7.2.2 Professional Obligations in the Face of Risks to Personal Health
Randi Zlotnik Shaul, PhD, LLM; and Margaret Ng Thow Hing, MSc, BSc
- To appreciate the legal and ethical basis for professional obligations in the face of risks to physicians' personal health
- To appreciate a range of perspectives in regard to professional obligations in the face of risks to physicians' personal health
Canadian health care workers are facing a wave of an epidemiologically significant respiratory infection for which a non-specific case definition is being used. There is no definitive diagnostic test at this point, given that the etiologic agent is unknown. There is no effective vaccine and no known effective treatment. During this new outbreak, dozens of health care workers have had occupationally acquired illness, some have infected their families and three have already died. Many are wearing cumbersome equipment in an attempt to protect themselves, causing significant discomfort, reducing their ability to work and reducing contact with their patients. There is much discussion of the similarities between this situation and the onset of severe acute respiratory syndrome (SARS) in 2003.
Dr. Penser is a 43-year-old emergency department physician working in a large pediatric tertiary care hospital. She is afraid of contracting this new infectious disease at work and infecting her partner and her two young children. She is unsure how to balance her range of conflicting obligations to her family, her patients, her profession, her colleagues and the hospital in which she works. Dr. Penser is unsure about how much personal risk she should accept as part of her job. She is also wondering whether the hospital in which she works is doing enough to create a safe work environment.
- Does Dr. Penser have a legal obligation to treat patients with the new infectious disease?
- Does Dr. Penser have a legal right to refuse her obligation?
- Does Dr. Penser have an ethical obligation to treat patients with the new infectious disease?
- Does this case highlight any specific obligations that the hospital has toward Dr. Penser?
Physicians should attempt to clarify and negotiate expected responsibilities with colleagues and supervisors before they are faced with risks to personal health. If no guidance polices exist, they should advocate for the creation of such documents. The ethically and legally grounded duties of both physicians and health care organizations, and Canada's experience with infectious disease as well as expected cases such as this one should serve together as the impetus for collaborative efforts to establish proactive guidelines for practice under circumstances that may pose health risks to physicians.
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