The impact of the ongoing COVID-19 pandemic on global health continues apace, generating widespread apprehension among the public and healthcare workers. In midwifery, the Royal College of Obstetricians and Gynaecologists (2020) and the Royal College of Midwives note that pregnant women seem no more likely to contract COVID-19 than the general population, and ‘there is currently no evidence that pregnant women are more likely to be severely unwell, need admission to intensive care, or die from the illness than non-pregnant adults’.
Nevertheless, during the spring months, as the UK death toll rose, including many health and social care workers, the concept of a ‘killer virus’ took hold. Although at the time of writing there are currently substantially fewer COVID-19-related deaths than earlier, the sight of gowned, masked and visor-wearing staff caring for acutely ill and infectious patients raised the question of the extent to which a healthcare worker's duty of care to a patient should be honoured.
A duty of care entails the application of midwifery skills for patients' benefit, according to a professional code of conduct. This is central to the midwife-patient relationship. But are suitably qualified midwives morally obliged to treat patients who have potentially deadly infections? Is a duty of care absolute?
One might argue that in terms of risk, entering the midwifery profession is no different from becoming a soldier or firefighter: one is not forced into the profession, so it is a case of doing one's duty irrespective of whatever infectious challenges might arise. An implication of this approach is that those who fail in their duties expose themselves to moral censure, whereas those who ‘get on with it’ deserve no special praise. Countering this, Ackerman and Detsky (2020) contend that to consider healthcare workers who undertake hazardous duties as no different to soldiers does them a disservice: ‘It whitewashes the elective nature of their sacrifice and, potentially, normalizes their deaths as the inevitable consequence of any war’. Significantly, co-author Dr Allan S Detsky was physician-in-chief at Toronto's Mount Sinai Hospital during the 2003 outbreak Severe Acute Respiratory Syndrome.
One assumes that those favouring the ‘war’ analogy would concede that it would be morally indefensible for a general to send soldiers into battle unarmed and unprotected. In that case, was it acceptable for some UK hospital staff at the height of the COVID-19 outbreak to threaten to quit their posts because personal protective equipment was unavailable? McConnell (2020) reminds us not only of this episode, but also of those elderly patients in Spain who appeared to have been abandoned by staff in their care homes, and he addresses the question of whether it is morally permissible for healthcare workers to decide not to work so as to protect their families from infectious disease. His conclusion is that it is morally acceptable for healthcare workers to abstain from work when their duty of care is outweighed by the risks and burdens of that work: ‘For healthcare workers who live with their families, the obligation to protect one's family from infection contributes significantly to those burdens’ (McConnell, 2020).
Perhaps similar motivations help explain the outcome of a survey of 1032 healthcare workers at three NHS Trusts in the West Midlands. Damery et al (2010) found that although 76.8 % agreed with the statement that ‘[d]octors and nurses have a duty to the sick, despite risks’, a duty of care towards patients may conflict with a duty of care towards one's family. The study notes that ‘Interestingly, nearly 25% of doctors did not consider that they had a duty to work where doing so would pose risks to themselves or their families’.
McConnell (2020) observes that, while society rewards specialised physicians and nurses to shoulder the burden of treating those who need specialised care, ‘towards the other end of the scale, social care workers receive substantially less from society than physicians and nurses, so their duty to treat is much weaker’.
However, it seems to me that the courage displayed by many health and social care workers has transcended their status, leading them to undertake acts of humanity far beyond what one might have expected a duty of care to include.