Tragic TriageMarch 17, 2020
TrustMarch 17, 2020
The Duty to Provide Care
A pandemic situation presents unprecedented challenges as organizations prepare to meet unforeseen demands and challenges and as individuals face their own personal decisions about their own well-being, their families and their professional commitments. Health care organizations should acknowledge those challenges and seek to provide guidance and support as care providers navigate their competing duties and expectations.
Is there a duty to provide care even under conditions of personal risk?
Yes – but…
The duty to provide care is grounded in:
Professional commitments and values.
CPSO Public Health Emergencies
In fulfilling their individual commitment to patients, professional commitment to colleagues, and collective commitment to the public, physicians must be available to provide physician services during public health emergencies. Physician services include:
- providing direct medical care to people in need, and
- performing administrative or other indirect activities that support the response effort.3
The Canadian Nurses Association Code of Ethics says:
During a natural or man-made disaster, including a communicable disease outbreak nurses have a duty to provide care using appropriate safety precautions in accordance with legislation. Regulations and guidelines provided by government, regulatory bodies, employers, unions and professional associations. (A9)
The professional duty to provide care is itself grounded in the social contract with health care professions. The privilege of practicing as a physician or nurse, and the privilege of self-regulation for those professions comes with accompanying duties.
The duty to provide care is also grounded in the fundamental commitments of health care providers to:
The health care professions are service professions, with commitment to serve the community built into their structure and values.
Others who work in the health care system
Physicians and nurses have long professional traditions of service and those expectations of service are deeply embedded professional values. However, contemporary health care relies on a far broader range of professionals and indeed health care organizations rely on many participants in many different roles to function to provide care. Some regulatory colleges explicitly identify a duty to provide care, others are less clear. However, the social contract argument applies to the members of all self-regulating colleges – the privilege of self-regulation comes with the duty of community service.
For those outside the framework of regulatory colleges the situations is perhaps more direct. Your community needs you. You have the knowledge and skill required to keep organizations functioning, without you care could not be provided. Simply put we need you.
But what are the limits to the duty to provide care?
This is nowhere clearly laid out. There is an obligation on employers to provide a safe working environment – but the concept of safe – or safe enough is not clearly defined.
Professional guidance often comes in the form of reflective practice – a careful thinking-through of the individual’s professional duties and expectations against his or her distinctive personal values and commitments. Employers can help here in two distinct ways: by helping employees understand the nature of their professional commitments and also by helping to create the conditions that allow employees to discharge their personal commitments.
Personal Pandemic Plan
There has been some discussion of helping health care workers develop their own personal pandemic plans. These plans can cover the lists of basic supplies and household items required to enable an individual or family minimize trips to grocery stores or pharmacies but can also include encouraging people to make contingency plans to discharge their domestic responsibilities in order to be as available as possible for health care duties.
- Identify my personal family or domestic responsibilities that may be exacerbated in a pandemic:
- Dependent family members
- Dependent children
- Other dependents
- Identify other commitments that may need to be managed in a pandemic:
- Home/domestic maintenance
- Other employment
- Other business interests
- Identify which, if any, of my personal responsibilities, commitments, obligations could be left or avoided in a pandemic situation.
- Identify others who could share the load of responsibility in a pandemic situation.
- List the supports currently available (or planned), which I could put in place to help me discharge my personal obligations:
What do I have to do now to ensure that those supports are available, if required?
- Be informed of what support my employer will provide to help staff balance/deal with competing personal/domestic obligations.
The employer’s obligation
There is a duty on health care workers to provide care – and there is a reciprocal duty on employers to support staff and to make the conditions of providing care as safe as possible. This clearly applies to identifying the appropriate personal protective equipment and to identifying the relevant – and perhaps changing expectations for standards of practice.
In addition, it behooves employers to think about the ways in which they can help workers discharge their other domestic responsibilities in order to maximise the conditions for employees coming to work.
The employer must be a trusted source of information and guidance for employees, and more broadly the community it serves. To that end communication should be timely, fulsome, accurate and expert.