If the coronavirus pandemic and the Russia-Ukraine conflict offer any reminders for physicians, one of them may be their obligation to provide medical care even in the face of considerable peril.

And while doctors may already be familiar with their ethical obligations, the nuances are arguably worth revisiting for potential scenarios ranging from manmade disasters to earthquakes, wildfires, and tsunamis.

Societal duty

In an exclusive interview with MDLinx, T. Patrick Hill, PhD, a retired associate professor at Rutgers University and author of a recently published book on law and ethics (No Place for Ethics: Judicial Review, Legal Positivism and the Supreme Court of the United States), explains the implied agreement between the medical profession and society: 

In some respects, but obviously not all, this parallels the obligation of firemen and women to respond to the call to fight a fire, even one that may threaten their life.

“In return for their licensure, doctors enjoy a monopoly on the provision of care which requires of them a societal duty to practice medicine in the best interests of the members of society, even in circumstances such as earthquakes, that may pose risk of harm to them while fulfilling their duty,” he said. “In some respects, but obviously not all, this parallels the obligation of firemen and women to respond to the call to fight a fire, even one that may threaten their life.”  

Obligations based on ethics

Morality and ethics are the foundation of this obligation, as Hill explained. “As a matter of professional practice, doctors have an obligation to attend to the medical needs of persons, even under conditions that may pose a risk of serious harm to them while providing medical care. The obligation is derived from ethics in the form of a particular moral relationship, born of the nature and purpose of medical care, between the person who has the right to medical care and the physician who has the duty to provide it.”

Certain conditions, however, determine when the obligation is operative, such as:

• There is the reasonable expectation that the doctor’s intervention will serve the medical needs of the individual.

• In the absence of the doctor’s intervention, the person in medical need will suffer serious harm and consequently be denied his or her right.

• The medical need is such that only a doctor can provide the appropriate care.

• There is no alternative way to meet the medical needs of the person.

The AMA offers similar sentiments in its code of medical ethics: “A physician shall, in the provision of appropriate care, except in emergencies, be free to choose whom to serve … and the environment in which to provide medical care.” (emphasis added) 

Duty to others, duty to self

Yet physicians and other healthcare professionals are not limitless in either their number or their abilities, and they must also care for themselves.

While the AMA’s Code of Medical Ethics Opinion 8.3 says that individual physicians have an obligation to provide urgent medical care during disasters, it recognizes that “…the physician workforce is not an unlimited resource. Therefore, when providing care in a disaster with its inherent dangers, physicians also have an obligation to evaluate the risks of providing care to individual patients versus the need to be available to provide care in the future.”

The obligation is derived from ethics in the form of a particular moral relationship, born of the nature and purpose of medical care, between the person who has the right to medical care and the physician who has the duty to provide it

The AMA advises individual physicians to take appropriate advance measures for natural or manmade disasters, including “acquiring and maintaining appropriate knowledge and skills to ensure they are able to provide medical services when needed.”

Similarly, in an American Nurses Association (ANA) issue brief titled “Who will be there? Ethics, the law, and a nurse’s duty to respond during a disaster,” the primary commitment to the patient is highlighted, but so, too, is the fact that “… nurses not only have an ethical obligation to care for others, but also to care for themselves.”

Citing Provision 5 of the ANA Code of Ethics for Nurses with Interpretive Statements, the ANA says the nurse owes the same duty to self as to others: “This conflict of obligation is especially prominent during times of disaster when nurses are put in the position to provide care to critically ill or wounded patients for extended periods of time. During these times of pandemics or natural catastrophes, nurses and other health care providers must decide how much high quality care they can provide to others while also taking care of themselves.”

The report separately notes that some states have implemented laws for disasters that “require licensed health care professionals to respond, and refusal to comply can be punishable.”

Sources:    

1. American Medical Association. AMA Code of Medical Ethics. June 2001.

2. American Medical Association. Physicians’ Responsibilities in Disaster Response & Preparedness. Code of Medical Ethics Opinion 8.3.

3. American Nurses Association. Code of Ethics for Nurses With Interpretive Statements.

4. American Nurses Association. Who Will Be There? Ethics, the law, and a nurse’s duty to respond in a disaster. 2017.