Epidemics and Physician Responsibility

"In the Line of Duty: SARS and Physician Responsibility in Epidemics" - This article was published in Medical Ethics Vol 13 Issue 2 Spring 2006 (Lahey Clinic Medical Ethics) as an edited transcript of a forum at Harvard Medical School in December 2005.

The guest speaker was Dr. William Ho, Chief Executive of the Hong Kong Hospital Authority at the time of the SARS epidemic in Hong Kong. He described the disadvantages and advantages at hand in the public hospitals. A disadvantage was that individual rooms and beds were unavailable; patients and nurses were in close confines in more than a thousand beds. An advantage was that all forty public hospitals use a uniform technology system that allowed similar definitions for illnesses.

Dr. Ho described the beginnings of the SARS epidemic starting with a mysterious disease in Guongzhou in the winter of 2002 that had symptoms similar to an atypical pneumonia. This was common in hospitals, so pinpointing an epidemic was difficult. Experts began to handle any community cases of pneumonia, but it was not until the hospital outbreak that anyone was positive they were dealing with an epidemic. Soon after the WHO labeled it as SARS and it became a public emergency.

At the Prince of Wales Hospital, the staff split into two teams. Those infected were labeled as "dirty" and remained on the respiratory ward, those not infected or "clean" switched wards. As the infection spread, the number of patients at the hospital was becoming over-whelming. Questions arose whether to discharge patients or accept new patients because of fear they would become infected or infect others.

Outside the hospital, community infection was spreading rapidly. Patients returning to populated housing blocks were putting those in that area at high risk of becoming infected. This lead to an ethical decision of whether or not to quarintine residents in these infected areas and to have family and those in close contact to report to clinics daily. Should those patients too afraid to seek medical treatment be charged with criminal offenses? The government stepped in and evacuated buildings like this one, sending residents to camps while they disinfected homes. Only buildings of those infected were released; no names.

Walter Robinson, MD, MPH, an assistant professor of pediatrics and medical ethics at Harvard then went on to discuss the aspect of medical staff being obliged to stay in the hospital in times of a crisis. When the HIV virus came to the US, many doctors refused to treat infected patients although there was never a greater risk than those of other infectious diseases such as Hepatitis B. It was only the stigma associated with the disease that scared physicians and patients. A long debated resulted in the AMA council on Ethical and Judicial Affairs concluding in 1987 that "a physician may not ethically refuse treatment to a patient whose condition is within the physician's current realm of competence."

Robinson went on to point out whether or not physician's have a moral obligation to treat the sick we live and work with when health care is not universal. I believe that if an epidemic was to occur in the US today or in the future, physicians would rise above the call of duty and moral obligations. Ethically this would be the "right" thing to do, regardless of whether they risked the chance of receiving the infection or not. Besides, they could very well get it outside the hospital, so they may as well do the morally justified action.