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Are doctors obliged to heed disaster’s call?

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Last month’s bushfires in NSW are a timely reminder for members to consider whether you are prepared to respond to a major public health emergency such as a natural or man-made disaster, disease pandemic, or even terrorist activity, whether in Australia or overseas.

There are many aspects to disaster and pandemic preparedness that require appropriate education, training, guidance, and support; for example, specific knowledge and skills are required to understand how to mobilise, triage, organise, and manage mass casualties, often with limited resources.

But such preparedness also requires personal reflection on the many ethical challenges that arise in times of major public health crises that do not generally occur during regular, day-to-day clinical practice.

You may find your duty to protect and care for an individual patient comes into greater conflict with your duty to protect others including patients, staff, colleagues, and the wider community. Just as important, you have a personal and professional duty to protect yourself from harm and a personal duty to your own family.

Consider the following questions that could well arise in a major public health emergency:

  • are you willing to risk your own health and wellbeing to care for patients?
  • Are you willing to put your family at risk in order to care for patients?
  • What are the reasonable bounds of personal risk you are willing to accept?
  • Is it reasonable to assume the full-fledged participation of the medical profession in responding to such a crisis?
  • Should doctors have an absolute duty of care in such situations? and
  • What should happen to those who choose not to respond?

Doctors face difficult personal and professional challenges when responding to a public health emergency, including greater professional duties; increased occupational risks; physical and emotional stress; isolation from colleagues, family and friends; professional liability risk; loss of income; discrimination and possibly stigmatisation; risk of personal injury, illness, and death; and the possibility of exposing family members and others to increased risk of personal illness, injury, and death.

The AMA’s Ethics and Medico-Legal Committee (EMLC) is currently reviewing the AMA Position Statement on Ethical Considerations for Medical Practitioners in Public Health Emergencies in Australia, and we are interested to hear your views on the limitations (if any) to a doctor’s duty of care during such events.

SARS, Bird Flu, Hurricane Katrina, the 2004 Boxing Day and Japanese tsunamis, the events of 9/11 in the United States – unfortunately, horrible, catastrophic events happen, and the medical profession, like many other professions, will be called upon, and indeed expected, to respond in the immediate aftermath.

Don’t wait until something happens to decide what you would do. It’s time to think about these issues now, reflect on them, and consider your response. Are you prepared? Are you willing?