# 745
This is a hot button issue, and the answers are far from simple.
New Ethical Concerns in the Wake of Pandemic
May 8th, 2007 @ 6:56pm
Ed Yeates Reporting
Should physicians be forced to care for the sick? Should people be compensated for quarantines? When should civil liberties be compromised for the good of the whole? These issues and more were part of a special conference looking at the ethics and edicts of handling epidemics.
The 1918 flu epidemic killed 20-to-50 million people worldwide, including more than 675,000 Americans. In political and legal arenas, we may be no more prepared than we were 89 years ago. That's the warning from University of Louisville's Mark Rothstein at a Medical Ethics Conference in Salt Lake. He's the director of the Institute of Bioethics, Health Policy and Law.
Rothstein says economics is a big issue during an epidemic. He says, "We have many people who live paycheck to paycheck. There are people who are self-employed. They've got to put food on the table, and if they don't have some income replacement stream then they are going to be tempted to break quarantine."
During the SARS epidemic, many health care workers in Canada, China, Hong Kong, Singapore, Taiwan and Vietnam refused to report to work to treat patients for fear of picking up infection themselves and passing it on to their families.
The original AMA Code of Ethics said, "In regard to measures for the prevention of epidemic and contagious diseases; and when pestilence prevails, it is the physician's duty to face the danger even at the jeopardy of their own lives." Rothstein says the rescinding of an American Medical Association Code of Ethics in 1977 now allows physicians to make their own decision about sacrifice.
The same holds true for others as well. "It's going to take a tremendous amount of selflessness and bravery for the whole population," says Rothstein. "For transportation workers to take people around. For first responders to go get people. For everyone involved in an epidemic. If everyone sort of runs to the hills, we're going to be in very dire straights."
About a dozen states are considering an epidemic benchbook that covers these issues and provides coordination and ethical guidelines for courts, hospitals and public agencies.
I'll admit, when I first started considering the prospects of a severe pandemic, my views were a bit different than they are today. I found it incredible that doctors or nurses or medics might refuse to work during a pandemic. It went against my training, and frankly, I was vocal in my disappointment.
But two years later, I've seen dismal progress in providing protection for first responders and front line workers, and so I'm more inclined to understand their reluctance to risk exposure.
Early promises of prophylactic antivirals have been withdrawn, in some places the types of recommended PPE's (Personal Protective Equipment) have been downgraded due to economic considerations, and in any event, very little stockpiling has taken place.
You wouldn't expect a firefighter to rush headlong into a burning building without bunker gear, and so it's hard to expect doctors and nurses to expose themselves to a lethal virus without adequate protection.
Today I visited a hospital where extensive remodeling was going on, and an impressive new lobby and waiting room for their outpatient area was under construction. It was a nice addition to the hospital, and likely needed; but it was far grander than necessary.
I have to wonder if this hospital will find itself short of PPE's for their staff when the next pandemic comes, and come to regret their priorities. The fancy marble statues in the lobby won't be of much use when the hallways are filled with the sick and dying and the staff has either died, or run for the hills.
Should the staff accept poor planning as a valid excuse for why vital supplies aren't available when they are needed, and sacrifice themselves anyway? And if they do, what happens when they fall to the virus? Who replaces them?
I still believe we need to find some way to rise to the occasion, and that we all can't run away and hide when a pandemic strikes. We will need courage and selflessness on the part of millions of people if we are to reduce the death, suffering, and economic impact of a pandemic.
It may sound trite, but we must save our communities, in order to save ourselves.
The decisions being made today will directly affect the decisions that millions of frontline workers will make during a pandemic. If they feel that they are being treated as expendable cogs in a for-profit machine, they will feel no great allegiance to their workplace. And it would be hard to blame them for electing to save themselves and their families.
A shift in priorities now would go a long way in convincing people to risk exposure during a pandemic.
Yes, states and nations may decide to pass laws forcing people to work in harms's way, and they may well succeed in forcing some doctors and nurses to work under duress. They have that power if they so choose.
But it's a lousy way to run a railroad.
