In Defense of (Some) Altered Standards of Care for Ebola Infections in Developed Countries
- 604 Downloads
The current outbreak of Ebola virus infection in West Africa continues to spread. Several patients have now been treated in the United States and preparations are being made for more. Because of the strict isolation required for their care, questions have been raised about what diagnostic and therapeutic interventions should be available. I discuss the ethical challenges associated with caring for patients in strict isolation and personnel wearing bulky protective gear with reduced dexterity and flexibility, the limitations this may place on available treatments and the permissibility of consequent departures from the standards of care. Restricting access to some interventions such as surgery requiring an operating room, advanced imaging, etc. is reasonable due to concern for protecting other patients, visitors and staff. Cardiopulmonary resuscitation is a special case and the implications for withholding this intervention in situations where it may be desired is discussed, especially with respect to those patients who have suspected, but not proven, infection. These same restrictions are also considered under conditions where there are scarce resources and thus limited numbers of patients may receive care. While it is to be hoped that there is only limited and sporadic infection with Ebola virus in the US, careful thought must be given to the care of these patients under the unusual circumstances demanded by their isolation. I argue that an altered standard of care is reasonable and ethically acceptable under certain conditions.
KeywordsEbola Altered standards Healthcare crisis
- Australia and New Zealand Extracorporeal Membrane Oxygenation (ANZ ECMO) Influenza Investigators (2009). Extracorporeal membrane oxygenation for 2009 influenza A(H1N1) acute respiratory distress syndrome. JAMA: The Journal of the American Medical Association, 302(17), 1888–1895. doi: 10.1001/jama.2009.1535.
- Calabresi, G., & Bobbitt, P. (1978). Tragic choices. New York: W. W. Norton & Co.Google Scholar
- Davies, A., Jones, D., Bailey, M., Beca, J., Bellomo, R., Blackwell, N., et al. (2009). Extracorporeal membrane oxygenation for 2009 influenza A(H1N1) acute respiratory distress syndrome. JAMA: The Journal of the American Medical Association, 302(17), 1888–1895. doi: 10.1001/jama.2009.1535.CrossRefGoogle Scholar
- Dixon, M. G., & Schafer, I. J. (2014). Ebola viral disease outbreak—West Africa, 2014. MMWR—Morbidity and Mortality Weekly Report, 63(25), 548–551.Google Scholar
- Emory Healthcare (2014). Emory Healthcare Ebola Preparedness Protocols. Atlanta: Emory Healthcare https://www.emoryhealthcare.org/ebola-protocol/ehc-message.html.
- Fins, J. J. (2014). Responding to Ebola: questions about resuscitation. In T. H. Center (Ed.), Bioethics forum (Vol. 2014). Garrison, NY: The Hastings Center.Google Scholar
- Health, New York State Department (2008). New York State Department of Health Pandemic Influenza Plan. Retrieved October 31, 2014, from http://www.health.ny.gov/diseases/communicable/influenza/pandemic/.
- Klompas, M., Diekema, D. J., Fishman, N. O., & Yokoe, D. S. (2014). Ebola fever: Reconciling Ebola planning with Ebola risk in US hospitals. Annals of Internal Medicine. doi:10.7326/M14-1918.Google Scholar
- North Carolina Task Force on Ethics and Pandemic Influenza Planning (2007). Stockpiling solutions: North Carolina’s ethical guidelines for an influenza pandemic. Durham, NC: North Carolina Institute of Medicine (http://www.nciom.org/task-forces-and-projects/?pandemicfluplanning).
- Rosoff, P. M. (2010). Should palliative care be a necessity or a luxury during an overwhelming health catastrophe? Journal of Clinical Ethics, 21(4), 312–320.Google Scholar