Health care workers treating patients with Ebola virus disease (EVD) deserve a clear framework for assessing difficult clinical scenarios that risk their own health, according to the authors of an Ethics article published in the Medical Journal of Australia.
A group of authors led by Dr Thomas Solano, Visiting Medical Officer at Westmead Hospital and co- authors, Professor Lyn Gilbert, Associate Professor Ian Kerridge, Dr Vineet Nayyar and Angela Berry wrote that two ethical questions confronted health care workers (HCWs) caring for EVD patients.
"The first is whether it is ethically appropriate in some circumstances for HCWs to decline to care for patients with EVD," Kerridge and his colleagues wrote.
"The second question concerns how treatment decisions should be made regarding limitation of therapy for patients with EVD."
Médecins Sans Frontières have reported case-fatality rates in Guinea of 25% (among 21 patients treated in Telimele) and 37% (among 59 confirmed cases in Donka). Of the 24 patients managed in Western countries to date, five (21%) have died.
"The key question for HCWs and policymakers becomes one of defining what constitutes an acceptable level of risk, and what obligations HCWs have to care for patients with high-risk illnesses."
Although there is an obligation to provide supportive therapy to EVD patients, employers had responsibility to ensure HCWs had the resources to provide that care without risk to themselves, the authors said.
Regardless of the circumstances, however, it was "crucial that the decision-making process is transparent, ethically and clinically rigorous, and acceptable to all stakeholders."
"These conditions are likely to be met if decisions are not made by a single clinician at the bedside but are based on a clear institutional policy or advice from an expert advisory group," Kerridge et al. wrote.
"These dilemmas can be resolved with an approach that includes a predetermined, institutionally endorsed process for assessing difficult clinical scenarios as they arise.
"This process should be transparent and consistent, with clear policies and governance structures to provide the optimal balance between ensuring a patient with EVD receives appropriate care and that staff are not placed at unnecessary risk," they concluded.