The Rise of Government Control

Concern about costs has also led the government to restrict doctors’ professional autonomy. Because the government pays the bills generated by Medicaid and Medicare, it has a large vested interest in controlling

A Duty to Provide Care?

In 2014, the Ebola virus disease began raging across Guinea, Liberia, and Sierra Leone. Soon reports appeared of high fatality rates, not only among patients but also among doctors, nurses, and aides.

In some ways these deaths were not surprising, given the almost total lack of gloves, masks, and other basic infection-control equipment in some West African clinics and hospitals. When two nurses were infected by an Ebola patient in a Dallas hospital, however, despite having taken what seemed like reasonable precautions, fears understandably spread among the health care community, some of whom began questioning whether they had a duty to care for such patients.

Do health care workers have a duty to provide care, even when their own lives or health might be at risk? This question surfaces whenever epidemics rage—from bubonic plague in the Middle Ages to HIV/AIDS 40 years ago and to the Ebola and Zika viral diseases today. It also surfaces during wars and disasters. For example, some doctors and nurses rushed to Puerto Rico’s hospitals to help during 2017’s Hurricane Maria, and some in El Salvador have stayed to help despite gang violence while others have fled.

According to the AMA, doctors have an obligation to provide care whenever they are competent to do so. This argument is based on the idea that anyone trained and licensed in a helping profession—especially when that training was heavily subsidized through government funding—has accepted the obligation to pay the nation back by helping others. This argument further suggests that the duty to care is highest among those trained in specialties such as infectious disease and lowest for those who receive far less subsidy or training, such as nursing aides.

But is that duty to care absolute? And most important, do nations and health care systems have a duty to protect health care workers whenever possible? And if nations and health systems fail to meet this obligation, does that release health care workers from the duty to care?