Studies show that not all providers will report to work in the face of an epidemic. One self-reporting study found that 20% of physicians would report to work.1 Every hospital effected by the SARS epidemic had difficulty with employee attrition.2 Thus, the concern is more than hypothetical.
There is a difference in putting oneself at risk for an illness and putting oneself at risk of death. Providers might be immunosuppressed or have, say, an underlying lung disease. Should higher-risk providers with direct patient contact responsibilities have the same obligation as providers who are not?
Providers who care for others will face different challenges. First, if social distancing becomes widespread and schools and daycare centers are closed, providers will face a dilemma over how to care for their dependents. A second issue for providers with responsibilities to care for others is that those dependent populations are likely to be at higher risk of bad outcomes if they are affected. A provider who is infectious puts their family at risk. Children may be disproportionately affected, and people who require assistance are more likely to have comorbid conditions. Should providers with other responsibilities have the same obligation as providers who do not?
Given that risk is not the same among providers, it is unfair to say that responsibility is the same. Parents simply cannot abandon their children. Risk of death is a serious concern for providers at higher risk. Hospitals should have an explicit plan in place for a pandemic; most do have a plan. The plan needs to consider these issues and have explicit provisions.
Another approach would be to ask providers to state their availability. If the hospital knows that a certain group of providers has specific concerns, the plan can take into account what impact those concerns will have. Transparency in the plan, expectations, and resources will better prepare hospitals.
There is a fundamental duty to provide care to patients who need it, and failure to do so is a violation of a societal and professional trust. However, this duty is not absolute. Giving providers that benefit of the doubt—that they will honor their duty to ill or injured patients—means that providers can be trusted to opt out only for valid reasons. The system must be designed to accommodate special needs. A one-size-fits-all approach is bound to fail. TH
References
- Alexander GC, Wynia MK. Ready and willing? Physicians’ sense of preparedness for bioterrorism. Health Aff (Millwood). 2003;22(5):189-197.
- Wynia MK. Ethics and public health emergencies: encouraging responsibility. Am J Bioeth. 2007;7(4):1-4.
The opinions expressed herein are those of the authors and do not represent those of the Society of Hospital Medicine or The Hospitalist.