Preamble

1. Public health emergencies can arise from events such as natural or man-made disasters, disease pandemics, and terrorist activities.

2. During such emergencies, medical practitioners and other health care professionals will be called upon to support the health care needs of those directly and indirectly affected by the emergency.¹

3. Medical practitioners will play a key role in responding to the challenging demands arising from a public health emergency, not only in terms of the immediate (acute) response to the crisis but also in terms of managing any associated long-term health effects in the population.

4. Medical practitioners may face difficult ethical dilemmas that do not generally arise during normal clinical practice regarding the need to balance their obligation to individual patients as well as to others.

5. Medical practitioners have an ethical obligation to look after the health and well-being of the individual patient as part of the doctor-patient relationship.

6. Medical practitioners also have an ethical obligation to protect themselves, their families, other patients, staff, colleagues, and the wider public from harm.

7. Under 'ordinary' clinical practice, these multiple obligations co-exist harmoniously as the interests of the individual patient do not generally conflict with the interest to protect themselves and others from harm. The health and well-being of the practitioner and others is not under threat; therefore, the practitioner's obligation to look after the individual patient can remain paramount.

8. During a public health emergency, however, the health and well-being of the practitioner and/or others may come under threat; thus, the practitioner's obligation to protect themselves and others from harm carries greater weight than during 'ordinary' clinical practice.

9. In order for patients and the wider community to support the medical profession in fulfilling its role during a public health emergency, it is imperative that they recognise and understand that the medical practitioner will continue to act in the primary interests of the individual patient to the best extent possible, but this must be weighed against the obligation to protect themselves and others from harm.

AMA position

10. Medical practitioners may face difficult personal and professional challenges while responding to a public health emergency including:

• greater professional duties;
• increased occupational risks;
• physical and emotional stress;
• isolation from colleagues, family, and friends;
• risk to their professional liability;
• loss of income;
• discrimination and possibly stigmatisation;
• the risk of personal injury, illness, or death; and/or
• the possibility of exposing family members and others to increased risk of personal illness, injury, or death.

11. The AMA advocates that in order for medical practitioners to fulfil their role during a public health emergency, the public must be informed that medical practitioners have an ethical and legal obligation to protect not only individual patients but also themselves and others from harm.

12. Whilst medical practitioners will respond to a public health emergency, the AMA believes that they should not be expected to exceed the bounds of reasonable personal risk.

13. The AMA advocates that employers, governments, and the public have a reciprocal obligation to protect and support medical practitioners responding to a public health emergency. This includes:

• protecting the health and well-being of the medical workforce (and their families) during the crisis response;
• providing immediate and ongoing health care and other support, including financial support to medical practitioners (and their families) who are harmed or die as a result of the emergency response;
• protecting the privacy of medical practitioners (and their families) (for example, practitioners undergoing quarantine during a disease outbreak may face stigmatisation, along with their families, from their community);
• providing medical practitioners with sufficient information, guidance, training, and support required to fulfil their duties; and
• ensuring the fair and appropriate designation of medical practitioners' roles and responsibilities.

14. The AMA advocates that, in order to ensure the medical workforce's preparedness to respond to a public health emergency, the medical profession must be involved in the development and implementation of public health emergency response protocols.

References:

1. This position statement is limited to addressing the obligations of medical practitioners only.American Medical Association. E-2.25 The Use of Quarantine and Isolation as Public Health Interventions. June 2006.

American Medical Association. E-9.076 Physician Obligation in Disaster Preparedness and Response. December 2004.
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University of Toronto Joint Centre for Bioethics. Pandemic Influenza Working Group. Stand on Guard for Thee. Ethical considerations in preparedness planning for pandemic influenza. Toronto, Canada, November 2005.
World Medical Association. The World Medical Association Statement on Avian and Pandemic Influenza. Adopted by the WMA General Assembly, Pilanesberg, South Africa, October 2006.
World Medical Association. The World Medical Association Statement on Medical Ethics in the Event of Disasters.. Adopted by the WMA General Assembly, Pilanesberg, South Africa, October 2006.