Abstract
When infectious disease outbreaks strike, health facilities acquire labels such as “war zones” and “battlefields” and healthcare professionals become “heroes” on the “front line.” But unlike soldiers, healthcare professionals often take on these dangerous roles without any prior intention or explicit expectation that their work will place them in grave personal danger. This inevitably raises questions about their role-related obligations and whether they should be free to choose not to endanger themselves. In this article, I argue that it is helpful to view this situation not only through the lens of “professional duty” but also through the lens of “role-related conflicts.” Doing so has the advantage of avoiding exceptionalism and allowing us to draw lessons not only from previous epidemics but also from a wide range of far more common role-related dilemmas in healthcare.
Highlights
Bioethical InquiryThere have already been cases of healthcare workers (HCWs) protesting and even striking over lack of adequate protective equipment (PPE) and other perceived forms of mistreatment by governments or hospital administrators (Anadolu Agency 2020; Jeffery 2020)
When infectious disease outbreaks strike, health facilities acquire labels such as “war zones” and “battlefields” and healthcare professionals become “heroes” on the “front line.” But unlike soldiers, healthcare professionals often take on these dangerous roles without any prior intention or explicit expectation that their work will place them in grave personal danger
This is because they don’t see themselves as heroes, because they are doing what they “have always done” (KevinMD Blog 2020, ¶1). In other cases it is because it is they associate heroism with lack of fear—and they are afraid (Lake 2020; Kane 2020). It is because they see the hero narrative as a means by which the public and politicians can assuage their guilt and feign appreciation despite acting for decades in ways that actively undermine health services, failing to prepare adequately for the pandemic, and, failing to engage in adequate social distancing and provide healthcare workers (HCWs) with adequate personal protective equipment (PPE) (Darlow 2020; Miller 2020; Mathers and Kitchen 2020): Private businesses and citizens are offering generous displays of public support for their doctors and nurses, cheering for them every evening, buying them dinner in hospital wards, and thanking them profusely for their service
Summary
There have already been cases of HCWs protesting and even striking over lack of adequate PPE and other perceived forms of mistreatment by governments or hospital administrators (Anadolu Agency 2020; Jeffery 2020). This discourse focuses primarily on the moral bases of HCWs’ so called “duty to care,” including both general duties and virtues such as altruism, beneficence, non-abandonment, justice, and solidarity (Klopfenstein 2008; Vawter et al 2008; Lowe, Hewlett, and Schonfeld 2020; Sawicki 2008) and more specific professional duties The foundations of these specific moral duties (which, in this context, refer primarily to obligations to individuals or groups) have been variously framed in terms of HCWs’ status as healing professionals, their voluntary choice to enter risky occupations and professions, their obligation to repay society for its investment in their training and for the professional privileges they enjoy, and their special training which means that they are both the most skilled and the “safest” providers of care during infectious disease outbreaks (Clark 2005; Malm et al 2008; Dawson 2016; Daniels 1991; Mareiniss 2008; Huber and Wynia 2004; Sawicki 2008). In the context of COVID-19, ethicists have argued that, while there is a duty to care, this duty is context-specific (e.g., depending on the likelihood of a patient benefiting from care, the HCW’s training, and their personal health status) and holds only if there is adequate planning and reciprocity in the form of PPE, reasonable shift schedules, professional acknowledgement, financial compensation, social and psychological support, information and training, testing and monitoring, and (more controversially) protection from litigation and priority access to critical care (Schuklenk 2020; Dunn et al 2020; Hick et al 2020; British Columbia Ministry of Health 2020)
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