The moral obligations of our health care workers in a pandemic

Do health professionals have an ethical duty to provide care amid the COVID-19 pandemic even if it exposes them to personal harm, including death?

That is one of the questions being debated around the world, as nurses and doctors speak out about the growing risks they are taking while tending to those suffering from the coronavirus. This, at the same time as the number of health-care workers who have died after contracting the disease on the job continues to mount.

Michael Gibson, a Harvard medical school professor who is keeping an incomplete list of health professionals who have lost their lives on the pandemic battlefield, has linked more than 130 deaths to infections acquired while caring for COVID-19 patients. The group includes more than 70 doctors from Italy. Meantime, thousands and thousands more health-care workers around the world have been infected with the virus.

It once was accepted wisdom that health workers, and in particular physicians, took an oath upon entering the profession that they would help their patients at any cost. That seems less of a guarantee now.

For decades, the obligation that most physicians agreed to accept upon graduation was modelled on the World Medical Association’s Declaration of Geneva. According to Udo Schuklenk, professor of philosophy and Ontario Research Chair in bioethics, that declaration included a promise by doctors to provide emergency care with few exceptions.

However, Mr. Schuklenk notes that you will not find that same pledge in the current iteration of the declaration.

Now, governments around the world are being asked to consider the ethical parameters that health-care workers are expected to meet amid the pandemic. The B.C. government, for instance, recently released an analysis around this question.

The key paragraph in the document may be this one: “HCWs [health care workers] have an ethical duty to provide care, even when it involves potential exposure to some risk of harm,” it states. “However, when individual HCW face certain and significant harm to their person – such as may be the case in performing some health care activities without appropriate PPE [personal protective equipment] – that duty may be discharged.”

Prof. Schuklenk has a problem with the word “certain” being included as a condition for a health-care worker refusing to treat a patient. When is anything ever certain in medicine? He believes the test should simply be the potential of “significant” harm.

“What if someone faced a 70-per-cent probability for life-threatening illness?” he asks. “They’re expected to work? You can’t expect any HCW to accept any higher than average risk of on-the-job injury without them volunteering to do so. It’s that simple.”

No health-care workers, including doctors, should knowingly risk their lives because they have not been provided with proper protective equipment. To be blunt, yes, someone might die because of their refusal to treat a patient in the absence of having proper gear. That person more than likely will be in their 70s or 80s. The doctors or nurses who refuse to jeopardize their own lives might be in their 40s with a spouse and kids at home.

I don’t believe we have any right to insist health-care workers put their lives in danger regardless of circumstance. We would never expect police officers to arrive at a shooting without guns themselves. We would never expect firefighters to enter a building about to collapse.

We should never expect doctors and nurses to treat patients without proper masks and gowns and face shields. Unquestionably, some of those health-care professionals who have died, maybe many, contracted the virus because they were not properly outfitted. And as the number of COVID-19 cases prepares to jump precipitously in North America, we are going to see a demand on safety supplies like never before.

And there are likely going to be an increasing number of health-care workers who will face a moral dilemma: Do they tend to patients with the virus despite not having all the protective equipment they need to completely feel safe in that environment?

It would be wrong for society to believe that our health-care workers have an unequivocal moral obligation to take care of us at any and all costs. Because that releases us, and our governments, from the obligations we have to ensure our hospitals are ready for any eventuality with which they may be confronted.

We may soon discover what happens when that bargain isn’t met. But it shouldn’t be our health-care workers who pay a price for our failure to live up to our end of the deal.

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