Sure, with COVID-19, the risk of death is low. But what are the odds that you are prepared to accept for your family? A one in 100 chance of dying? One in 10,000?
I try to live by the oath I took in medical school to treat all patients fairly and equally, even with risk to my own health. But after the West African Ebola epidemic, and now with COVID-19, I know I am not necessarily that strong. The hair stands up on the back of my neck when I hear ethicists, hospital administrators, and politicians, sitting in their safe offices, lecture me on my obligation to die providing health- care. We don’t take these risks because of an abstract “ethical duty”; we take them because it is what we do every time we walk into the chaos and danger of the emergency department. We do it because it is our job.
Read: How the coronavirus became an American catastrophe
Yes, physicians and nurses have an ethical duty to provide care. (I have even written about it.) The perspective of medical ethicists is pretty straightforward—health-care providers, especially physicians, should continue to care for the sick even if it puts their life at risk. We have an obligation to treat all patients, because we chose our profession and are well rewarded by society with money and respect. Nurses have a similar professional duty, but have specific exemptions. But there are few, if any, obligations for all the support staff that make my work possible—the techs, clerks, registrars, environmental staff. They don’t take an oath. Some are paid minimum wage, have few benefits, and get none of the societal accolades reserved for doctors and nurses. Why should they die for a $25,000-a-year job and $10,000 worth of life insurance? Who’s going to feed their kids when they’re gone?
When you’re the one wearing a flimsy paper gown and mask in the same room as someone dying from an invisible virus that makes its home in the same air you breathe, nothing is simple.
Our duty is not boundless, and in bad situations, sacrificing providers is not what is best for society. If health-care providers are going to risk their life, then there is a reciprocal obligation—the fairness principle—that society, employers, and hospitals keep them safe and ensure that they are fairly treated, whether they live, get sick, or die.
First, hospitals must provide the resources necessary to protect the staff caring for infected patients—not just PPE, but also training, environmental controls, and policies and procedures to prevent spread. At a minimum, providers should be offered a free place to stay away from their family and be compensated for the time that they may not be able to touch their own children. Who’s going to take care of my wife and kids if I have to sleep on a cot in the hospital for two months? What about single parents whose kids are home because their schools are closed?