Better late than never: a re-examination of ethical dilemmas in coping with severe acute respiratory syndrome

Department of Nursing, Tel Aviv University, Tell Afif, Tel Aviv, Israel
Journal of Hospital Infection (Impact Factor: 2.54). 10/2005; 61(1):75-9. DOI: 10.1016/j.jhin.2004.12.018
Source: PubMed

ABSTRACT At the end of 2002 severe acute respiratory syndrome (SARS) emerged and spread worldwide. The pathogen was unknown, as was its mechanism of transfer, and there was no effective therapy for the disease. There was a large element of hysteria and anxiety in society's reaction to SARS. The initial steps taken to cope with SARS were clear-cut and even dramatic. Decision-making in a time of emergency is associated with a high potential for ethical dilemmas and conflicts. In the course of efforts to cope with a threatening disease, it is important to appraise our activities from an ethical point of view. A retrospective look at this period of time shows that we did not do this. This article examines the ethical aspects of the process undertaken to cope with SARS in our medical centre.

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Available from: Ilya Kagan, Jan 29, 2015
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    • "At the same time, however, serious concerns did surface during SARS about the extent to which HCPs would tolerate risks of infection [8,9]. Some baulked at providing care to those infected with the unknown virus. "
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    ABSTRACT: As a number of commentators have noted, SARS exposed the vulnerabilities of our health care systems and governance structures. Health care professionals (HCPs) and hospital systems that bore the brunt of the SARS outbreak continue to struggle with the aftermath of the crisis. Indeed, HCPs - both in clinical care and in public health - were severely tested by SARS. Unprecedented demands were placed on their skills and expertise, and their personal commitment to their profession was severely tried. Many were exposed to serious risk of morbidity and mortality, as evidenced by the World Health Organization figures showing that approximately 30% of reported cases were among HCPs, some of whom died from the infection. Despite this challenge, professional codes of ethics are silent on the issue of duty to care during communicable disease outbreaks, thus providing no guidance on what is expected of HCPs or how they ought to approach their duty to care in the face of risk. In the aftermath of SARS and with the spectre of a pandemic avian influenza, it is imperative that we (re)consider the obligations of HCPs for patients with severe infectious diseases, particularly diseases that pose risks to those providing care. It is of pressing importance that organizations representing HCPs give clear indication of what standard of care is expected of their members in the event of a pandemic. In this paper, we address the issue of special obligations of HCPs during an infectious disease outbreak. We argue that there is a pressing need to clarify the rights and responsibilities of HCPs in the current context of pandemic flu preparedness, and that these rights and responsibilities ought to be codified in professional codes of ethics. Finally, we present a brief historical accounting of the treatment of the duty to care in professional health care codes of ethics. An honest and critical examination of the role of HCPs during communicable disease outbreaks is needed in order to provide guidelines regarding professional rights and responsibilities, as well as ethical duties and obligations. With this paper, we hope to open the social dialogue and advance the public debate on this increasingly urgent issue.
    BMC Medical Ethics 02/2006; 7(1):E5. DOI:10.1186/1472-6939-7-5 · 1.50 Impact Factor
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    • "tients in countries outside China were health care workers , who became infected when caring for recognized or unrecognized patients with SARS ( Wenzel et al . 2005 ) . Professional decision - making was most difficult , with many ethical dilemmas and conflicts , and with the need to appear calm and professional amid chaos , anxiety and hysteria ( Ovadia et al . 2005 ) . Workers and leaders of a SARS designated hospital acknowledged that , although they made an effort to meet the conditions of accountability of reasonableness , the decision - making was not ideal ( Bell et al . 2004 ) . The work was also technically and physically demanding with the necessity to be scrupulous in infection control me"
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    ABSTRACT: Public health emergencies, such as hurricanes and the constant threat of an influenza pandemic, present public health responders with many ethical issues and little time to think them through. We interviewed 13 responders in the Epidemiology Section of the North Carolina Division of Public Health to learn how they have identified and addressed ethical issues in public health emergencies affecting the state and to identify potential means of improving those processes for North Carolina and other states. The Epidemiology Section staff demonstrated an awareness of several ethical issues in public health emergencies and an ability to identify and address issues through group interactions. However, few study participants in the section had received any training in public health ethics. Perhaps for this reason, the range of ethical issues they identified excluded several mentioned in the Public Health Code of Ethics. Moreover, their ethical decision making could be enhanced by a more detailed understanding of the ethical issues they named. We recommend seven practical steps that the Epidemiology Section can take to improve their ability to identify and address ethical issues in a public health emergency. The recommendations are likely relevant to many state, city, and county public health departments throughout the United States.
    Journal of public health management and practice: JPHMP 01/2009; 15(2):E16-21. DOI:10.1097/01.PHH.0000346021.06803.76 · 1.47 Impact Factor
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