Should doctors “have” to treat Ebola patients?

Do doctors have to treat you?

Are doctors, and other health care personnel, required to treat any and all patients, even if doing so might cost them their lives?

Think about that for a moment. I’d like to hear your opinion.

This is an issue that has come up with the recent Ebola outbreak. Though it is not a new issue, it still requires some thought in the Age of Ebola.

During the early HIV/AIDS era in the 1980s, when there was little information (but a lot of speculation) about the disease, there were physicians and other health care workers who refused to treat HIV infected patients. The doctors (even some dentists) were worried about risking their lives by treating patients who had a fatal, infectious disease that had no cure.

The Ebola virus, courtesy of Shutterstock

The Ebola virus, courtesy of Shutterstock

An accidental nick with a scalpel used on an AIDS patient could lead to the death of the surgeon. A needle stick done on an HIV positive patient by a nurse, who then accidentally stuck herself, could be fatal. Health care professionals were extremely concerned that they might catch the disease. Some outright refused to treat HIV patients entirely for that reason. Others, while concerned over their own health and safety, were also worried that their practices would suffer. Would other patients want to be in the same waiting room with AIDS patients?

You have to remember that, at the time, some members of the general public feared that HIV could be transmitted through casual contact or airborne transmission. The topic of the unwillingness of some health care providers to treat AIDS patients was raised by C. Everett Koop, MD, former US Surgeon General.

Surgeon General C. Everett Koop Wednesday denounced doctors and other health workers who refuse to treat AIDS patients as a “fearful and irrational minority“ who are guilty of “unprofessional conduct.“

In the strongest condemnation yet by any top federal health official of the small but growing number of doctors, dentists, nurses and other professionals who refuse treatment, Koop called their conduct “extremely serious“ because it “threatens the very fabric of health care in this country,“ which is based on the assumption that “everyone will be cared for and no one will be turned away.“

I had several experiences where I saw doctors, nurses, technical personnel and others refuse to treat HIV positive patients, supposedly because of the possible risk to their own health. All were allowed to make the choice of whether or not to treat. As far as I know, none was forced to treat an AIDS patient, and none suffered repercussions for their decisions.

We’re also now seeing instances from the Ebola outbreak where health care personnel have refused to treat infected patients.

Nigeria: Recently, Nigerian doctors were on strike. They had issues with some of their government’s policies. Even as Ebola reached Nigeria, they refused to end the strike (though a few weeks later they did call off the strike with the issues unresolved and are back at work.) Technically, these doctors were refusing to treat all patients, not just Ebola patients — but ethically, do doctors have the right to strike, especially during a deadly outbreak?

Charities in Africa withdrawing: Some charitable organizations have recalled their personnel from Ebola-infected areas because of the danger of contracting Ebola. Others are holding off on sending scheduled medical missions into the areas. Some, however, are maintaining their presence in the regions in spite of the risk to their personnel.

The Peace Corps also withdrew its volunteers from the affected areas a few weeks ago.

And some nurses in two of the affected countries, Liberia and Sierra Leone, are refusing to work at their clinics or hospitals. They say that there are insufficient amounts of needed supplies (masks, boots, gloves, hand sanitizer) available and that isolation protocols for infected patients are not being followed. They are afraid of contracting Ebola and will not return to work.

So we have a number of medical professionals and groups who are not willing to treat Ebola patients because of the degree of risk involved. And there are some individuals and groups who continue to treat Ebola patients, knowing the risks.

AIDS-HIV activist dispenses awareness information near Yoyogi Park, popular with teens and young adults on Sept. 18, 2009 in Tokyo. 20-30 year-olds have the highest rate of HIV in Japan. cdrin /

AIDS-HIV activist dispenses awareness information near Yoyogi Park, popular with teens and young adults on Sept. 18, 2009 in Tokyo. 20-30 year-olds have the highest rate of HIV in Japan. cdrin /

One concern that has surfaced in some online medical discussions has to do with doctors and other health care professionals treating Ebola patients. The question is, what happens if medical professionals refuse to treat Ebola patients because of the degree of risk to themselves? Can they be forced to treat these patients? Or do they have the right to refuse as a matter of self-preservation?

To date, 10 or so Ebola patients brought back to the US have been treated without incident at hospitals forewarned about them. Hospitals that are well-equipped to handle patients who need to be in isolation. But what if some members of the staff had refused? Enough so that the patient’s care was compromised. What happens then? Let the patient suffer or force staff to work?

I’m not sure that there is one right answer for all the possible scenarios in which this might occur. The answer given for poorly trained staff in a tiny, ill-equipped clinic in Africa might be very different from the answer given for the staff in a major medical center in the US. But basically, what it could come down to is who’s rights triumph. Does the patient’s right to adequate medical care supersede the doctor’s right to self-preservation.

I know what I’d say, sitting safely in the US, and currently not having any patients infected with Ebola. But would I hold the same opinion if faced with a patient who had Ebola?

What do you think? Do doctors have to treat Ebola patients?

Mark Thoma, MD, is a physician who did his residency in internal medicine. Mark has a long history of social activism, and was an early technogeek, and science junkie, after evolving through his nerd phase. Favorite quote: “The most exciting phrase to hear in science... is not 'Eureka!' (I found it!) but 'That's funny.'” - Isaac Asimov

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48 Responses to “Should doctors “have” to treat Ebola patients?”

  1. OKBlue says:

    As an emergency physician who has served on disaster teams, the first question we always ask, both as individuals and as a team, is “Is the scene secure?” It does not do much good to turn the health care providers into more patients or dead bodies. That’s already been the problem in the current outbreak–decimation of medical providers in the affected African countries. If there is adequate protective equipment then I think medical staff should take care of patients, but otherwise they have to do the best they can within the confines of protecting themselves. This requires the best information possible on how exactly to do that. Misinformation about HIV being spread through casual contact was a big problem in the initial stages of the AIDS epidemic. We need to make sure we have good information on ebola, that health care providers are educated, and that they have the resources they need to do their jobs.

  2. B.J. Nash says:

    Now that Obama has decided to force 3000 of our military to take on this task, how does that change your outlook on the original poster’s question?

  3. rmthunter says:

    No discrete “source,” just the way evolution works — very seldom does a single mutation make a dramatic change in an organism, but a series of mutations may make incremental changes but stop short of, for example, enabling the Ebola virus to become an airborne contagion. (In other words, we had a whole series of eggs before we finally got a chicken.) It’s the final one that does it. And nature doesn’t seem to be particularly averse to finding a new use for traits that developed in response to something else — just one or two small adjustments, and the structure bacteria use for infecting hosts becomes a flagellum, used for locomotion.

    And of course, we have no way of knowing how close the Ebola virus is to expressing that trait until it happens.

    As for sources — well, I confess I spent a lot of time at one point visiting, reading about evolution (Ernst Mayr’s “What Evolution Is” is an excellent book on the subject), and googling things like the intelligent design theory of “irreducible complexity” and how it was debunked.

  4. Thom Allen says:

    ER docs, hospitalists, infectious disease docs, critical care docs, IMs, FPs, surgeons, etc. sure.

    I’d hardly expect psychiatrists in private practice to be up on isolation techniques. Or most pain medicine doctors, ones in physical medicine/rehab, basically any that don’t see patients in hospitals on a regular basis.

    And let’s not forget the country docs who probably rarely need to do more than handwashing and gloves.

  5. pricknick says:

    Any doctor that does not know isolation techniques, regardless of disease, isn’t much of a doctor.

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  7. Naja pallida says:

    Posts, “people”… members of the US Congress are blathering that kind of nonsense in every forum they can. As if the situation wasn’t concerning enough, but then we have Fox Noise purposefully going out of their way to spread disinformation. Anything at all to back up their hatred of brown people.

  8. rmthunter says:

    I doubt 9-0, as long as Scalia and Thomas are on the bench. I’d guess 6-3 as more likely, possibly even 7-2, if Alito can can get past his “belief trumps fact” thing.

  9. Houndentenor says:

    I heard something interesting this week from Andy Humm on Gay USA. (That’s a public access gay news show from nyc but it’s available online as well as a free podcast from the itunes store. Anyway, it seems that the big corporations are lining up to sign on to an amicus brief in favor of gay marriage when it hits the supreme court because it’s a nightmare for them to have different rules in different states AND they have employees who will not take transfers to certain states now because basically their marriage dissolves when they cross the state line. Federal benefits only apply to federal things and a great many things (including probate) happen at the state level. And with the corporations lining up behind gay marriage some are predicting that the corporate interests will trump the religious ones among the right-wing justices resulting in a 9-0 decision. I’ll believe that only if it happens but it does make a victory far more likely and not just a 5-4 decision. It was an interesting analysis anyway.

  10. Thom Allen says:

    Comparing police to doctors is pretty much of a stretch.

    Police are more of a paramilitary organization. When hired, they realize that they may well be in danger, that could cause their deaths, possibly on a daily basis. We often hear of police officers being killed or injured. They are armed with pistols, tasers, pepper spray, body armor and other offensive and defensive weapons. Doctors don’t sign on to put their lives (and the lives of their loved ones) at risk as a part of their duties.

    Police are employed by the government and have specific duties that they are required to perform as part of their jobs. Many doctors are in private practice and can decide what patients they want to see. And some doctors are specialists who would have difficulty treating Ebola patients because they don’t have the familiarity with the disease, isolation techniques, etc. putting them at increased risk to themselves.

  11. Mark_in_MN says:

    The screening in Taiwan on arrival isn’t targeted at any specific disease, and certainly not at Ebola. It is something they’ve been doing since the SARS outbreak. Likewise, my comment isn’t specifically about Ebola and screening for it specifically, but in general screening for disease on arrival, or departure.

  12. docsterx says:

    Passengers leaving Ebola-infected areas are supposed to be screened before they are allowed to board an outbound flight. So, theoretically, any passenger with more than just a slight temperature elevation, would have been halted before leaving. But since this isn’t a perfect world, the Taiwanese may be double-checking.

  13. docsterx says:

    For Ebola, the recommendation is that they have a temperature check as part of the screening. Officials are also supposed to question travelers as to where they’ve traveled in the past 21 days (and verify with passport info when possible) ask if they’ve been in contact with anyone with Ebola or anyone who has been sick with symptoms of Ebola (coworkers, family, neighbors, etc.) Have they attended any funerals recently, especially funerals of people dying with Ebola. Have they eaten bushmeat or hunted or prepared bushmeat. So the travel history, family history and social history are important as part of a screening, as well.

  14. docsterx says:

    The can quarantine and test the patient with the fever. They can also track his contacts from the plane and follow them if the man with the fever does have Ebola. One of the reasons that Ebola has spread so efficiently in Guinea, Liberia and Sierra Leone is that they have been doing a very poor job with tracking contacts of Ebola patients.

  15. docsterx says:

    From what I’ve read, it may take more than one mutation to allow for airborne spread, if this strain even has the potential to become airborne. If you have solid evidence that shows a single mutation that would allow Ebola to spread via the airborne route, I’d appreciate a link.

  16. rmthunter says:

    I also see it as a culture-wide phenomenon, the unholy child of fear and ignorance, nurtured by those who see something in it for themselves — profit, power, what have you — and now all grown up and wearing a tricorn hat.

    There are lots of symptoms these days — the 1%, “religious freedom” trumping everything else, the anti-immigrationists (that one’s particularly ironic, considering that they are all descendants of immigrants), the “I’ve got mine, screw everyone else” contingent (and it’s not only old white men — listen to some of the anti-gay black spokesmen on LGBT civil rights), and now doctors refusing to treat Ebola patients (although the nurses mentioned in the article have a valid point — we owe it to them to make sure they have what they need to do what they signed on to do — there’s a line between altruism and insanity).

    Unfortunately, I have no answers — only questions.

  17. rmthunter says:

    A footnote to the idea of trying to keep diseases out of a country: there are often instances in which people are infected but are asymptomatic, so what is anyone going to look for? Take HIV as a prime example: many people infected with the virus don’t know it and show no symptoms for as long as a decade. Do we start screening every arriving tourist for HIV? And what else should we screen for while we’re at it?

  18. rmthunter says:

    All it takes is one mutation to make Ebola airborne — the right one. But, mutation being the random sort of thing it is, there’s no telling when or if that’s going to happen.

  19. Baal says:

    They should only be required to do this if they can be given the facilities, equipment, and protective clothing that allows them to do it safely. Of course, we need to know what that consists of. I don’t think doctors are ethically required to take unreasonable risks. Of course the problem is deciding what is unreasonable.

  20. Mark_in_MN says:

    The camera at the airport in Taiwan was on the entrance side, not at passport control for departures. So the people they are screening have already been on the airplane, quite likely for many hours.

    They started the practice during or in the wake of the SARS epidemic. That was a disease that spread from China to other parts of the globe largely via air travel. While it was serious, it didn’t prove to be quite that nightmare scenario. Nor has it been repeated sense. I don’t think that the lack of a repeat in the nearly decade and a half since SARS flew around the globe is really the result of measures like these. I think it’s simply because such events are unlikely and uncommon.

  21. Houndentenor says:

    At the end of WWI we had a global flu pandemic. We haven’t had anything quite like that since but not only could we, it would be much easier for such a disease to spread thanks to air travel. The CDC and their corresponding agencies in other countries are very afraid that something like that would happen again. I’m not sure if the Taiwanese practice will help but not putting someone with a fever on a plane is not a terrible idea. Send them to a hospital rather than letting them infect an entire plane, then an airport, then all the planes that people at the airport get on and on and on…that’s a nightmare scenario obviously but it could easily occur and honestly it’s rather surprising that it hasn’t (at least not to that extent).

  22. Mark_in_MN says:

    I’m not sure that I would call upon our own self-interest, long or short term, as a reason to combat diseases in other parts of the globe. I’d want to argue that we should do so for the interests of the people where the outbreak is occurring. That is, we should do it for compassionate reasons, rathe than self-interested ones. (But if appalling to someone’s self-interest is the only way to motivate a compassionate act, then I guess that’s better than nothing.)

    But I also think that attempts at keeping diseases out of a country are rather futile and perhaps often a waist of resources. I don’t think we can control microbes that well. That doesn’t mean we should intentionally import things, but it also means that if it’s going to come, it’s inevitably going to come. I recently visited Taiwan. At the airport, right at the entrance to the customs area, they had an inferred camera looking for people with fevers. They paid someone to sit at that booth and monitor the camera. They also send that video feed to their CDC, where it is also monitored. They get few positives, and almost all of those are false positives. It was started during the SARS epidemic. But of what use is it if they do detect something. The best they can do is either send the person back on an airplane or isolate them in a hospital. But they have already potentially exposed people, and might do so even in isolated care. Is the expense really going to be worth it? I’m thinking it simply is not over the long term.

  23. Mark_in_MN says:

    Yes, I think doctors have an ethical and moral obligation to treat all patients. In entering their profession, they have devoted themselves and their lives to caring for those who are sick, ill, and injured. That brings with it a serious obligation to all. It is good for them to take necessary precautions to protect their other patients, and themselves. The knowledge and equipment necessary to do so should be provided to the best of our ability to do so. But necessary precautions should never include not treating a patient. That sentence should end with the word “period.” It is probably inevitable, however, that some physicians and medical staff will buck ethical requirements in the face of an especially deadly or terrifying disease or high risk situation. They probably shouldn’t be “forced” to provide that care unwillingly, but neither should they expect that unwillingness to provide care to be without consequence of one sort or another (best determined based on the facts of the situation than a general rule or universal ethical pronouncement).

  24. Indigo says:

    I want to assume that a medical doctor is obligated to treat whomever crosses the threshold but I’m also aware that hospitals turn away patients on a regular basis based on their inability to pay. Doctors regularly refuse this, that, or the other patient because they don’t have the correct insurance. At least here in that States, it’s the Insurance Establishment rather than the medical profession that make those decisions anyhow.

    Maybe if doctors were to hold themselves to a loftier ethic than financial motivation, there would be a revolution in the American Medical Establishment. As things stand, although an interesting debating point, medical ethics doesn’t play a major role outside of the conceptual realm except as contractual obligations in the clinic or hospital or corporate practice or insurance decisions where the individual doctor does business. Should a medical doctor treat whoever comes in the door? Old fashioned common sense says, Yes, of course! Existential reality in the world where we draw our breath suggests otherwise.

  25. docsterx says:

    The New York Times has a brief video showing a family trying to get an Ebola victim admitted to a tiny, overfilled hospital. It’s called, “Dying of Ebola at the Hospital Door” and shows the severe lack of supplies, isolation beds, frustration, fear and other emotions facing the people in these areas.{%222%22%3A%22RI%3A18%22}

  26. docsterx says:

    I like your immune medical technician approach. That would decrease patient load, would be good PR (“I survived Ebola!”) to help encourage people to go to hospitals, etc.

  27. docsterx says:

    I’ve seen some posts where some people are claiming that Ebola is already coming across the Mexican border.

  28. docsterx says:

    I saw it and I don’t want to second guess his motives, but he could easily cause people to panic.

    Ebola does mutate. Ebola has been known for about 40 years. Yet in that amount of time, no respiratory cases have been seen. So 40+ years of Ebola mutating and it hasn’t become airborne. Also, it’s not known what mutations (or how many) might be necessary to make Ebola airborne. It’s not even known if ANY mutation(s) will allow Ebola to be able to spread via the airborne route.

  29. docsterx says:

    During the AIDS epidemic, I saw both types. One surgeon would refuse patients if he even THOUGHT that they were gay, even if their HIV test was negative. Others made logical decisions on a case-by-case basis. Others just went ahead and saw them without fanfare.

  30. GarySFBCN says:

    I agree with you, but I think you missed my point. We should be using all resources to fight this virus. But the op-ed author proposes some ridiculous ‘what if’ scenarios that do nothing other than to incite hysteria. I’m guessing that any day now, it will be cited by some right-wing nutcase to make the case against any immigration.

  31. Houndentenor says:

    One of many lessons that our species seems not to learn is that isolated events like wars and diseases have a tendency to wind up on our doorsteps anyway. Ignoring an outbreak in Africa or Asia is shortsighted. Stopping it there is in our own long-term interests. And the cost of that is minor compared to dealing with an epidemic here. Imagine if proper actions had been taken at the beginning of the AIDS crisis? Or any other such medical crisis. Of course that’s the same line of thinking that leaves us unprepared for natural disasters that are inevitable (see: Katrina, et al.) because we think we can just wish away the future danger and maybe it won’t happen? Such thinking is short-sighted and foolish and unfortunately epidemic at all levels of our government and society.

  32. Houndentenor says:

    I worry about what’s happening in our culture. I see people getting angry at having to get out of the way of ambulances (or even not doing so). Are we that selfish? Yes. And to think we have a whole political movement that tells us we aren’t selfish enough.

  33. pricknick says:

    As a RN, I would refuse to work with any doctor who did not care for a patient regardless of the medical need.

  34. docsterx says:

    There are some great questions below and interesting opinions. Thanks for contributing.

    Let me give you a little more background information on the “to treat or not to treat” question.

    I mentioned this below in response to a question raised by Tamarz. She asked if any of the boards had come out with guidelines as to whom might have to, or not have to, take care of Ebola patients. During the AIDS epidemic a similar question was raised. The AMA said:

    In warning doctors that they have no ethical right to decline to
    treat patients who test positive for the human immunodeficiency virus
    (HIV), the AMA ethics council noted that “the tradition of the American
    Medical Assn., since its organization in 1847, is that when an epidemic
    prevails, a physician must continue his labors without regard to the
    risk to his own health.”

    Upholding Tradition

    In the new AIDS statement, the council emphasized that “that tradition must be maintained.”

    those who have the disease nor those who have been infected with the
    virus should be subjected to discrimination based on fear or
    prejudice–least of all by members of the health care community.

    is an ethical pronouncement and not legally binding, The AMA also
    supplied some wiggle room as to how to get rid of HIV patients by
    passing them off to other doctors.

    The AMA suggested that if
    patients felt that they were being turned away because of their HIV
    status, they could contact their state’s medical licensing board to file
    a complaint.

    I can’t find anything similar about Ebola, yet.

    I’m not a lawyer or medicolegal expert but I’ve gleaned some information over the years that might be relevant.

    I found out, about 20 years ago, that doctors and other health care personnel do NOT have to render aid in an emergency situation at an accident site. I was in residency at the time, and sever of the residents were arguing over that idea. We asked the hospital attorney and he said that there was nothing to force us to render emergency care unless we were on salary at the time. However, if we DID begin emergency care then we were liable to continue it till the patient got to an ER, was handed off to another doctor or died. So if a doctor sees an Ebola patient, or any other, patient on the street or at his office door, he doesn’t have to treat him. But if the patient is already in his practice and develops Ebola, then he will need to treat him, at least until he can transfer him to another doctor. [This information is based on state law that’s probably 25 years old now. It may not be completely applicable today.]

    If a doctor is refusing to treat all Ebola patients who come to him for treatment, that could lead to a discrimination suit. State laws would apply. Or the state medical board could investigate and, if proven, require him to take Ebola patients or just shut down the office.

    A doctor does not have to accept new patients. I’m sure that many of you have had this happen. You call to make an appointment with a new doctor and the receptionist tells you that the “office can’t take new patients.” There are any of a number of valid reasons for this. Doctor shortage at the practice. Practice overcrowded. Doctor going to retire or sell practice. Practice being bought or merged. And other reasons.

  35. docsterx says:

    Good question. Nothing that I’ve seen about mandating that doctors must treat Ebola. However, the American Medical Association did come out during the AIDS epidemic and say that doctors were ethically obligated to treat AIDS (and HIV) patients.

    From the AMA:

    In warning doctors that they have no ethical right to decline to
    treat patients who test positive for the human immunodeficiency virus
    (HIV), the AMA ethics council noted that “the tradition of the American
    Medical Assn., since its organization in 1847, is that when an epidemic
    prevails, a physician must continue his labors without regard to the
    risk to his own health.”

    Upholding Tradition

    In the new AIDS statement, the council emphasized that “that tradition must be maintained.”

    those who have the disease nor those who have been infected with the
    virus should be subjected to discrimination based on fear or
    prejudice–least of all by members of the health care community.

    This is an ethical pronouncement and not legally binding, The AMA also supplied some wiggle room as to how to get rid of HIV patients by passing them off to other doctors.

    The AMA suggested that if patients felt that they were being turned away because of theit HIV status, they could contact their state’s medical licensing board to file a complaint.

  36. 1jetpackangel says:

    There’s a paramedic’s blog that I like to read, and every time his pager goes off in the middle of the night or while he’s suffering from the revenge of Taco Bell, even if he knows the address and the medical history of the person at that address and just knows the complaint will be non-emergent and he knows his services would be better spent on people who are actually dying, he’s still ruled by one ethos: “You call, we come.” I can understand self-preservation, but what I really wonder is how long a refusing medical professional would think over the decision before making it. Do they wonder how useful they could be, do they weigh the risks versus how many people they could help? Those people, I’m okay with it. It’s why not everybody rushes into a burning building to save somebody. But the knee-jerk “Nope, not touching Ebola” really bothers me.

  37. Colin says:

    I agree with your point Naja though I disagree with any basic idea that nobody is really responsible for anything if the going gets too rough. Like I said , if you are afraid of the water , don’t go to Sea.

  38. Naja pallida says:

    Except there really is no standard oath that all physicians take. There are about ten different ones, that all say different things. Some don’t even take an oath, as there is no legal requirement to do so. While it may be the ethical and moral ideal, it really doesn’t apply, as much as we’d like it to. I would argue that such an oath would be violated by participating in a for-profit health care system, much less refusing to treat someone.

  39. Tatts says:

    Yes, they have to treat them. There are precautions that everyone knows about that can protect the doctors. If they don’t want to, or haven’t thought about this before, they shouldn’t be doctors (or they should be podiatrists).

    Watch the recent PBS Frontline episode about Ebola and Boko Haram (two separate stories). It’s very sad watching the people who are sick, and whom we know will soon be dead (not all, but most).

  40. Colin says:

    I swear by Apollo Physician and Asclepius and Hygieia and Panaceia and all the gods and goddesses, making them my witnesses, that I will fulfil according to my ability and judgment this oath and this covenant: ………

    I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person’s family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.

    I will prevent disease whenever I can, for prevention is preferable to cure.

  41. quax says:

    A dead doctor is no help to anybody, if a doctor has good reason to fear for his, or her, own life it’ll be unethical to force this individual to perform a treatment.

  42. BeccaM says:

    Well… in a word, yes. Providing treatment is both the moral and ethical thing to do. To withhold treatment might reduce an individual doctor’s risk, but it increases the risk for everyone else, due to the greater likelihood of disease transmission. It is a societal imperative.

    However, I would add that it is also necessary, moral, and ethical to provide healthcare professionals with the absolute top-of-the-line protective gear and decontamination facilities. And absolute top-rate healthcare if they should become sick. And as Psyspace notes, there are things that can be done to greatly reduce the direct risks to physicians and nurses, including teaching Ebola survivors how to care for the sick, provided the survivors are willing.

    We have professions in our society where certain sacrifices and accommodations are expected. A firefighter isn’t allowed to refuse to put out a fire because he doesn’t like the people living in the house. A police officer can’t refuse to serve in a given area because he or she thinks it’s too dangerous, as noGOP notes below. If you want to be an astronaut, you’d best be okay with enclosed spaces and zero-G. And if you want to be a soldier, you have to be willing to take orders that might include killing other people.

    Doctors, nurses, and other healthcare professionals are faced with sick people every day. That’s their job. Ebola is just one of the many scary things they have to deal with, although yes, the high mortality rate makes it scarier than most. But if that’s seen as a justification for refusing to do one’s job, where do we draw the line? HIV, Hepatitis, prion diseases, drug-resistant strep and staph — heck, even the flu can kill. Is one chance in 100 enough of a fatality risk for a doctor to turn away? How about one in 10?

    No, you can’t force someone to treat a patient if they don’t want to. On the other hand, a position on a medical staff is a privilege, not a right. If you’re collecting a paycheck but refusing to treat “certain” patients, that means you’re actively preventing someone who would do your job from doing so. To be harsh about it, if a doctor doesn’t want to deal with sick people, he or she should go into cosmetic surgery or something similar, or leave the profession altogether.

    Basically, a doctor’s right of self-preservation consists of the right to quit his or her job (or switch to one of the medical disciplines that doesn’t involve sick people at all). That’s the third alternative to the question, “Let the patient suffer or force the staff to work?” Namely, “Fire the staff who won’t work and replace them with staff who will.” And like I said at the beginning of this comment, the necessary moral and ethical thing to do is to provide them with the absolute best of training, equipment and facilities possible. (The biggest problem in Africa right now is they have none of those things.)

  43. GarySFBCN says:

    Off topic, but did you see this op-ed in the NY Times? I’m guessing that the author’s objective is to motivate people to act now to stop Ebola, but it seems irresponsible in that it WILL incite hysteria, discussing ‘what if the virus mutates.’ If many viruses mutate, especially some nasty flu viruses that are confined to animal to human transmission, the results could be devastating.

    “What We’re Afraid to Say About Ebola”

  44. Psyspace says:

    I am a physician myself. These are very difficult questions that you raise here. I guess that my approach would be biphasic. People and professionals are driven by many different, complex and at times inexplicable factors. At the same time that some professionals would run away from treating ebola patients there seem to be significant numbers drawn to this work. Be this for religious reasons, for professional ethical reasons or general high-risk taking behavior. In this first phase I would say “yes” let medical professionals answer their own personal callings be it self preservation, prioritization of ones family’s wellbeing or an altruistic (or other) drive to serve in high risk environments. I see this as a “fair” approach to the professional and one likely to provide the most compassionate care to the suffering patient. I guess the second phase would be if and when availability of care is compromised by a lack of willing professionals…it is here where the answers become more murky for me and the sense that there is a “greater duty” for those of us who society has trained and licensed. I think about the nuclear plant workers in Chernobyl who entered the plant to face certain radiation poisoning and likely death.
    Now, as an ebola specific measure that is more practical and less moral / ethical. We should be sending teams to Africa to train ebola survivors to be basic medical technicians (and we should pay them well for their services). Evidence suggests that ebola survivors develop immunity to the particular ebola strain. Their must be over 1000 survivors now. These medical technicians would be able to limit the exposure of uninfected professionals and other workers.

  45. noGOP says:

    can police refuse to take calls in an area that poses a greater danger to them?

  46. Outspoken1 says:

    This is a double-edged sword. As a massage therapist, I am at risk (though very minimal) for blood-born pathogens. Sports massage events often have people who have crashed or fallen during the event or in prior training and may have open or scabbed wounds. There is the rare shaving wound or other open wound during a traditional table massage. My solution is to treat everyone as if they have some sort of blood-born pathogen and not work around the area of the wound. If they are bleeding (a scab that may have come off), I keep polysporin and bandages in my office and cover the wound. I always carry gloves to use in case there is some other hazard for me touching the client. (For instance, some types of chemo exude through the skin and can be harmful to me.) So with proper precautions, I choose to treat my client. Again, I am also at very minimal risk.

    On the flip-side, I have to admit I did not provide a chair massage to the man with all the Nazi and other hate-tattoos. I just kept working on the person in my chair until he left. While relating the story to a friend of mine who was a nurse, she did comment that I had acted discriminatorily (is that a word?). She further explained that she takes care of women who have had abortions while she is vehemently opposed to abortion. This did give me great cause for reflection and I still have not really come to a satisfactory answer for me. I try not to discriminate, but … You get the idea.

    HIV/AIDs and Ebola do raise very similar ethical and professional issues. I could be wrong, but I understand the striking medical workers were primarily striking because of lack of supplies to keep themselves safe. The issue seems to be lack of support for proven safety procedures rather that discrimination against Ebola patients.

    All of us live in this giant Petri dish. An virus can become a threat to any population on this planet. Learning and controlling the virus (as best we can) is the safest solution for everyone.

    Great read of a similar medical crisis – The Great Influenza by John M. Barry.

  47. 2patricius2 says:

    I think of the person bringing food to my first buddy with AIDS in the hospital, opening the door, putting the tray on the floor, and shoving the tray into the room. I think of the first responders who went into the towers on 9/11 to rescue those in the towers.

    Not being a doctor, and not being a fireman or EMT or food provider in a hospital, I can’t give a definitive answer. I did, however, work as a mental health professional for quite a few years, and there were also dangers from a few unpredictable patients in the office and on hospital wards. There are dangers inherent in the work of some professions, and the question is whether those who choose to work in those professions should refuse to carry out their duties under certain circumstances.

  48. tamarz says:

    Ebola is terrifying and I can understand why medical personnel would refuse to treat an Ebola patient — particularly when many medical personnel in Africa have already died (I think I read 120?). It’s pretty clear that medical personnel in the West African countries don’t have the protections they should have to avoid contracting Ebola. Safe in my western country, I don’t feel I can judge doctors or nurses in Africa who avoid Ebola. But I have tremendous admiration for the medical people there who continue working with Ebola patients.
    I have to assume that when CDC sent more people to West Africa, they did not force anyone to go who didn’t want to. And I wonder if the medical personnel at Emory and the other places treating Ebola here in the U.S. were given a choice. While I’d have less patience for someone here in a good hospital who refused to care for an Ebola patient, still, I can understand the reluctance. What if you have young children at home and you view caring for an Ebola patient as putting your whole family at risk? (I feel lucky to be a non-clinical public health person who will never have to make that decision).
    On the ridiculous end of this discussion about whether doctors/nurses are required to treat all comers is the “conscience clause” that many states have enacted that allow doctors and pharmacists to refuse care for something that goes against their moral values. (some states only allow this when it comes to women’s reproductive care — you don’t hear about a pharmacist refusing to fill a prescription for ED for an unmarried man, for example).
    Have any of the medical societies and boards come out with statements about the ethics of either end of this spectrum — the very difficult issues of treating a dangerous infectious disease versus the political decisions by some not to provide care or medications that endangers the provider not at all?

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