Will doctors stand and fight or will they skedaddle?


Outbreaks of infectious diseases in the US and Canada could give the medical profession a chance to test its commitment to a value even more fundamental than informed consent or autonomy: their duty to provide care to the sick and dying. A feature in the New York Times Magazine about an outbreak of monkeypox in the American Midwest suggests that many doctors and nurses might shrink from being heroes when faced with highly infectious patients carrying dangerous diseases. There were several dozen cases of monkeypox, a disease related to smallpox with a 1% to 10% fatality rate, in June 2003. Before then it had never been seen outside of Africa and US hospitals were hardly expecting it. Smallpox vaccinations also immunise against monkeypox -- but few people are immunised nowadays. Fortunately, because of the fear of bioterrorism in the wake of 9/11, US public health officials had been campaigning to get health care workers immunised and some of these were available to care for monkeypox victims. But doctors and nurses without vaccinations often refused to get involved.

No one died in the monkeypox outbreak, but the SARS outbreak in Toronto was reminder that Good Samaritans can pay the ultimate price. Dozens of healthcare workers, many of them nurses, caught the new disease. Some infected their families and two of them died.

Last year an article in the journal Health Affairs found that only 33% of doctors surveyed would treat smallpox without having been immunised and only 55% agreed that doctors have an obligation to care for patients even if it might endanger their own health. The authors wrote that "the threat of new disease outbreaks, from bioterrorism or natural causes, has provided an opportunity for physicians to rearticulate and reaffirm longstanding ethical principles regarding the duty to treat." "It remains unclear," comments the Times, "whether doctors will seize that opportunity or hide from it."




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