SARS and Health Care Workers' Duty

- Yujin Nagasawa
Philosophy Program, Research School of Social Sciences
Australian National University, Canberra, ACT 0200
Australia
Email: yujin@coombs.anu.edu.au

http://philrsss.anu.edu.au/~yujin/

Eubios Journal of Asian and International Bioethics 13 (2003), 208.
In the July 2003 issue of EJAIB James Dwyer, in discussing what we have learned from the experience of SARS, contends that the SARS outbreak tested various aspects of our ability to respond to new infectious diseases. While I agree with most of what he says, I have a reservation on one specific point.

Dwyer claims that one of the most important things that SARS tested is the duty of health care workers to treat. He points out that while most health care workers lived up to their professional duty, some doctors and nurses in Taiwan were reported to have stayed away from work or even resigned their positions.

It seems obvious that health care workers are not justified in giving up their professional duty to treat patients in an ordinary situation. However, it is less obvious that they are not justified in giving up their professional duty in any situation.

In the case of SARS an ethically challenging question is, as Dwyer says, whether health care workers had a professional duty to go to work, stay involved, and treat patients of SARS even at some risk to themselves. He answers to this question as follows: "I think the answer is a qualified yes. Like firefighters and police officers, health care workers implicitly agree to accept a reasonable level of risk when they enter their profession."

I think it is far from clear that the answer should be a yes, even if it is a qualified yes. For in order for the answer to be positive the following two assumptions, both of which seem to me to be quite controversial, must be made:

(1) Health care workers have a professional duty to treat patients even at some risk to themselves because they implicitly agree to accept a reasonable level of risk when they enter their profession.

(2) SARS placed health care workers at only a reasonable level of risk.

First, it is not clear that health care workers universally agree to accept a reasonable risk when they enter their profession. Normally, health care workers do not need to expect serious risk in their work, particularly compared with firefighters and police officers. If, as Dwyer says, it really is agreed that they have a professional duty to treat patients at some risk to themselves, then it is unfortunate that the agreement is only implicit.

Second, it is far from clear that SARS placed health care workers at only a reasonable level of risk. The facts appear to show otherwise. At the beginning of the outbreak, more than 1/4 of the people who became infected, and more than 1/5 of the people who died, were health care workers.

It is at least very difficult to determine whether health care workers really do have a professional duty and moral obligation to treat people with highly infectious and fast-spreading diseases, when it is obvious that their own lives are at risk.


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