Their stories — the nurses who have resorted to wearing garbage bags as protective gear, the doctors banished to the basement for fear of infecting their spouses and children — are at once maddening, heartbreaking and inspiring.
As are, most of all, the deaths, beginning with Dr. Li Wenliang, a Wuhan, China, opthalmologist who warned his medical school classmates about this strange new virus and was reprimanded by Chinese authorities — only to later contract the virus himself and die. Now, Li’s counterparts in overcrowded and under-resourced hospitals around the world have given their own lives to save others.
In Italy, more than 40 health-care workers have died. In France, at least three doctors. In the United States, the toll is beginning to mount: In New York on Tuesday, 48-year-old Kious Kelly, an assistant nursing manager at Mount Sinai who suffered from severe asthma, died. “I’m okay,” he had texted his sister only the week before, letting her know he had tested positive and was on a ventilator. “Don’t tell Mom and Dad. They’ll worry.”
A grim report by The Post’s Rachel Siegel featured the emergency medicine doctor who wrote out her funeral playlist; the dual-physician family who found backup guardians for their backup guardians, in case of the worst.
Is this what they signed up for? There is some danger inherent in the ordinary practice of medicine, but not this much. I confess: I do not know that I would do the same in their circumstances; I am not sure I am so generous or so brave. If my child were graduating from medical school, how would I deal with her being sent, inadequately protected, into an emergency room? If my husband were a physician, would I send him off to the hospital — or let him back into the house in the interim?
What is fascinating about the selflessness of health-care providers in the current pandemic is that their ethical obligations are not absolute. During the influenza pandemic in 1918, when more than 600 physicians died, the American Medical Association’s code of ethics mandated that physicians continue caring for patients “without regard to the risk to [their] own health,” according to a 2018 article, “The Physician’s Duty to Treat During Pandemics,” by David Orentlicher in the American Journal of Public Health.
In subsequent years, that strict ethical standard was first relaxed and then, if only in the aftermath of debates over the duty of health-care providers to treat AIDS patients, restored, although not quite as strictly. The current version of the code obliges doctors to “provide urgent medical care during disasters,” and “this obligation holds even in the face of greater than usual risks to physicians’ own safety, heath, or life,” Orentlicher writes.
But at the same time, according to an AMA ethics opinion, “Physicians also have an obligation to evaluate the risks of providing care to individual patients versus the need to be available to provide care in the future.” Similarly, according to the American Nursing Association, “Nurses are morally obligated to care for all patients.” However, the group’s ethics code advises, “in certain situations the risks of harm may outweigh a nurse’s moral obligation or duty to care for a given patient. . . . Accepting personal risk exceeding the limits of duty is not morally obligatory; it is a moral option.”
As Orentlicher observes, the duty to provide care cannot be absolute: “It would not make sense to expect physicians to treat patients who cannot be saved but would readily transmit their deadly infection to their care providers.” Orentlicher argues for imposing on physicians a more stringent requirement to treat than does the AMA, but he also notes, “We cannot ask physicians to assume risks to their health unless we do all we can to reduce the risk.”
Which, of course, we didn’t. Not enough, and not in time. And that is what makes the heroism of the health-care workers even more extraordinary. This is their version of running into a burning building. It is what they do — what they do for us. We must be forever grateful, and we should not fail them again.