Duty to care: acknowledging complexity and uncertainty.

As a regulated health professional what are your obligations in situations such as SARS, a Katrina-like event or an influenza pandemic? Do you know? If you do not know, where would you seek guidance? Have you had a conversation about these issues with colleagues? With your family? With management? With your professional association? The issue of duty to care is one of profound ethical significance. In communicable disease outbreaks, individuals providing care may expose themselves or their family to the risk of infection, which could lead to serious morbidity and possibly death. Most healthcare workers are in ethically complex situations, balancing other-regarding obligations (to colleagues, patients, family, for example) and self-regarding obligations (to maintain wellness). Members of the public may expect healthcare workers to behave in a self-sacrificing way, serving society like members of the armed forces or emergency forces with no chance to opt out of situations of significant personal risk. The ability of healthcare professionals to be adversely affected in the context of their duties is not new. History records the enormous danger and high mortality of physicians and nurses during the great epidemics of the first two centuries following the death of Christ. And there is ample evidence in medieval stories of the Black Death of the great catastrophe for carer and cared for alike. In more modern times, the epidemics of cholera, yellow fever and other infectious diseases took a high toll in the nineteenth century on adults and children and all who attended them. During those terrible times, not everyone stayed at their post risking their lives for the common good, but those who did were certainly much lauded as public heroes and heroines. Perhaps it should come as no surprise then that in recent surveys a significant proportion of healthcare providers express an unwillingness to work if a pandemic should occur. This response has profound implications for the health professions. How then should we think about these issues?