, might strengthen medicine's relationship with society, improve society's capacity to prepare for threats such as bioterrorism and new epidemics, and contribute to the development of a more robust and meaningful medical professionalism.

Ethics, Pandemics, and the Duty to Treat

“…In particular, a number of proponents of a duty to treat cite the AMA principles of medical ethics in support of their view. That set of principles, initially called a code, was first promulgated in 1847 and was the first widely accepted code of ethics for physicians (Huber and Wynia 2004). It also defined a physician's duties as matters of a profession, as opposed to matters of good character, religion, or charity:…”

Influenzapandemie: Würde das Krankenhauspersonal zur Arbeit kommen?

“…Die Mitarbeiter haben ihre medizinische Berufswahl in der Regel aus freien Stücken getroffen; das damit verbundene Infektionsrisiko ist ihnen spätestens im Laufe ihrer Ausbildung bewusst worden [15]. Beschäftigte im Gesundheitswesen sind für die Betreuung und Versorgung von Patienten ausgebildet worden; sie können dies besser oder ausschließlich im Vergleich zu nicht ausgebildeten Personen [15,16,17,18]. Folglich stellt sich die Frage, ob daraus nicht sehr wohl eine Verpflichtung für die Beschäftigten abgeleitet werden kann, aus ethischer Sicht im Pandemiefall arbei- …”

Avian Flu Pandemic – Flight of the Healthcare Worker?

“…They identified ten substantive values and five procedural values necessary to guide ethical decision-making for a pandemic influenza outbreak. Other researchers have also articulated ethical frameworks concerning the ethical issues of a possible pandemic, and they share common elements with the Toronto group (Huber & Wynia, 2004;Kotalik, 2005;Gostin, 2006;Thompson, Faith et al, 2006;CDC., 2007;Barr, Macfarlane et al, 2008;Brody & Avery, 2009). These elements include creating an atmosphere of mutual trust and solidarity, reciprocal obligations of healthcare organizations to protect and support their workers, an ethical framework validated through a stakeholder engagement process to increase trust and solidarity, public cooperation in a participatory decision making process, fair and transparent decision making, and engaging the community in a process of open dialogue and inquiry.…”