Although issues of medical professionalism have been discussed in the aftermath of the SARS epidemic [1–8], to our knowledge, only few studies have addressed this topic in relation to the anticipated influenza pandemic [9]. Our results suggest that most HCP at our institution recognise their professional obligation to treat patients despite the potential risks. A majority of respondents disagreed that reporting to work during pandemic should be an individual decision of HCP; at the same time, most respondents would not like to see non-reporting HCP harshly punished. The latter finding may reflect the recognition of the difficulty of decisions that HCP have to face.
Although HCP generally accept their obligation to the public, personal risks involved, coupled with lack of clear ethical standards confronting an influenza pandemic, place ethical burden of decision on individual HCP. The existing general ethical guidelines of professional societies, e.g. the Amercian Medical Association [10], establish the duty to treat despite possible risks. Our findings underscore the importance of incorporating these guidelines in the pandemic preparedness plans and to foster a broader discussion among HCP about these guidelines and their implications [1, 6, 7, 9]. For example, while acknowledging the difficulty of recruiting enough medical personnel to care for patients during a potential pandemic, German federal health authorities (Robert Koch Institute) ignore ethical issues of deciding which HCP should be assigned to highly infectious patients; similarly, the effect of fear of contracting a potential lethal influenza infection among HCP is not discussed [11]. A recently published draft of a WHO working group gives a good overview of ethical controversies in regard to the role and obligations of HCP during an outbreak of pandemic influenza and provides preliminary recommendations for pandemic planning [12].
A majority of HCP participating in this survey, including those with small children, asserted their readiness to care for patients during a pandemic. In the era of vaccines and antibiotics the actual and perceived professional risks for HCP have declined [3]. Faced with the possibility of contracting a potentially lethal disease during the SARS epidemic, some of the involved HCP questioned their choice of career and indeed some left their profession [3]. To get a better appraisal of the HCP willingness to accept professional risks, we included hospital administrators as a surrogate group for the general population in our survey. The rate of administrators not willing to accept personal risk was approximately twice as high as the rate of HCP.
Only about one third of the distributed questionnaires were returned, with nurses having the lowest response rate. If persons with perceived undesirable answers were less likely to respond, we could have over-estimated the willingness of HCP to forgo personal safety in order to care for highly infectious patients. Of course, the actual HCP behaviour during a pandemic should not solely be predicted by their answers to the hypothetical questions of a survey. Nevertheless, our study illuminates aspects of HCP perceptions of risk and duty while facing a possible influenza pandemic.
Our survey should be replicated in different healthcare settings or other countries to learn more about the generisability of the results. Regardless, we believe that the surveyed HCP at our tertiary-care, 1000-bed medical centre represent well clinicians confronting a potential influenza pandemic, because – at least in the initial phase of a pandemic – patients will be referred to tertiary care facilities for treatment.
