This article is more than 5 years old. Information may no longer be current.
Twenty-five percent of HCWs consider it ethical to refuse care to Ebola patients
The willingness of health care workers to treat patients with Ebola was not entirely consistent with their beliefs regarding the ethics of refusing care, according to a study published in Open Forum Infectious Diseases.
While surveyed health care workers (HCWs) were shown to be strongly influenced by their ethics, such beliefs were balanced against the risks of providing care for Ebola patients, and for extending that risk to their friends and families.
“In 1988, a seminal article was published reporting the degree to which physicians felt that it would be ethical to deny care to patients with AIDS,” Deepa Maheswari Narasimhulu, MD, from the department of obstetrics and gynecology at the Maimonides Medical Center, New York, and colleagues wrote. “Slightly more than a quarter of a century later, in the fall of 2014, the world’s attention turned to Ebola, and a level of concern similar to that which had been seen in regard to AIDS in the pre-[highly active ART] era could again be seen in the lay press. Not as much attention has been paid to whether physicians’ attitudes toward Ebola mirror those of physicians in the 1980s in regard to AIDS.”
To assess attitudes regarding the treatment of patients with Ebola, the researchers surveyed HCWs at two New York hospitals using a self-administered questionnaire. The anonymous 15-question survey polled physicians, residents, medical students, physician assistants, registered nurses and midwifes from various departments. Of the 514 HCWs the researchers approached, 428 completed the survey.
The survey gauged respondents’ willingness to care for patients with Ebola as well as their views on the health care system’s level of readiness to treat Ebola patients. In addition, it asked whether they believed it was ethical to refuse care to patients with Ebola and patients with HIV/AIDS.
According to survey data, 25.1% of HCWs believed it was ethical to refuse care to patients with Ebola virus disease (EVD), while 25.9% reported they were unwilling to provide care to them. Of those who believed it would be unethical to refuse care, 21.3% reported they would be unwilling to care for patients with EVD.
“Only 44.1% of participants felt that their hospital was well-equipped to take care of patients with Ebola,” the researchers noted.
In a multivariate analysis, female gender (OR = 3.2; 95% CI, 1.4-7.7), nursing profession (OR = 2.7; 95% CI, 1.4-5.2), ethical beliefs about refusing care to patients with EVD (OR = 3.71; 95% CI, 2-7) and increased concern about the risk for spreading the disease to friends and family (P = .003) were independent predictors of unwillingness to care for patients with EVD. While 90% of the respondents expressed concern about potentially exposing friends and family to Ebola, 16.8% said they were concerned for their personal risk.
The researchers concluded that providing a safe work environment and mitigating the risks to HCWs’ families may address these concerns.
“This is comparable to what was seen with HIV in the 1980s in the study by Link et al, in which 25% of health care workers would not continue to care for AIDs patients if given a choice, and 24% believed that it was ethical to refuse care to patients with HIV/AIDS,” Narasimhulu and colleagues wrote. “Almost 3 decades later, with increased knowledge and improved prognosis for HIV patients after the advent of [highly active ART], only 12.6% of HCWs in our study believed that it was ethical to refuse care to patients with HIV/AIDS.
“As knowledge of the pathophysiology and epidemiology of EVD and its implications for health care providers become more widely disseminated, it is hoped that a similar evolution may take place for EVD.” – by Jason Laday
Reference:
Link RN, et al. Am J Public Health. 1988;doi:10.2105/AJPH.78.4.455.
Disclosure: The researchers report no relevant financial disclosures.