While clinicians have valid reasons for leaving their positions in healthcare, COVID-19 persists and healthcare professionals are in short supply. These circumstances call into question the ethics of working and quitting during a pandemic.

Facing public health crises

In training, healthcare professionals (HCPs) are often guided by the Kantian ethical view that their primary concern is to care for individual patients. It follows that physicians are morally obliged to provide care. This duty-based philosophy, however, is complicated by the presence of global pandemics and other special circumstances.

According to an October 2020 article published in the Journal of Medical Ethics, pandemics require doctors to settle into role-related duties based on specialised skills. Because clinicians have a skillset that non-clinicians lack, physicians have a greater moral obligation to serve during a public health crisis than untrained personnel.

Physicians who choose to practice in pandemics including during COVID-19 are subject to working longer hours and facing increased exposure to the disease. When the circumstances demand it, doctors may also be assigned tasks that surpass their medical competency, prompting legal concerns.

But, let’s face it: You and your colleagues are operating under enormous pressure right now. And it’s reflected in the nearly one in five physicians and other healthcare workers who are dropping out of medicine. The duty to serve endures, however, and physicians are feeling its weight.

Reciprocity and solidarity

Much hinges on whether doctors are being cared for and protected in return.

An August 2020 article published in the Journal of Medical Ethics argues the importance of reciprocity on behalf of a clinician’s state or employer.

Author David Ian Jeffrey wrote,

“While healthcare workers are willing to take necessary risks, they are not willing to take unnecessary ones.”

Supplying physicians with PPE to mitigate unnecessary risks is one form of reciprocity to which doctors may be entitled. Reciprocity also includes access to psychosocial treatment programs, as well as the encouragement to pursue them. The same goes for immunisation: Doctors and their families should be among the first populations to receive vaccines as they become available.

Spontaneous applause, banners, and graffiti are all means by which people showed their gratitude and support for HCPs throughout COVID. Whether the thousands of physicians who came out of retirement to help during the pandemic is a result of such visible solidarity efforts is unknown. But those efforts certainly couldn’t have hurt.

The question of opting out

Authors Stephanie Johnson and Frances Butcher wrote in the October 2020 Journal of Medical Ethics article that older doctors with comorbidities who lack access to PPE might consider opting out of work altogether, and should be justified in doing so.

This option is pertinent for clinicians whose training doesn’t line up with the specialised skills needed to handle a public health crisis. For example, an ophthalmic surgeon may be less inclined to work on the frontlines, compared with an infectious disease doctor, whose speciality necessitates the acceptance of the risk of illness.

With all of this in mind, physicians should be seen as human beings who have rich lives and are faced with several competing demands. Their decision to opt-out of work, while not ideal during a pandemic, can be justified when personal or professional circumstances arise that require them to step away from the frontlines.

What’s next?

If you’re working on the frontlines of the COVID-19 pandemic, don’t shy away from asking your employer and government for what you need. Whether you’re short on PPE or in need of a vaccine, you are entitled to appropriate care as you work each day to treat patients.

According to Dr Lalita Abhyankar, MD, MHS blog post published by the American Academy of Family Physicians,

“Remember who you are, while our interests may have shifted since we began our pre-med courses, there was a kernel of truth to whatever big picture goal existed for us then. There is a good chance that we lost touch with it in the weeds of training. Take some time to remember and rebuild your passions and interests that may have been stripped throughout training.”

This story is contributed by Ashley Perez and is a part of our Global Content Initiative, where we feature selected stories from our Global network which we believe would be most useful and informative to our doctor members.