Beyond the Duty to Care: Ebola and Healthcare Worker Obligations

Diego S. Silva argues that local and international governments need to pay attention to what healthcare workers need to uphold their supposed duty to care during the Ebola epidemic.


Public debate about current affairs often fixates on what ought to be the case, but enough time isn’t given to thinking about how to bring about what ought to be the case. Given the mortality and devastation surrounding the recent epidemic of Ebola in Guinea, Sierra Leone, Liberia, and Nigeria, the topic of healthcare workers’ (both domestic and foreign) obligations to treat Ebola patients has become a central ethics question. The question most often asked is, ‘Is there a duty to care for Ebola patients?’ But is this even the right question?

Aminu Yakubu and colleagues have recently argued that any duty to care on the part of healthcare workers disappears if they are not given adequate protection while caring for those infected with Ebola and that in such instances “the philosophy of ‘duty to provide care’ [is] inadequate as a moral guide”. For example, healthcare workers in the affected region, who want to treat Ebola patients but lack personal protective equipment, may face extreme dangers (namely, becoming infected with Ebola) because of breakdowns in the local and international health systems.

Questioning whether there is a duty to care during this Ebola epidemic, however, is not limited to academic journals but can be found in mainstream North American media and blogs and international media, too.

But we shouldn’t be asking (or fixating on) whether there is a duty to care: we should be asking instead, ‘What mechanisms and supports need to be in place to allow or persuade healthcare workers to successfully and safely treat those infected with Ebola?’

beak doctor

The beak doctor costume (1720). This precursor to the modern-day hazmat suit consisted of a long trench, boots, gloves, and a beak-like mask containing aromatic materials, and was worn by the physician as protection against the illnesses borne by the patients he treated.

This question is significant for both ethical and practical reasons. If we want healthcare workers to put their lives (and potentially the lives of their loved ones) on the line to care for patients during infectious disease outbreaks, then society owes them as much protection as it can afford. So if healthcare workers ought to care for Ebola patients, then governments need to figure out how we ought to care for the healthcare workers. But what can be done if local governments can’t afford to protect their healthcare workers?

At present, the infected region is largely dependent on international charity. However, insofar as such dependency has been created, in part, by international indifference to, and abuse of, the region in the first place (e.g., this historical perspective on the USA’s obligation to Liberia), one could argue that there is an international obligation to provide aid.

In addition to ethical reasons for protecting healthcare workers during the Ebola epidemic, there exists a practical reason: if Ebola patients aren’t cared for, the disease will spread further out of control than it has already. It’s in the region’s and global health community’s best interest to care for healthcare workers, domestic and foreign, in order to persuade them to care for Ebola patients.

So what can local governments and the international community do to support healthcare workers during the Ebola epidemic?

First and foremost, they must provide the necessary equipment to protect healthcare workers from becoming infected with Ebola. This includes personal protective equipment, but it also means providing the infrastructure and training necessary to allow healthcare workers to do their jobs as best and as safely as possible. The international community has pledged to help provide beds and train healthcare workers. This is an important step, but additional support is needed.

Second, if healthcare workers do become infected with Ebola, then their being treated properly and promptly is imperative, not only for ethical reasons but for practical reasons, too, as described above. However, here we run into problems of the unequal treatment between foreign and domestic healthcare workers. For example, the death of Sierra Leone’s Dr. Olivet Buck and the World Health Organization’s hesitation to evacuate her to better treatment facilities outside of the country, while governments of other countries evacuate their own foreign healthcare workers, creates further mistrust in the region than already exists. Although one might argue that governments have an obligation to protect their own citizens, the inability or lack of desire to care for all healthcare workers equally might have dire effects. Practically speaking, combating the Ebola epidemic will necessarily require the mobilization of local healthcare workers, and for local and foreign healthcare workers to band together; treating local and foreign workers differently may lessen the desire of local workers to place themselves in harm’s way.

Finally, there may be things that we can’t imagine prima facie that healthcare workers fighting the Ebola epidemic might want; therefore, it becomes imperative to talk to healthcare workers throughout the crisis to see what local and international governments can do to make their jobs and lives easier. Doing so might help us better answer the question of how we can do what we believe we ought to do.


Diego S. Silva is a Scientist at St. Michael’s Hospital and an Assistant Professor at the University of Toronto.

One comment

  1. catherine womack · · Reply

    Great post. Your point that we should ask health workers what they DO need is borne out in this week’s statements, especially by nurses’ groups and unions in the US, that as a matter of fact they have not been properly trained to use PPE and, in the words of one nurse interviewed, they don’t even know where they are. Anecdotally, among my provider friends, I’m hearing stories of hospitals scrambling to figure out how to erect systems of access and training on the fly. Somehow, even though this outbreak has been designated a major public health crisis for 2 months, the US healthcare system has been caught flat-footed. I hope that they take the needed time for discussions among stakeholders and start to provide real training.

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