Understanding Ethical and Legal Obligations in a Pandemic: A Taxonomy of "Duty" for Health Practitioners

The duty of care and the right to be cared for: is there a duty to treat the unvaccinated?

Vaccine hesitancy or refusal has been one of the major obstacles to herd immunity against Covid-19 in high-income countries and one of the causes for the emergence of variants. The refusal of people who are eligible for vaccination to receive vaccination creates an ethical dilemma between the duty of healthcare professionals (HCPs) to care for patients and their right to be taken care of. This paper argues for an extended social contract between patients and society wherein vaccination against Covid-19 is conceived as essential for the protection of the right of healthcare providers to be taken care of. Thus, a duty of care is only valid when those who can receive vaccination actually receive it. Whenever that is not the case, the continuing functioning of HCPs can only be perceived as supererogatory and not obligatory.

The Ethical Unjustifications of COVID-19 Triage Committees

The ever-debated question of triage and allocating the life-saving ventilator during the COVID-19 pandemic has been repeatedly raised and challenged within the ethical community after shortages propelled doctors before life and death decisions (Anderson-Shaw and Zar 2020; Huxtable 2020; Jongepier 2020; Peterson, Largent, and Karlawish 2020). The British Medical Association's ethical guidance highlighted the possibility of an initial surge of patients that would outstrip the health system's ability to deliver care "to existing standards," where utilitarian measures have to be applied, and triage decisions need to maximize "overall benefit" (British Medical Association 2020, 3) In these emergency circumstances, triage that "grades according to their needs and the probable outcomes of intervention" will prioritize or eliminate patients for treatment, and health professionals may be faced with obligations to withhold or withdraw treatments to some patients in favour of others (British Medical Association 2020, 4). This piece is a response and extension to articles published on the manner of involvement for ethics and ethicists in pandemic triage decisions, particularly examining the ability and necessity of establishing triage committees to ameliorate scarce allocation decisions for physicians.

Carrying a Community on Their Shoulders: Virgil's Aeneas and the Duty of Healthcare Workers

The term "duty' has occurred frequently in discussions about the role of healthcare professionals in the current pandemic. Duty can take multiple forms in the professional and private worlds of those working to save the lives of others. At times, different forms of duty create confliciting demands, necessitating some kind of sacrifice. This dilemma is not new; it was a central theme of Virgil's Aeneid, the best known epic poem of ancient Rome. Statues and paintings of a scene from this poem, in which a man carries his father on his shoulders to safety from a burning city, became the most common representation of duty in Rome after the first century BCE and were frequently copied in later ages. Examining how Virgil's poem and these images communicate the rewards, complexity, ambiguity, and costs of duty can contribute to our understanding of the experiences of those who work to heal others in this lethal pandemic. Like Aeneas, the mythical Roman, healthcare workers have been called heroes of duty as they are asked to carry their entire communities on their shoulders.

The uncertainty trope: the duty to treat during a pandemic

BACKGROUND

Past guidance in the codes of practice urged doctors to provide treatment even in the context of extreme adversities. Despite the significant societal changes of recent times, contemporary guidance regarding the duty to treat during a pandemic has been limited.

OBJECTIVE

The authors herewith examine deontological aspects pertaining to the duty to treat during a pandemic and the potential disruptions to health care services.

CONCLUSION

The ethical, legal and professional guidance for duty of care during a pandemic is uncertain and demands further debate.