Ethics of health care in bird flu debate

Many of us expect the fireman to enter the burning building to rescue the baby, the policeman to go up the dark alley and face the robber; do we also expect nurses and doctors to face possible illness and death, just because they are health care workers? I know when I became a nurse I never thought of it as a hazardous job. Nursing could become one in a true flu pandemic: where the flu surge would overwhelm hospital resources and protective devices like masks and gloves would not be available for the care providers.

I reported earlier in this blog about a health care worker survey which stated that many health care workers would not work during a flu pandemic. The sited workers included the secretaries, housekeepers, dietary people and others who help hospitals to run. It also included doctors and nurses, many who said they were concerned about their families needing them and not wanting to spread illness to them.

I think the images of New Orleans Hospitals struggling following Katrina first got me to thinking about my role in an emergency. I worked thru the Northridge earthquake in 1994, where my hospital, like many others in the area suffered major damage and yet remained open for several days. It was an extraordinary time and health care workers including doctors and nurses all pulled together to manage the patients who were in the hospital when the quake struck and those who needed to be admitted. They rallied and perservered until the hospital was finally evacuated and all the patients placed in less affected facilities.

Throughout the emergency there was a sense of family and community and that we were working for nobler reasons than ususal. I do not recall anyone balking at the duties required, although certainly the aftershocks were terrifying and many health care workers knew that their homes had suffered major damage. They worked and worked hard taking care of the needy patients. We set aside our personal problems in order to facilitate the greater good. We delayed our personal reactions to the earthquake by keeping busy working and providing care.

The earthquake experience was time-limited. It seemed to be forever as we were going thru it, but it lasted less than five days. We always had resources available. We were not cut off from the world and ususally had phone and power available.

Katrina showed me a less positive side of being in an emergency nursing situation and not getting the expected help in a timely fashion. I do not know how many of the stories about generators failing and ventilated patients needing to be hand ventilated are true, nor have I seen actual death figures from these hospitals, but the feelings expressed by the nurses and therapist lead me to believe that it was a hellish time to be a nurse. They could not escape and were stuck being "heroes".

The flu pandemic has the potential to be a worse hellish experience. It is not time limited like the earthquake or Katrina. The pandemic problems in health care settings could go on for a year and then recur with the next wave of the pandemic.
I think working in an Intensive Care Unit as I do, that I will notice the trend of pneumonia cases being admitted. The news reports will tell us that the pandemic flu is here. What do I do then? Just merrily go to work and care for patients with masks and gloves until these are gone. Then do I wrap a t-shirt around my face to protect myself from the virus? What if my husband gets sick? There is no one else to care for him. Isn't my moral and ethical obligation to care for my sick husband as opposed to strangers? Or does my committment to being a nurse mandate that I go to work as assigned and personal needs come second?

How much of a risk is too much risk to take for a nurse? What if I have the flu, do I still work, or protect those who don't have it by not working? We have the example of SARS. Health care workers caught the disease and some of them died. What if we get quarantined AT work? Not allowed to go back home and be with family. What if I get sick and never get to see my family?

I do not have answers for these questions, but believe they should be debated, even if no flu pandemic occurs. I look forward to others input.