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Ebola virus and the duty of care

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At the time of writing, a patient who had traveled in an Ebola-affected region of West Africa is in isolation at Belfast's Royal Victoria Hospital awaiting the outcome of tests for Ebola virus. The patient is being cared for by doctors and nurses wearing protective clothing, in accordance with national guidelines.

Meanwhile in the US, nurse Kaci Hickox, who had treated Ebola patients in Sierra Leone, achieved notoriety recently when she went out cycling, contravening an attempt by the state of Maine to restrict her movements until she was shown to be Ebola-free.

These incidents, combined with the cases of nurses in Spain and the UK who contracted Ebola from patients, raise the question of the limits of a nurse's professional and ethical duties and the need to protect society at large from dangerous infections.

Writing in the Guardian (10 October 2014), about the Spanish case, reporter Ashifa Kassam quoted Elvira González of the SAE nurses' union as saying that '… fear of Ebola had caused some staff to refuse to treat certain patients, while others had resigned.'

A so-called 'duty of care' – entailing the application of one's nursing skills for patients' benefit, according to a professional code of conduct – is central to the nurse-patient relationship. But are suitably qualified nurses morally obliged to treat patients who have potentially deadly infections?

One approach is to say that, in terms of risk, entering the nursing profession is no different from becoming a soldier or fire-fighter. One is not forced into these occupations, so it's a case of getting on with it and doing one's duty. The implication is that those who fail in their duties can be subjected to moral censure, whereas those who 'get on with it' deserve no special praise.

Damery et al investigated 'Healthcare workers' perceptions of the duty to work during an influenza epidemic'. Their survey of 1032 healthcare workers (HCWs) who worked at three NHS Trusts in the West Midlands, found that 76.8 per cent agreed with the statement that 'Doctors and nurses have a duty to the sick, despite risks'. Writing in the Journal of Medical Ethics (2010, 36: 12-18), the authors also stated that '… nearly 25 per cent of doctors did not consider that they had a duty to work where doing so would pose risks to themselves or their families.'

It's difficult to condemn nurses who judge the risk of looking after an Ebola patient too great because it might endanger themselves and their families. However, nurses who choose to care for Ebola patients are not only displaying acts of duty, but courage that could not have necessarily been expected.

What do you think? Leave a comment below or tweet your views to @IndyNurseMag

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