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In 1918, half the world’s population was infected by the Spanish flu of the 1 billion infected 50 million past away from the disease. In 2003 humanity was faced once again by a terrible pandemic, Severe acute respiratory syndrome (SARS). SARS was merely a wakeup call, calling to attention the unpreparedness of Canada. In 2005 the World Health Organization (WHO) addressed this concern by implementing an influenza pandemic preparedness plan checklist. Canada responded to this fear of unpreparedness with the “Ontario health plan for an influenza pandemic”. One of the ethical key issues that were addressed was health care workers duty to provide care during a communicable disease outbreak. That is to say do health care workers from practitioners to nurses to volunteers have an obligation to come to work during a pandemic. With a estimated absenteeism rate of 39% amongst all health care workers in Canada during the first two weeks of a pandemic and 34% of nurses who would seek other employment during a pandemic due to fear. Stricter guidelines must be set for Canada health care workers standard of care during a pandemic crisis. Engaging the public to set these guidelines is one of the best ways to reach a consensus on what the duty of health care workers should be. Although there are punishments should a health care worker breach their duty to provide care it is insufficient. Health care workers will be faced with an ethical dilemma when a pandemic arises because of the conflict between performing their duty to provide care, self preservation, and the health of their families. Health care workers need to have an array of facts towards a pandemic situation then contemplate their position on what to do when a pandemic takes place using deontological, teleological, bioethical principles and Kohlberg’s theory of moral development.
When the public was engaged 90% said that health care workers should face all risks if safety precautions are taken, 47% of the public agreed that the government has the right to conscript health care workers during a pandemic. 50% of the public agreed that health care workers should face lose of employment and licensing should they not show up to work. However, as of now health care workers are subjected to a 184050 dollar fine according to the occupational health and safety act. Due to 30% of all SARS cases being health care workers, there is an understandable level of fear. Nurses in particular seem to have a reserved fear during a pandemic with 34% of nurses primarily young nurses would quit during a pandemic. Nurses also exhibit the highest level of fear with 61% of nurses who were scared to care for SARS patients to the point where they would avoid them. This fear felt is brought on primarily from having less than two hours of infectious disease control training. The first step to preparedness, to make an ethically sound decision is to educate and raise awareness. Increased fear was due to perception of greater risk of death, lifestyle change and being treated differently because they are health care workers. Therefore, Health care workers need to understand that although they are in a high risk area there have been several steps taken in regards for their safety. Knowledge of preventive measures should not be assumed by the staff but rather educated by the employers. The knowledge of preventive measures can be learned and preserved by facts, protocol, procedures and practise. When the health care workers are informed of the precautions that they are given it lessens the fear from the pandemic. Once the proper factual presumptions are made the health care worker can then apply ethical knowledge to make their decision.
Deontology ethics stresses that a morally right action is directly brought upon by ones performing their duty. Since a deontological ethical approach emphasizes that our actions be governed by our duties, then a definition of duty must be given concisely. In the Canadian Medical Association’s Code of ethics the expected procedure for physicians during an epidemic is vague and silent to say at best. However, physicians like all health care workers have a duty to provide care. The duty to provide care is one that is given to all health care workers this assumed duty to provide care is initiated and taught in the health care system. Duty of care is the legal term for the obligation that a health care worker has to his or her patients. There is both a duty of care and a duty to provide care for both nurses and physicians. When you first accept the meeting the standard of care you recognize duty to care then the continuity of that care is the health care workers duty to provide care. When a health care worker, nurse or practitioner refuses to go to work during a pandemic they breach both their duty to care and duty to provide care. They are wrong when they violate the duty to care for any new patient and they are wrong when they have going against their duty to provide care to their current patients. Furthermore, when a health care worker does not go to work they impose on the rights of others. Residents of Ontario and citizens of Canada have a right to health care; this right is ill-treated when health care workers do not go to work. Therefore, although there are no specific duties during a pandemic crisis the regular duty to care and to provide care are still valid and should be obeyed from a deontological point of view.
A Teleological stand point evokes that in order to make a morally good decision the decision maker must weigh out rationally and objectively the outcomes of their actions. The decision maker has to consider ethical hedonism which preserves self interest, versus ethical altruism which emphasizes the benefits of others even at the price of self sacrifice. Fear and concern for self was the second largest barrier for health care workers willingness to work. If the health care workers do go to work the good consequence is that they are helping several people and the bad consequence for this action is that only one person in addition is at risk; themselves. Versus, if the health care worker does not go to work he alone is safe while many others are suffering. However, the largest barrier for health care workers willingness to work is fear and concern for their families. Now the bad consequence of going to work does not only affect only the health care worker but their entire family is at risk. Teleological Utilitarianism states that the morally good action provides the greatest good for the greatest number. In the instance where the health care worker decides to go to work they are most likely serving and helping more people then they puts at risk, even though those they puts at risk are their own family. Therefore, what is teleologicaly good is that health care workers go to work during a pandemic. Moreover, the decision not to go to work can be seen as ethically hedonistic, but at the same time could be selflessly made if it is to protect their families that may rely on them. The public seems to support the latter 64% of which agree that health care workers with young children and or elderly should not be expected to work during a pandemic.
There are four classical principles that guide health care workers on how to ethically function at work. The first is the principle of nonmaleficence as seen in the Hippocratic Oath, fundamentally states that no action taken should result in any harm unless it is necessary to prevent greater harm. The health care workers are creating harm indirectly by not going to work and helping, this negligence that is creating the harm is just as bad as directly doing the harm themselves. The second principle is that of beneficence which states that the professional has a duty to do good. In order for the health care worker to do well and be in compliance with the guiding principle of beneficence they must go to work during a pandemic and perform good; This good is performed by helping others. The third principle of Autonomy is in respect for the patient to have the liberty to choose their own course of action. Most likely a patient with SARS or similar disease will want some sort of treatment. In order to even have the option of treatment, to allow autonomy a health care worker needs to report to work especially during a pandemic when they are needed the most. The final guiding principle of justice interjects that patients need to be treated fairly without discrimination. In order for care to be non-discriminatory then health care workers need to provide care to everyone equally including people who are suffering from the pandemic disease. Also care should be consistent from before the pandemic to after the pandemic. If the health care worker should decide not to go to work during a pandemic both people suffering from the pandemic and non pandemic diseases suffer and do not receive just treatment.
Kohlberg’s theory of moral development can be applied to this ethical maxim to decide which decision would be preconventional, conventional or post conventional. A preconventional action focuses primarily on an egocentric basis. The choice for a health care worker to not go to work during a pandemic due to fear of their own lives is a hedonistic decision. Therefore, according to Kohlberg the decision for health care workers to not go to work due to selfish concerns is preconventional. A conventional decision would encompass that a decision be made that will be good for a group rather than purely yourself. The decision to not go to work for the sake of taking care of your family and children is a self less decision for a certain group. Although the decision is still to not go to work it is considered conventional because it is for the sake of the health care worker’s family. A post conventional decision holds true to the law of justice. The law of justice and individual human rights can be applied to this scenario because every citizen of Canada has a right to health care and health care is to be distributed justly. The decision for the health care worker to go to work for the sake of universal society is considered post conventional. In order to make a truly moral decision Kohlberg’s theory of moral development could be used as a guideline for health care workers to make ethically appropriate decisions.
In conclusion, the choice whether or not health care workers should go to work during a pandemic is an ethical dilemma. In order for health care workers to make an informed decision they need to be made aware of the facts. Although there is a fine set in the occupational health and safety act of 184050 dollars the penalty is not enough as the public agrees health care workers who do not go to work should face loss of employment and licensing. The decision for health care workers to not go to work during a pandemic due to selfishness and fear even thought precautions have been set is a hedonistic decision. This hedonistic decision falls under Kohlberg’s stage of preconventional or immature level of moral reasoning. Although health care workers have a duty to care and to provide care to their patients they also have a duty to take care of their families. The decision for health care workers to not go to work during a pandemic due to fear of infecting their family which needs them, falls under a conventional and mature decision. The decision for health care workers to go to work during a pandemic in compliance with the duty to care and to provide care is a post conventional decision and is most applauded. Since this decision provides the greatest good for the greatest number of people it falls under utilitarianism. Furthermore, this decision also conforms to the principles of professional ethics. A health care worker going to work prevents harm from being done i.e. nonmaleficence; this treatment being provided is beneficial and is in accordance with the principle of beneficence. Autonomy and Justice is fulfilled by the health care worker going to work because it provides patients the option of treatment and all patients receive treatment justly without discrimination. The guidelines currently set for health care workers role during a pandemic are to incoherently put and need to be clearly stated in terms of their responsibility to go to work. The guidelines should integrate a full array of ethical theories in order for health care workers to reach a sound and informed decision.
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