Pandemic Ethics: What Do Doctors Owe Us?

As doctors are being called to the front lines of the COVID-19 crisis in the United Kingdom, questions around the minimum duties and responsibilities held by members of the profession are being placed into the spotlight. Lack of PPE and the chronic underfunding of the NHS are putting doctors at risk of contracting, and potentially dying, from the virus. In light of the crisis do doctors have a duty of care for patients when doing so exposes them to considerable risks, even death?

I shall delineate a few directions from which we can approach the question but before we begin I feel that it would be interesing to contemplate what the role of a doctor entails. I found this a holistic summarisation:

1) a duty to patients; 2) a duty to protect oneself from undue risk of harm; 3) a duty to one’s family; 4) a duty to colleagues whose workloads and risk of harm will increase in one’s absence; and 5) a duty to society.


Lives on the line? Ethics and practicalities of duty of care in pandemics and disasters
A. K. Simonds, D. K. Sokol
European Respiratory Journal Aug 2009

However it is worth noting that individual doctors may have signed up to the profession with different ideas of the work they were about to undertake. The Declaration of Geneva ( which includes elements of the Hippocratic Oath), provides rough framework, which allows for discrepancies such as an individual signing up with the impression of pursuing Cardiology to fufil their ‘duty’, but not signing up to be effectively conscripted to the medical frontlines. Would they be within their right to refuse redeployment despite societal and ,potentially, professional pressures which could result in them standing before a medical tribunal?

  1. 4 Pillars Approach

Beneficence is a key principle underlying any action a doctor takes. To do good for their patient and their society, seems to well founded in caring for them despite danger to themselves. For example if all trained medical professionals were practicing during the pandemic the magnitude of risk per worker and the community would be decreased. However on the flip side, perhaps it is could be argued to be more beneficent to not treat a COVID positive patient. Doctors are highly trained experts; when they become ill and are removed from the work force, they aren’t available to treat patients. As a result doctors aren’t acting in the interest of their future patients by exposing themselves to risk. Perhaps refusal to treat patients is justified when motivated for the wellbeing of patients rather than personal interests.

physicians should balance immediate benefits to individual patients with the ability to care for patients in the future

American Medical Association

2. Reciprocity

Another arguement, more socially rooted, argues that since doctors have a duty to society, society has a duty to doctors.

reciprocal duties to its employees. These duties include: 1) communication to staff on what is expected of them and how to minimise risk to themselves through appropriate infection control measures; 2) adequate support to enable staff to perform their duties; 3) adequate resources, including personal protective equipment; 4) skill training; 5) a safe environment; 6) accommodation; 7) means of communication between teams and for support, e.g. mobile phones and mobile e-mail devices; 8) medical advice, e.g. screening when attending for duty; 9) counselling and psychological support; 10) adequate security, e.g. for ambulance staff, those working in emergency room areas and dispensing oseltamivir; 11) provision of post-exposure antiviral medication, if staff are exposed and fulfill criteria as contact; and 12) vaccination


Lives on the line? Ethics and practicalities of duty of care in pandemics and disasters
A. K. Simonds, D. K. Sokol
European Respiratory Journal Aug 2009

The current situation in British hospitals fall short on the government’s end of the bargain as inadequate PPE and underfunding means that doctors don’t have the resources to practise safely. Following this line of reasoning of reciprocity, it could be argued that due to the degradation of the social contract doctors are no longer obliged to do their job until they are made to feel safe by adequate resourcing.

If the lack of available PPE for frontline health care professionals would have been due to a natural occurrence, one could argue that doctors should be prepared to accept a certain higher degree of risk, but in the current situation that lack of protective equipment is truly deliberate: it is by human, cost-cutting design. An adequately resourced NHS would not have required a significant degree of beyond-the-call-of-duty heroism by health care professionals.

Health Care Professionals Are Under No Ethical Obligation to Treat COVID-19 Patients | Journal of Medical Ethics blog, 2020

To end this post I think it would be useful to think about the current guidelines issued by the GMC in respond to physicians concerns in the current crisis as one of dynamism. There is no hard and fast answer to what is morally correct and not, and the professional judgement of medical professional places them in good stead to ‘do their best in the circumstances they face’.

We do not expect doctors to leave patients without treatment, but we also don’t expect them to provide care without regard to the risks to themselves or others. This pandemic is an unprecedented challenge in which clinicians are understandably balancing the imperative to provide care with their own fears.

General Medical Council

Bibliography

https://blogs.bmj.com/medical-ethics/2020/04/01/health-care-professionals-are-under-no-ethical-obligation-to-treat-covid-19-patients/?int_source=trendmd&int_campaign=usage-042019&int_medium=cpc

Click to access bma-covid-19-ethics-guidance-april-2020.pdf

https://blogs.bmj.com/bmj/2020/03/09/covid-19-triage-in-a-pandemic-is-even-thornier-than-you-might-think/

https://blogs.bmj.com/medical-ethics/2020/03/31/personal-protective-equipment-for-front-line-health-workers-an-ethical-imperative/?int_source=trendmd&int_campaign=usage-042019&int_medium=cpc

https://www.gmc-uk.org/ethical-guidance/ethical-hub/covid-19-questions-and-answers#Your-health-and-wellbeing

https://blogs.bmj.com/medical-ethics/2020/03/31/personal-protective-equipment-for-front-line-health-workers-an-ethical-imperative/?int_source=trendmd&int_campaign=usage-042019&int_medium=cpc

https://blogs.bmj.com/medical-ethics/2020/03/31/personal-protective-equipment-for-front-line-health-workers-an-ethical-imperative/?int_source=trendmd&int_campaign=usage-042019&int_medium=cpc

https://www.ama-assn.org/delivering-care/ethics/what-do-health-care-organizations-owe-doctors-battling-covid-19

https://blogs.bmj.com/medical-ethics/2020/05/05/covid-19-and-health-workers-rights-in-africa-the-duty-to-treat-or-not-to-treat/

https://erj.ersjournals.com/content/34/2/303

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