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Ethics of Outbreaks Position Statement. Part 1

Therapies, Treatment Limitations, and Duty to Treat

Papadimos, Thomas J., MD, MPH1,2; Marcolini, Evadne G., MD3; Hadian, Mehrnaz, MD4; Hardart, George E., MD5; Ward, Nicholas, MD6; Levy, Mitchell M., MD6; Stawicki, Stanislaw P., MD, MBA7; Davidson, Judy E., DNP, RN8

doi: 10.1097/CCM.0000000000003416
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Objectives: Outbreaks of disease, especially those that are declared a Public Health Emergency of International Concern, present substantial ethical challenges. Here we start a discourse (with a continuation of the dialogue in Ethics of Outbreaks Position Statement. Part 2: Family-Centered Care) concerning the ethics of the provision of medical care, research challenges and behaviors during a Public Health Emergency of International Concern with a focus on the proper conduct of clinical or epidemiologic research, clinical trial designs, unregistered medical interventions (including vaccine introduction, devices, pharmaceuticals, who gets treated, vulnerable populations, and methods of data collection), economic losses, and whether there is a duty of health care providers to provide care in such emergencies, and highlighting the need to understand cultural diversity and local communities in these efforts.

Design: Development of a Society of Critical Care Medicine position statement using literature review and expert consensus from the Society of Critical Care Medicine Ethics committee. The committee had representation from ethics, medical philosophy, critical care, nursing, internal medicine, emergency medicine, pediatrics, anesthesiology, surgery, and members with international health and military experience.

Setting: Provision of therapies for patients who are critically ill or who have the potential of becoming critically ill, and their families, regarding medical therapies and the extent of treatments.

Population: Critically ill patients and their families affected by a Public Health Emergency of International Concern that need provision of medical therapies.

Interventions: Not applicable.

Main Results: Interventions by high income countries in a Public Health Emergency of International Concern must always be cognizant of avoiding a paternalistic stance and must understand how families and communities are structured and the regional/local traditions that affect public discourse. Additionally, the obligations, or the lack of obligations, of healthcare providers regarding the treatment of affected individuals and communities must also be acknowledged. Herein, we review such matters and suggest recommendations regarding the ethics of engagement in an outbreak that is a Public Health Emergency of International Concern.

1Division of Critical Care, Department of Anesthesiology, University of Toledo College of Medicine and Life Sciences, Toledo, OH.

22nd Department of Anesthesiology, University of Athens, Athens, Greece.

3Department of Emergency Medicine, Critical Care Education for Emergency Medicine, Neurological Critical Care Fellowship, University of Vermont Larner College of Medicine, Burlington, VT.

4Department of Medicine, Institute for Public Information in Research and Education in Critical Care Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA.

5Division of Pediatric Critical Care, Department of Pediatrics, Center for Bioethics, Program in Women and Children’s Bioethics, Columbia University College of Physicians and Surgeons, New York, NY.

6Division of Critical Care, Pulmonary, and Sleep Medicine, Department of Medicine, Warren Alpert Medical School, Brown University, Providence, RI.

7Departments of Research and Innovation and Surgery, St. Luke’s University Heath Network, Bethlehem, PA.

8Nurse Scientist, Education, Development and Research, University of California San Diego Health System, San Diego, CA.

The authors have disclosed that they do not have any potential conflicts of interest.

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