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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