According to a national survey of 526 physicians by G. Caleb Alexander,
M.D., and Matthew K. Wynia, M.D., of the University of Chicago Hospitals,
fewer doctors reported a willingness to treat patients as the threat to
their personal safety grew more specific, and only 21 percent said they
are well-prepared to help respond to a bioterrorism attack.
The survey results appear in the September/October issue of the journal
Health Affairs.
The 80 percent who were willing to treat patients came disproportionately
from the 55 percent of the physicians who acknowledged a professional obligation
to care for patients in epidemics, even if that might endanger their own
health. These physicians were significantly more likely to be willing to
treat infected patients than those who did not feel such a professional
duty.
After analyzing their data, the researchers found that such willingness
was associated with being in primary care practice, feeling personally
prepared to treat patients in epidemics and believing in a duty to do so.
Professional codes of medical ethics have long supported this “duty
to treat.” The American Medical Association, for instance, says that
doctors should commit themselves to “apply[ing] our knowledge and
skills when needed, though doing so may put us at risk.”
But in this survey, overall willingness to treat dropped from 80 percent
to just 40 percent when physicians were asked if they would risk contracting
a deadly illness to save the lives of others. Only 33 percent said they
would treat smallpox patients without having been vaccinated against the
virus themselves.
However, real bioterrorism seemed a distant prospect to most of these
doctors. Only 15 percent believed their own communities might be struck
by a bioterrorist event in the next few years. That unlikelihood, combined
with the complexities of learning how to deal with actual bioterror threats,
might account for the low sense of preparedness among the respondents.
Alexander and Wynia suggest that providing physicians with instructions
for general early response to medical disasters — as simple as where
to report in an emergency — might encourage a greater feeling of
readiness, even if every physician cannot become an expert on smallpox,
anthrax, or other potential source of bioterror infection.
“Preparedness for handling a bioterrorist attack entails more than
knowledge,” say Alexander and Wynia. “It requires the willingness
to put knowledge to work, perhaps at some risk to oneself.”
Bioterrorism may not be the only case which calls for doctors to act in
the face of personal risk. Natural occurrences of epidemic diseases may
pose similar dangers.
“Outbreaks of smallpox, viral hemorrhagic fevers, plague and new
diseases such as severe acute respiratory syndrome (SARS) could require
physicians to act at some risk to their own health,” they say. “The
threat of new disease outbreaks, from bioterrorism or natural causes,
has provided an opportunity for physicians to rearticulate and reaffirm
long-standing
ethical principles regarding the duty to treat.”
This research was supported by funding from the Institute of Ethics at
the American Medical Association and by the Robert Woods Johnson Foundation
Clinical Scholars Program.
