The article I posted a few weeks ago in regards to the H5N1 vaccine caused me to consider a potential pandemic and the health care workers’ obligation to work should the event come to pass.

The World Health Organization estimates that

today a pandemic is likely to result in 2 to 7.4 million deaths globally. In high income countries alone, accounting for 15% of the world’s population, models project a demand for 134-233 million outpatient visits and 1.5-5.2 million hospital admissions.

The romantic notion of selfless sacrifice in medicine may be the exception rather than the norm in the face of a global pandemic, which would stretch our already over-stretched resources to the breaking point. Although history has given us many noble figures in medicine, how noble will we be if we are faced with a highly virulent strain of flu to which none of us are immune, and to which a vaccine to prevent the illness might not be available until after the outbreak of the disease has already begun?

There is a precedence for this,

during the early years of the Human Immunodeficiency Virus (HIV) epidemic doctors debated whether it was acceptable to refuse to treat those with HIV; and during the Severe Acute Respiratory Syndrome (SARS) outbreak some HCW’s were not willing to treat SARS patients.

Fear is a powerful motivator. Although health care workers generally are a selfless lot, many health care workers may refuse to work during a pandemic due to fear for their own safety and that of their families. Is it ethically wrong to refuse to work if a spouse or a child becomes ill? To what extent are health care workers expected to put the welfare of others above their own, or their children’s, needs?

In the US Armed Forces, soldiers who go AWOL (absent without leave) can be severely punished, including a jail term. Can (or should) health care workers be held to the same standard, which boils down to duty to country first and personal concerns last?

I don’t have any answers to these questions. This issue will have to be addressed personally by all health care workers who are involved in direct patient care. When the time comes, we will all be faced with hard decisions.

The only thing I am sure of is that this issue should be planned for and thought about before the time comes that the notion of self-sacrifice must be put to the test.

Reference

Draper, H., Wilson, S., Ives, J., Gratus, C., Greenfield, S., Parry, J., Petts, J., Sorell, T. (2008). Healthcare workers’ attitudes towards working during pandemic influenza: A multi method study. BMC Public Health, 8(1), 192. DOI: 10.1186/1471-2458-8-192