The Ebola virus disease (EVD) crisis affects emergency physicians working both domestically and abroad, particularly those returning to U.S. soil after serving in an endemic area. Emergency physicians who have been exposed to Ebola patients may find themselves in the crosshairs of the debate over individual health care worker (HCW) rights versus HCW responsibilities. What follows is a discussion of some of the issues on each side of the debate.
Pro: Individual HCW/EP Rights Come First
Most EPs would hope that their individual liberties would be upheld before, during, and after caring for patients with EVD or other infectious diseases. Before caring for such patients, it is a reasonable expectation that processes and procedures (including access to training) that protect professional EP interests would be in place locally and nationally. Similarly, proactive policies must be in place to protect the interests of trainees and students who are, in some cases, paying for the privilege of a professional education. Junior doctors, in particular, should not be put in the line of fire when senior faculty and attending EPs have more experience in caring for high-risk patients. Proactive policies should restrict residents from working with highly contagious diseases (in either a research or clinical capacity) without advanced training and immediate faculty backup. Local policies that protect vulnerable providers from specific infectious agents (eg, pregnant physicians from TORCH [toxoplasma, other viruses, rubella, cytomegalovirus, herpesvirus]) should be considered when an ED has multiphysician coverage or a backup plan that does not put patients at imminent risk.
During an encounter with a highly contagious patient or a patient deemed to be at substantial risk, EPs have a right to safety. The workplace should provide adequate security, materials, and equipment (eg, personal protection equipment [PPE]) as well as adequate space (isolation rooms, etc.) to care for the contagion. While ED boarding and overcrowding can seem antithetical to these goals of isolation and provider safety, EPs and other HCWs have legitimate rights to be safe from hospital-based or prehospital harms.
After caring for patients at high risk, EPs should continue to have their interests protected. Those taking exposure risks on the frontlines should not suffer discrimination nor should they risk loss of employment or income. Unlike what happened in the widely publicized case of a New York City EP who returned from working with EVD in Guinea, EP privacy and confidentiality should be protected. The fear-mongering media have rights also, but freedom of the press should be subordinate to the privacy interests of providers and patients alike. Furthermore, physicians working on the frontlines of outbreaks of Ebola or related diseases should not be incarcerated or subject to baseless quarantine policies, especially when such policies are motivated more by political interests than by science.
Con: Individual Rights Are Subordinate to Public Health
While individual rights to life, liberty, and the pursuit of happiness are fundamental freedoms for all American citizens, these freedoms aren’t entirely free. Indeed, every right carries with it parallel obligations, duties, and responsibilities.