The news has been rampant with discussions about Ebola lately, but many centers are handling the integration of learners into their disaster plans differently. This month’s ALiEM MEdIC series case hopes to elicit our community’s considerations on the ethical and educational principles behind education during a possible outbreak scenario. Join us as we discuss this topic!

MEdIC Series: The Concept

Inspired by the Harvard Business Review Cases and initially led by Dr. Teresa Chan (@TChanMD) and Dr. Brent Thoma (@Brent_Thoma), the Medical Education In Cases (MEdIC) series puts difficult medical education cases under a microscope. On the fourth Friday of the month, we pose a challenging hypothetical dilemma, moderate a discussion on potential approaches, and recruit medical education experts to provide “Gold Standard” responses. Cases and responses are be made available for download in PDF format – feel free to use them! If you’re a medical educator with a pedagogical problem, we want to get you a MEdIC. Send us your most difficult dilemmas (guidelines) and help the rest of us bring our teaching to the next level.

The Case of Ebola Outbreak Ethics

by Sarah Luckett-Gatopoulos (@SLuckettG)

There were patients in the emergency department to be seen, but Katelyn, Amy, and Hamad were gathered around a computer in the back room. The three residents were whispering urgently about the patient in Acute Care Room 4. She had arrived in the department only minutes before with a fever and sore throat. Not an unusual presentation for a patient in the emergency department, except that this particular patient had flown through the Lungi International Airport in Freetown, Sierra Leone only two weeks before. With the recent introduction of the Ebola virus into North America, everyone was on high alert, and this patient had been identified immediately as a possible case. As Katelyn searched the departmental website for an instructional video on personal protective equipment, the emergency department was kicking into high gear. The only two cases reported thus far in North America were front-line health care workers who had been exposed to the virus when infected practitioners were transported from Africa for care. Everyone working in the department had seen the frequent reports on CNN, read the headlines in the Globe and Mail, and were aware of the WHO’s warnings that health care workers were at highest risk. They all now worked with urgency to collect the prepared PPE kits, review procedures, and alert the relevant authorities. “Dr. Chen had better not ask me to see her,” Amy declared grimly, mouth set in a thin line. “I don’t know how I’d say no, but I definitely do not want to expose myself to a patient infected with Ebola. I won’t risk bringing it home to my family. It’s bad enough that there may be one victim; I don’t want to be the one to multiply that number.” “Are you kidding me?” Hamad countered. “I’ve heard that staff plan to block residents from seeing suspected Ebola cases. That’s crazy. If there’s a case of Ebola in this town, I want to be involved. I should get to make that decision.” Katelyn chewed her lip. “I’m not sure we have a choice in the matter, guys. We have to attend to the needs of our patients, and we’ve been given the resources to protect ourselves,” she pointed out. The three turned their attention to the personal protective equipment instructional video, refreshing themselves on the donning and doffing procedures they had practiced in the department just days before. Heading back out into the acute care section of the department, they watched through the glass window of room 4 as a nurse in full protective gear attached the patient to monitors. Stepping out into the anteroom, he removed his personal protective equipment with great care. A nursing colleague kept a watchful eye to ensure he avoided contamination. Suddenly, the patient’s bedside monitor started to alarm. The patient was tachycardic at 120. Blood pressure 70/40. The residents looked to one another – what should they do?

Key Questions

Should residents be expected to see patients with suspected Ebola in the emergency departments or other settings? What about physicians? If asked to see a patient by someone in a position of power (most likely an attending physician), how and when can residents refuse if they feel uncomfortable? Should residents and other learners be blocked from seeing these patients? Is this a paternalistic strategy or a necessary protection of a vulnerable population who might not be able to refuse when asked by a direct supervisor? Should crashing patients with suspected Ebola in the emergency department be resuscitated when this might result in dispersion of blood and other bodily fluids?

Weekly Wrap Up

As always, we posted the expert responses and a curated commentary derived from the community responses one week after the case was published. This time the two experts were:

Dr. Jennifer Tang (@JCTangMD) is a staff ED physician at Hamilton Health Sciences and a medical ethicist. She holds a Masters in Ethics from the University of Toronto. She is a Clinical Scholar at McMaster University, serving as a clinical and instructional teacher for residents and students.

(@JCTangMD) is a staff ED physician at Hamilton Health Sciences and a medical ethicist. She holds a Masters in Ethics from the University of Toronto. She is a Clinical Scholar at McMaster University, serving as a clinical and instructional teacher for residents and students. Dr. N. Seth Trueger (@MDAware) holds a Masters of Public Health, and has completed a fellowship Health Policy. He is also the Assistant Social Media Editor for Annals of Emergency Medicine.

On December 5, 2014 we will post the Expert Responses and Curated Community Commentary for the Case of Ebola Outbreak Ethics. After that date, you may continue to comment below, but your commentary will no longer be integrated into the curated commentary which will be released on December 5, 2014. That said, we’d love to hear from you, so please comment below!

All characters in this case are fictitious. Any resemblance to real persons, living or dead, is purely coincidental. Also, as always, we will generate a curated community commentary based on your participation below and on Twitter. We will try to attribute names, but if you choose to comment anonymously, you will be referred to as your pseudonym in our writing.