How Should Clinicians Respond to International Public Health Emergencies?

This case analysis examines obligations health care workers have to support relief efforts when an infectious disease outbreak could impact us all.How clinicians, institutions, and local communities ought to balance increased need for global solidarity in response to global disease outbreaks with concerns of local stakeholders is one specific tension this article investigates.We explore how emphasizing global health solidarity in the face of highly hazardous communicable diseases can help mitigate global risk.Case Dr W is a hospital administrator at BB academic medical center in the United States.BB has a prominent global health program, and Dr V, an expert in epidemic responses, has expressed interest in working abroad with Médecins Sans Frontières (MSF-Doctors Without Borders) on the current Ebola outbreak.Upon returning from work in prior Ebola outbreaks, clinicians have been monitored in isolated Ebola units until it can be confirmed that they have not contracted the virus.Despite staff having been "cleared," however, some BB patients worry about attending appointments or coming to a hospital where "some doctors and nurses have been around Ebola."Even some members of BB's staff have stated that they will not treat patients who have a disease as deadly as Ebola out of fear for their own safety.Concerned about bad publicity and media attention, the BB board of directors has asked Dr W to dissuade Dr V from continuing international work on Ebola containment, suggesting that "there are other important global health projects that don't scare people so much."Dr W wonders how to respond.Commentary Health care workers (HCWs) are holders of privileged knowledge and of the public's trust; they have a sacred duty in society-that of healers.In return for the public's trust, they owe a duty to care based on their fiduciary relationship to patients. 1 In the legal sense, the phrase a duty of care stems from a special relationship between a physician and his or her patient-a relationship that is voluntary and entered into by mutual agreement.2 Certainly, this definition is clear when applied to a cardiologist treating a patient presenting at the hospital with chest pain.However, what is the obligation of an expert in epidemic responses, like Dr V, to those suffering from highly hazardous communicable diseases in the midst of an epidemic?