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Among the many practical and ethical issues raised during the recent Ebola outbreak were the obligations of healthcare workers, reopening risk-benefit debates from the early days of the AIDS epidemic. In a new article published in the journal Disaster Medicine and Public Health Preparedness, bioethics experts at Johns Hopkins describe important considerations for addressing these issues and providing care in nonepidemic settings such as the United States.
“This latest Ebola outbreak has prompted healthcare professionals to question the scope of their obligations, both to patients with highly contagious diseases like Ebola and to other patients, in both epidemic and nonepidemic settings,” says Jeremy Sugarman, lead author of the article and the Harvey M. Meyerhoff Professor of Bioethics and Medicine at the Johns Hopkins Berman Institute of Bioethics.
As patients are very contagious in the end stages of Ebola virus disease (EVD), when they are likely to seek medical help, healthcare workers risk infection.
“Clinicians face a moral predicament of choosing between their trained instinct to treat all patients and the real fear of spreading infection by taking extreme and/or invasive measures that may pose little chance of saving an Ebola patient’s life,” says Cynda Rushton, co-author of the article and the Bunting Professor of Clinical Ethics at the Berman Institute and Johns Hopkins School of Nursing.
“Data will be essential in separating facts from fears,” the article states.
“Fears about Ebola are understandable; it is contagious and often deadly. However, in the United States and other settings with a limited number of infections, it seems possible to keep health care workers safe,” says Nancy Kass, the Phoebe R. Berman Professor of Bioethics and Public Health at Berman Institute and co-author of the article.
Sugarman underlines the importance of continuing to monitor and collect data on effective and safe ways to care for Ebola patients. “Now is the time, when we are not mid-disaster, to take a careful, measured approach to finding out what works best in treating Ebola for both patients and the safety of healthcare professionals, utilizing the standard tools of quality improvement research,” he says.
Professional obligations are not unconditional, the authors write, quoting the American Nurses Association’s position statement on risk and responsibility: “in certain situations the risks of harm may outweigh a nurse’s moral obligation or duty to care for a given patient.”
Clarity is key. “Institutions have an obligation to disclose their expectations of clinicians, make explicit the processes and protocols that govern practice, outline their scope of commitment to clinicians who become infected, and articulate the consequences to clinicians for failure to fulfill their expected duties,” the article states. Clinicians who do become infected must receive optimal care, compensation when they are off work, as well as disability and life insurance, the authors say.
And there is some reason for hope; the authors look ahead to successful outcomes of current pharmaceutical research, writing that, “if and when effective vaccines or treatments become available, the risk context will shift considerably, and the ethical tensions health care professionals would face in caring for patients with EVD should be further reduced.”
The article, “Translating Professional Obligations to Care for Patients With Ebola Virus Disease Into Practice in Nonepidemic Settings” Disaster Medicine and Public Health Preparedness," is avaolable at: http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=9674833&fileId=S1935789315000610
Source: Johns Hopkins Berman Institute of Bioethics