While most researchers, policymakers, lawyers, and journalists have always advocated that doctors are obligated to treat patients with infectious diseases, the Covid-19 pandemic might have changed that long-held view. According to a new study that analyzed people’s tolerance for doctors withholding treatment to Covid-19 patients, researchers observed a steadily growing acceptance of the view that it could be ethically acceptable for doctors to refuse care.
“All the papers throughout history have shown that physicians broadly believed they should treat infectious disease patients,” lead author, Braylee Grisel, a student at Duke University School of Medicine, said in a press release.
“We figured our study would show the same thing, so we were really surprised when we found that COVID-19 was so different than all these other outbreaks,” Grisel added.
Grisel and colleagues assessed 187 published articles, which included legal briefings, news stories, academic papers, opinion pieces, and policy statements. The researchers selected those articles because they addressed the ethical dilemma that doctors have been facing over the last four decades while treating outbreaks of infectious diseases like HIV, influenza, SARS, and more recently the novel coronavirus.
Around 75% of the articles staunchly advocated for every doctor’s obligation to treat patients. However, Covid-19 had the highest number of articles (60%) stating that it is ethically acceptable for doctors to refuse treatment. Meanwhile, only 13.3% of the 187 articles said doctors refusing to treat patients with HIV was acceptable.
Until the Covid-19 pandemic started wreaking havoc globally five years ago, only 9% to 16% of published views from the 1980s to 2019 argued that it was okay for doctors to withhold treatment from patients.
“Some of these results may be because we had the unique opportunity to evaluate changing ethics while the pandemic was actively ongoing, as COVID-19 was the first modern outbreak to put a significant number of frontline providers at personal risk in the United States due to its respiratory transmission,” said senior author of the study, Krista Haines, an assistant professor at Duke University School of Medicine, in a press release.
The researchers found that the main reason views shifted so significantly was due to labor rights and worker protections, which were key issues that authors had highlighted in 40% of articles published after the Covid-19 pandemic began. Compared to that, labor rights were brought up in only 17% to 19% of articles for influenza and SARS and only 6.2% of the articles cited that issue for HIV.
The study, in the journal Clinical Infectious Diseases, brought out various factors that altered views on doctor’s obligation to care for all Covid-19 patients. First, healthcare workers struggled through severe shortages of resources like hospital beds, ventilators, oxygen cylinders, and personal protective gear while being overwhelmed during multiple Covid-19 waves with different variants of the virus. Secondly, a growing number of health care workers faced mistreatment and aggression from patients and relatives and had to deal with patients refusing vaccinations and other forms of misinformation.
“There was a great deal of discussion among frontline providers and ethicists on how best to allocate scarce resources,” the authors wrote. “Patients who refused vaccination were at a higher risk of complications while also putting other patients and providers at risk. Arguments were made based on reciprocity, medical triage, and personal responsibility to exclude patients who refused vaccines from consideration when ventilators and other resources were limited.”