DUTY OF CARE

During a pandemic, thousands of frontline healthcare providers are called to care for infected patients, placing their own health and lives at risk. Because healthcare providers are critical to an effective response during a pandemic, it is important for them to be aware of the rights and responsibilities around caring for patients in such an emergency.

Duty of care is defined as the ethical and legal responsibility of a person or organization to avoid any behaviors or omissions that could reasonably be foreseen to cause harm to others (LD, 2017). Healthcare professionals have an ethical duty to provide care. They have an obligation to treat all patients and are not at liberty to abandon them.

Considerations during a pandemic involve weighing the potential harm to a healthcare worker against the potential benefit to a patient. Where risk to the worker is low and benefit to the patient is high, the duty of care obligation increases. However, where the risk to the healthcare worker is high and the benefit to the patient is low, the obligation to care for the patient decreases.

Governments and healthcare employers also have duties and obligations to healthcare professionals. They have a responsibility to ensure safe working conditions, including making certain there are appropriate safety precautions in place to protect those healthcare professionals and to ensure that counseling and mental health supports are available during such a crisis (Gruben & Czarnowski, 2020).

There are also limits to the personal risk of harm that healthcare personnel can be expected to accept as an ethical duty. Harm includes emotional, psychological, physical, or spiritual. Balancing their professional demands with the need to protect and care for self and family may therefore introduce a dilemma. Some may feel the personal risks are too great and choose not to care for infected patients. When this happens, the effects on the healthcare system can be profound.

The American Nurses Association, as one example, provides guidance for decisions about care made during extreme circumstances, including pandemics. In such situations, “a utilitarian framework usually guides practice decisions and actions, with special emphasis on transparency, protection of the public, proportional restriction of individual liberty, and fair stewardship of resources” (ANA, n.d.). Specific ANA guidance to nurses states:

• Professional nurses have a duty to care during crises like pandemics. Their employers and supervisors have a corresponding duty to reduce risks to nurses’ safety, plan for competing priorities like childcare, and address moral distress and other injuries to personal and professional integrity such crisis events can cause.
• No crisis changes the professional standards of practice, Code of Ethics, accountability for clinical competence, or values of the registered nurse. However, the specific balance of professional standards and crisis standards of care will be based on the reality of the specific situation, such as the presence or absence of necessary equipment, medications, or colleagues.
• Decision-making during extreme conditions can shift ethical standards to a utilitarian framework in which the clinical goal is the greatest good for the greatest number of individuals, but that shift must not disproportionately burden those who already suffer healthcare disparities and social injustice. Sacrifices in desired care must be fairly shared. This means that care decisions are not about “the best that can be done” under normal conditions. They are necessarily constrained by the specific conditions during the crisis. Any move to crisis standards of care must be done within the institution’s response structure and ideally in collaboration with other healthcare professionals, policymakers, and the community.
• Registered nurses may be asked to delegate care to others, such as students, staff displaced from another institution, or volunteers. This will require a rapid assessment of the skills of the others available to assist in patient care. Nurses must continue to emphasize patient safety and appropriate delegation.
• An increased reliance on a nurse’s own or the collective accumulated competence may be needed, as the usual range of colleagues, experts, or support services may not be available (ANA, n.d.).