Health workers are intrinsic to an effective and functional healthcare system. Despite their crucial role, health workers encounter a range of challenges that threaten their ability to perform their functions effectively. These challenges can either be physical, cultural, or social. Additionally, health workers can also be exposed to life threatening situations, where a patient’s family may resort to physical violence if they are not satisfied with the patient’s treatment or consider the worker directly responsible for the death/disability of the patient. In an attempt to address some of these challenges, the United Nations Special Rapporteur on the Right to Health recently called for submissions for his upcoming report, which, among other things, examines the challenges that health workers face and how the healthcare workforce can be strengthened.
In light of the current pandemic outbreaks globally, access and use of Personal protective equipment (PPE) by health workers is one of the key challenges that health workers encounter while treating infectious diseases. PPE refers to garments and gear, which are used by health workers as a prevention and control measure while treating infectious diseases. Health workers must be provided with personal protective equipment to reduce health risks to themselves and to others around them. However, workers continue to be exposed to infectious agents.
During the 2014 Ebola outbreak, more than 170 health workers were infected by the virus by August 2014, with more than 80 dead. Researchers cited insufficient supply of and lack of adherence to PPE as key factors. Moreover, failing healthcare infrastructure and insufficient workforce pushed health workers to choose between caring for patients with an increased risk to themselves or abandoning patients. Several workers stayed and treated patients, but contracted the disease and died. Similarly, during the 2003 SARS outbreak in Canada as well, it was reported that many health workers lacked clear understanding of how to remove PPE, so as to not contaminate themselves; health workers have also found it difficult to treat diseases like tuberculosis and HIV/AIDS, despite access to PPE, due to lack of adequate training and awareness on the effectiveness of PPE.
The ILO states that all health workers are required to be provided with adequate information, comprehensive instructions and necessary training for their occupational health and safety by their employers. Employers are also required to provide workers with protective equipment and protective clothing, along with social protections, like insurance coverage. Additionally, ethical frameworks all over the world governing health workers dictate that workers have the right to remove themselves from situations which they believe present a risk to their own life/health or the life/health of their family members. The level of risk is determined differently by medical associations in different countries. Moreover, this right must be read in conjunction with the obligation of health workers to treat their patients in good faith and do everything in their power to benefit their patient/s. In practice, health workers treating infectious diseases may often be conflicted about whether to protect their own physical/mental health or that of their patient’s. In this context, the availability and access of personal protective equipment for health workers is often a challenge for resource poor settings, which exposes health workers to greater risks to their own health.
The trends discussed above raise two key questions:
Did health workers who lacked PPE and still treated Ebola patients violate their duty of care to themselves, or did health workers who abandoned patients for fear of contracting the disease violate their fundamental duty to care for their patient/s? How does one define the bioethics principle of non-maleficence in this context?
Does the bioethics principle of beneficence apply to patients only or also to health workers? How does one strike a balance between these two, oftentimes competing duties?
While the answers to these questions require further deliberation, they would certainly help inform the standards of care that health workers owe to their patients and to themselves, along with the labor rights of health workers. In the meantime, efforts are underway to accord greater emphasis on resource allocation, policy changes and training of healthcare institutions and health workers, so that adequate protection is available and guaranteed to all such workers. It is my hope that health workers receive the care and attention they deserve to function better and perform their vital role in protecting/saving lives.
About the Author
Yashaswini Mittal is a public health lawyer working at the intersection of public health and human rights. After graduating from law school, Yashaswini worked with an India-based think tank to advise the Indian government on health law and policy. Thereafter, she obtained her master’s degree in global health law and went onto to work with advocacy organizations in the US on non-communicable diseases and reproductive health and rights respectively. Yashaswini is currently based in South Sudan on an assignment.