Tags: Ebola Outbreak | ebola | quarantine | policy | workers

Ebola Healthcare Workers Need to Remember: 'Do No Harm'

By    |   Saturday, 01 November 2014 11:20 AM

Primum non nocere. That’s the cardinal precept for healthcare workers. It means, “First, do no harm.” 
As the pundits, media, consultants, and doctors offer opinions about treating and containing the Ebola virus, it is worth considering the implications of this principle.
We speak about those who put themselves in harm’s way as they care for the most desperately ill. Those who do the work that few others will do are indeed heroes.
However, the issue about what happens to these heroes once they return to the United States is more complicated and nuanced than is presently being discussed.
When we hear about healthcare workers going bowling or deciding to go for a jaunt after treating Ebola patients we need to consider the implications of these actions.
Until we know more about this virus we need to implement some type of quarantine for those exposed to it. This may seem somewhat reactionary, but if we consider the risks posed by the returning healthcare worker to those who did not sign up for this hazardous duty it seems a little more measured.
For instance, did the people bowling or riding the subway consent to the potential exposure posed by the nearby infected physician?
Did the nurse who refuses to self-quarantine ask the people she plans to interact with whether they agree to assume whatever degree of risk that her potential infection poses?

In both instances, the answer is most assuredly no. Neither of these people asked those around them whether they would consent to a potential biohazard exposure.
This is materially different than the nurses and doctors who consented to care for the Dallas Ebola patient or the healthcare workers caring for the doctor in New York. They all signed up for the job of dealing with this risk.
It is tragic that two nurses were infected with Ebola and we are all grateful that they lived, but their infection is exactly what we should consider. They had ample barrier protection and training to avoid infection, yet they still developed Ebola. Is it fair for them to impose this risk on others?
Common sense dictates that we develop a policy that protects the rights of those who would be exposed to returning Ebola caretakers.
This policy needs to protect the rights of the people who could potentially be exposed to the healthcare workers as well as to prevent the development of a critical mass of infected people that would exceed our ability to care for them.
Once this threshold amount is reached, people infected will need to be cared for not in the controlled isolation units with specially trained staff, but instead be relegated to their local community hospitals where the staff may or may not be prepared to deal with them and to contain the virus.
And what of the employers for healthcare workers who are quarantined? There have been discussions about who should pay for the time that they are away volunteering or in quarantine.
For employers, the costs associated with these absences may not be financially viable. In addition, if they embrace these returning workers without some type of quarantine or federal policy indemnifying them, they face potential litigation from exposed co-workers.
The images of the Ebola-exposed nurse traipsing through the Maine countryside are indeed the images of personal freedom. Whether or not they represent a picture of the greater good needs to be discussed in a balanced and realistic manner.
Policies, including those regarding liability, need to be developed in a measured, realistic manner.
Kenneth Beer, M.D,. is a board-certified dermatologist and dermatopathologist in Palm Beach, Fla. Dr. Beer is an instructor in dermatology at the University of Miami, and he is an A.B. Duke Scholar at Duke University. He obtained his medical degree from the University of Pennsylvania School of Medicine, and received his dermatology and dermatophathology training at the University of Chicago.

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Primum non nocere. That's the cardinal precept for healthcare workers. It means, "First, do no harm." As the pundits, media, consultants, and doctors offer opinions about treating and containing the Ebola virus, it is worth considering the implications of this principle. ...
ebola, quarantine, policy, workers
Saturday, 01 November 2014 11:20 AM
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