http://news.bbc.co.uk/1/hi/health/8163459.stm
^ Inspired from this thought-provoking BBC article.
Should they simply accept the risks as an occupational hazard, or should they be given preferential treatment over more needy and severely afflicted patients? (E.g. if intensive care units are overrun, tough decisions will need to be made about who can drafted into them, and for how long).
I think both doctors and nurses should receive preferential treatment. As the article suggests, it reduces absenteeism, increases morale, and supports the backbone of first-line clinical defense. My views are fairly set on this.
But what about other hospital staff? Where do you draw the line?
And how would you react if you find out that a loved one is not receiving full treatment because a doctor or a nurse, less badly affected, was being treated in their stead as part of a preferential treatment initiative?
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NOTE: I’m not trying to be alarmist or negative, but this type of scenario could happen. I’m interested in your views.
EDIT: My disclaimer at the bottom of the question said that this is just a possible scenario. I’m not scaremongering.
I’m more interested in your ethical opinions on this than whether it is likely to occur.
I don’t understand how there can be overcrowding of hospitals for a simple virus. If you get a normal flu, you go to the ER right away right?
Better do some fact checking. Swine flu is no big deal. More people are dying from regular flu.
Same with bird flu a few years ago. Major panic in the media, predictions of major epidemics, people dying all over the world, doom, defeat, despair, yada yada yada.
What happened?
Not much.
Swine flu is doing even LESS.
Stop feeding the panic mongers. THINK.
THEY SHOULD GET THE VACINE FIRST CAUSE THERE RISKING THERE LIFE TO HELP US
AA – good question. Anyone working in healthcare should get preferential treatment for flu vaccines. It’s simple – if we’re all sick, we can’t take care of anyone else. Not just doctors & nurses, but without techs, pharmacists, housekeeping staff, etc. the hospital breaks down and makes it more difficult to treat patients.
Edit – Tmuk55 – interesting perspective and I love your analogy to the fuel shortage!
Finaldx – While it is understood that H1N1 so far has been relatively mild, certain cases have been quite severe. I had a 20 year old who died of it, and my otherwise healthy 39 year old neighbor was seriously ill with it for over a week. This is a rare case where I think an unnecessary amount of fear mongering might be a good thing – it may scare many more people than usual into getting a flu shot this year, thus protecting them from the more virulent strains.
Ahem… aren’t the BBC rather missing the point here? “absenteism” and “morale” are not the issue here.
If fuel were suddenly scarce, would you want to deny fuel to fleets of tanker lorries so that they cannot effect deliveries of what little fuel is available? Won’t *that* exacerbate the situation, by preventing scarce supplies from reaching customers?
Similarly, if Doctors and Nurses are denied vaccination or treatment and as a result they fall ill with swine flu, won’t *fewer* patients survive, owing to the shortage of essential health personnel to treat them?
Clinical Ethicistis are in the business of debating cold-blooded, pragmatic choices in unusually extreme conditions. In a climate of severe shortages, a physician cannot base decisions about whom to treat on emotive responses. so we should accept that either :
a) hospitals and clinics put all the patients’ names in a hat and draw out as many as there are courses of treatment,
b) they choose the healthiest, most useful members of society, by drawing up a cold-blooded but pragmatic list of priority professions
c) they provide guidance on what professions and social profiles are most indispensable and distribute them to the patients or their families, asking each adult patient/family to examine his/her conscience and, if they find that their social function is not crucial to others’ survival, they request that their names be taken off the list for treatment.
Given a choice, I would elect for c), in my case, and request that my place be given to a child at risk, as recent data shows that the current swine flu pandemic disproportionately affects children under 5.
An ethical conundrum persists, however, with physicians having to ask themselves “do I treat a child with a limited life expectancy, owing to some other condition, or do I treat all children, irrespective of ancillary medical conditions?”
Regrettably, in the face of insufficient production of Tamiflu, it may be that *neither* child gets the scarce treatment, which instead is kept back in to treat essential personnel or even factory workers in the pharmaceutical production plants that produce Tamiflu.
In the most extreme of cynical appraisals, with almost 7 billions humans at the moment and a pattern of diffusion that disproportionally affects Developed Nations – the greatest consumers of resources *and* greatest polluters – it would seem logical to limit treatment and vaccination to key professions children and their parents/carers.
I am so glad I am neither a doctor or a nurse and so won’t be faced with such conundra, instead I’ll gladly forfeit my Tamiflu and opt for a quick, painless death if available, or at least pain relief to ease my passing.
Having been a member of the committee that addresses these issues, we indeed did discuss the ethics of giving “first responders” the first level of vaccine, with health care workers in the second tier.
Police, EMS, and ER personnel are considered “first responders”. But one responder is correct, in that swine flu is no more virulent than seasonal flu, but the difference is that there is a level of community immunity to seasonal flu, and that is thought to be less for swine flu.
One of the problems I found with such bureaucratic-driven “scenarios” is that they have little knowledge of medical issues, and don’t bring in epidemiologists, at least on local and state levels. I was invited to a “tabletop” exercise looking at a terrorist release of smallpox. They had no historic information to fold into the data set. For example, even in the last smallpox outbreak, long before modern medicine, or antibiotics, or residual immunity from vaccine in a lot of the population, the death rate was 10% or less. This information was astonishing to those who had put together the exercise. They were planning on close to 100% fatality rate.
The only thing one can be certain of is that if there is any sort of outbreak, it will not resemble what has been imagined, in the least.
I have no ethical problems with those required to give care getting vaccinated early, as it will make for better delivery of care to the remainder.
Health care workers are traditionally among the group who get some preference for immunization. It has nothing to do with ideas like morale but is simply because (1) they come in contact with sick people all day every day, and may serve as a reservoir for spreading disease in an epidemic and (2) when you do get in an epidemic, you don’t want your health care workers home sick.