A Healthcare Worker’s Obligation to Treat: Our Cultural History & COVID-19 Dilemmas
PPE shortage. Thoughtlessness. Unprepared medical institutions. Ignored social distancing orders. Should healthcare workers continue to risk their lives to help us?
A History of the Healthcare Worker’s Obligation to Treat Patients in the Face of Personal Danger
What was expected of medical professionals throughout history when major outbreaks occurred?
The Black Plague (The 1300s)
We did not expect physicians to care for patients during the Black Plague.
Doctors advised their patients to “cito, longe, tarde,” or “leave quickly, go far away, and come back slowly,” and they typically practiced what they preached by escaping to the country.
Only a small number of physicians stuck around to care for the sick during the plague, and they typically stayed either to prosper or to adhere to what they felt was a moral duty.
Physicians had neither a professional nor social obligation to treat infectious patients during the Black Plague, and this was also true of earlier epidemics like the Antonine Plague (AD 160s-180s).
The absence of accepted social and professional “contracts” to treat patients in the face of personal danger remained in effect for hundreds of years.
The American Medical Association addressed the mass fleeing of trained medical professionals in 1847 in its first Code of Medical Ethics.
The Code said:
“When pestilence prevails, it is the duty of physicians to face the danger, and to continue their labors for the alleviation of suffering, even at the jeopardy of their own lives.”
In 1912, the American Medical Association wrote the “Principles of Medical Ethics of the American Medical Association.” In it, they stated:
“When an epidemic prevails, a physician must continue his labors for the alleviation of suffering people, without regard to the risk to his own health or life or to financial return.”
Basically, in 1912 we saw doctors being morally mandated to care for patients in the face of a deadly threat, possibly without pay.
1913 to 1980s
The ethical obligations that physicians had to treat the sick relaxed substantially between 1912 and 1980, probably due to a decline in epidemics.
However, in the widespread hysteria surrounding AIDS, the American College of Physicians and the Infectious Diseases Society of America issued a statement that said that medical workers must care for patients “even at the risk of contracting a patient’s disease.”
This statement, made in 1986, was, in part, a response to the fact that some physicians refused to treat AIDS patients for fear of contracting the disease themselves.
September 11, 2001
Many healthcare professionals risked their lives to provide care during 9/11.
Studies are still assessing the long-term health effects of 9/11 on firefighters, law enforcement, and medical professionals.
Obligation is a Two-Way Street
We can probably safely conclude that medical professionals—be them doctors or nurses— enter into an “agreement” with society that they will treat the sick during an epidemic at the expense of their health, lives, and possibly, pay.
However, an obligation is a two-way street.
Should doctors still be obligated to treat the sick if people repeatedly ignore social distancing rules?
Should nurses still be expected to risk their lives amid institutional thoughtlessness (e.g., relaxing social distancing for Easter)?
Should medical professionals be forced to treat positive COVID cases if their employers can’t provide either PPE or the supplies needed to adhere to evidence-based PPE protocols?
We do not expect firefighters to run into a building that is about to collapse without proper PPE. Do we expect medical staff to treat COVID patients without adequate PPE?
What is reasonable to expect from doctors, nurses, and medical support staff during the COVID-19 crisis?
Everyone Has a Responsibility
The majority of healthcare workers will probably continue to go to work. However, it would be unfair and naive to expect them to be martyrs.
Arguably, it would also be unfair to retaliate against or restrict any healthcare worker’s ability to express safety concerns if they do so legally and appropriately.
Society has to hold up their end of the bargain if they expect healthcare workers to continue to fulfill their social/professional “contracts”— this isn’t’ to say that all healthcare workers are “innocent” and all of society is not—it’s simply to say that society has an obligation to its physicians, nurses, and medical support staff, and that responsibility should not be taken lightly, by anyone. Afterall, healthcare workers have an obligation to their families too, and their families could include high-risk individuals.
Perhaps, the question we should be asking is: how can we help our healthcare workers and their families stay safe while we fight COVID?
One idea is use hotels located near major medical centers as free refuges for healthcare workers. Academic medical centers could use their dormitories to house their medical staff. And, breastmilk shipping companies could provide free shipping to babies of breastfeeding medical professionals who may self-isolate to protect their families.
Learn More about Ethical Responsibility in Healthcare
The American Nurses Association (ANA) put together a fantastic free webinar on navigating the ethics of COVID. It’s called “How to Respond to Ethical Challenges and Moral Distress during the COVID-19 Pandemic – On Demand.”
Ethicist and Bioethics Program Director at Virginia Mason in Seattle, Washington, Laura Webster, D.be, RN, HEC-C, explains what’s ethical and reasonable for medical staff and patients when it comes to PPE and standards of care.
You may also want to read this 3-page PDF created by the ANA on COVID ethics for the healthcare professional.