Covid-19 has led to renewed interest and discussion regarding the duties of physicians in a high risk environment. The pandemic resulted in large shortages in emergency and critical care providers, and those that remained were overworked and dealing with shortages of key equipment such as personal protection devices. In one study during the pandemic, about 25% of physicians and nurses thought it was ethical for health care providers to abstain from treating patients given the personal risk to themselves and their families [1]. Those who choose healthcare as a career certainly assume certain risks relating to psychological stress, long hours, and personal risk such as exposure to harmful and potentially deadly infections. When these challenges increase dramatically, which moral and ethical duties are inherent in the jobs of physicians? I argue that there is an ethical duty for physicians to treat patients despite the personal risk involved during events such as pandemics.
An important consideration in discussing physicians’ duties and responsibilities is that of implied consent. Since it is commonly accepted that some patients are infected and contagious, it is reasonable to assume that risk is inherent in the field of medicine, and by entering the field certain risks are implied and accepted. Although this does not imply that a duty to treat exists, it establishes an accepted reality regarding physician practice.
In 1847, the American Medical Association published its first Code of Ethics stating, “When pestilence prevails, it is their [physicians’] duty to face the danger, and continue their labors for the alleviation of suffering even at the jeopardy of their own lives” [2, p. 3]. While this wording no longer exists in the AMA code, it points to the long tradition of self-sacrifice in the field of medicine, a concept which draws many to pursue the profession. In addition, pledges made by physicians such as the Hippocratic Oath reference the special nature of physicians’ duties. The World Medical Association has a similar pledge, although like the Hippocratic Oath, does not address risk to physicians [2].
When discussing the difficult concept of physician duty to treat, it is also useful to consider the ethical concept of beneficence. In their work entitled, Bioethics: The Islamic Perspective, Al-Bar and Chamsi-Pasha argue that the principle of beneficence has special meaning for health care workers, and implies unique moral obligations. They state, “beneficence is a continuum…professionally things which are considered as supererogatory for the public become obligatory for the professional, e.g., a physician or nurse in a hospital where he is tending patients with highly infectious diseases” [3, p. 132]. This perspective goes a step further in applying unique moral duties to physicians.
Making broad arguments about moral and ethical duties is particularly challenging, because physicians may face health risks that extend to others–family members at home may be especially vulnerable to an infectious disease. Although contentious, the concept of beneficence still applies: physicians have a unique commitment to provide. In the case of a future epidemic, perhaps one that is more lethal than Covid-19, a physician who pauses their labors to protect members at home may indirectly result in deaths of others. Risks that extend into a physician’s personal life should not interfere with priorities when health care is valuable and dire. These duties should be clearly outlined for prospective health care providers, as ambiguities in a code of ethics will not guarantee care from physicians.
References
McConnell D. (2020), “Balancing the duty to treat with the duty to family in the context of the COVID-19 pandemic”, Journal of medical ethics, April 24, 2020
Kirsch T. D. (2022), “Heroism Is Not a Plan-From "Duty to Treat" to "Risk and Rewards”,” The American journal of bioethics, March 4, 2022
Al-Bar MA, Chamsi-Pasha H. “Contemporary Bioethics: Islamic Perspective”, Cham (CH): Springer, May 28, 2015