Thousands of healthcare providers around the world are working tirelessly on the frontlines of the COVID-19 crisis. They are being called upon to care for infected patients, to work outside their usual specialties, and to make difficult decisions about patient care. Many are placing their health and their lives at risk to combat this pandemic. The risks are starkly illustrated in hard-hit Italy – more than 8,300 healthcare providers have been infected by COVID-19, and over 60 have died, and those numbers keep rising. Similar experiences are occurring in many other European countries. This is not surprising. During the 2003 SARS outbreak, 45 percent of individuals diagnosed with SARS in Ontario were healthcare workers.
Because healthcare providers are critical to an effective response, it is important for them to understand their rights and responsibilities around care for patients during a pandemic. In turn, it is equally important that healthcare employers and governments are aware of the responsibilities they owe to the healthcare providers.
What does “duty of care” require?
It is well established that healthcare providers have a duty to care for patients during a pandemic. This duty is rooted in the moral obligation of healthcare providers to act in the best interests of their patients.
But it is less clear what this duty requires. For example, must a healthcare worker who is not trained to treat respiratory infections provide care to patients suffering from COVID-19? May healthcare providers be redeployed to work in different areas of a hospital where there is a shortage of staff? In Canada, many applicable policies and codes of ethics establish that healthcare providers have a duty to care for patients during a pandemic, but also recognize that there are limits on this duty.
The extent to which a healthcare worker owes a duty of care depends on several factors. For example, healthcare providers who have chosen to work in high risk settings, such as an intensive care unit or the emergency room, are considered to have increased obligations to provide patient care during pandemics than healthcare providers who work in lower risk settings, such as ophthalmology or dermatology. This is because the former group is considered to be better trained to deal with these crises, and to have accepted a higher risk work environment.
Weighing the potential harm to a healthcare professional against the potential benefit to a patient is another important consideration. Where the risk to the healthcare worker is low and the benefit to the patient is high because the condition is quite treatable, the obligation increases. Conversely, where the risk to the healthcare worker is high and the benefit to the patient is low, the obligation to care for the patient decreases.
Of course, we must acknowledge that healthcare providers often have competing interests and obligations to family members and others that could influence their decision-making at work. During the current pandemic, healthcare providers have expressed fear of spreading the virus to their families, friends, or colleagues.
Healthcare providers may also be called upon to make ethically and emotionally charged decisions during pandemics. In harder hit jurisdictions, the number of COVID-19 patients needing ICU beds or ventilators may greatly exceed the amount of hospital resources. As a result, healthcare providers in many jurisdictions are being forced to prioritize patients with the best chance of survival. Deciding who will have an opportunity to live is highly stressful, and an emotional burden for healthcare providers to bear.
The responsibilities of governments and healthcare employers
Governments and healthcare employers, such as hospitals, also have duties and obligations to healthcare professionals. They have a responsibility to ensure safe working conditions, which includes putting in place appropriate safety precautions for healthcare providers.
Indeed, some have questioned whether healthcare providers have access to adequate personal protective equipment. For example, the Ontario Nurses’ Association recently urged the Ontario government to adopt more stringent guidelines for protective gear. According to a statement the association put out on March 11, a leaked document suggested that the province of Ontario had been watering down guidelines pertaining to protective personal equipment for healthcare providers. While COVID-19 has been shown to spread via droplets, there is some suggestion that COVID-19 might also be airborne. If this is the case, healthcare providers would require greater amounts of protective equipment to remain safe.
As the pandemic progresses, healthcare workers may also face a shortage of personal protective equipment. There are many reports of nurses who have refused to work due to the unavailability of proper equipment. On a positive note, the federal government has announced that it will allocate $2 billion to acquire more personal protective equipment for healthcare providers.
The obligation to healthcare providers does not end at personal protective equipment. Governments and employers should be prepared to put a range of other measures in place to protect healthcare providers. Many important measures have already been rolled out: relevant up-to-date information is available to healthcare providers, and standalone assessment and testing centres are operating.
Governments and hospitals should also consider the role that technology can play in mitigating some of the risks to healthcare providers, such as using telemedicine to assess and treat patients who are suffering from milder forms of the virus. Telemedicine can also be used to provide follow-up or consult appointments to patients who are suffering from other diseases, such as heart disease and cancer, which will reduce the burden on the healthcare system, and reduce the risk of spread to patients and healthcare providers. Furthermore, governments and hospitals should ensure that much-needed counselling and mental health supports are in place to support health care providers during this difficult time.
The responsibilities of the public
Importantly, the public also plays a vital role in protecting healthcare providers. Our public health officials have recommended that we should continue physical distancing, limit contact with others outside our households, and self-isolate after return from travel outside the country. Through diligently implementing these measures, everyone can help the fight against COVID-19. Our healthcare providers have said it best: « I stayed at work for you. You stay at home for us.”
Ultimately, our success lies in understanding our rights and responsibilities to one another. This applies equally to healthcare workers, healthcare employers, governments, and the public alike.
This article is part of the The Coronavirus Pandemic: Canada’s Response special feature.