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Ebola Virus Disease: Ethics and Emergency Medical Response Policy.
Chest. 2015 Apr 9;
Authors: Jecker NS, Dudzinski DM, Diekema DS, Tonelli M
Abstract
Abstract.: Caring for Ebola Virus Disease (EVD)-affected patients while simultaneously preventing EVD transmission represents a central ethical challenge of the EVD epidemic. To address this challenge, we propose a model policy for "Resuscitation and Emergent Procedure Policy of EVD Patients" and set forth ethical principles that lend support to this policy. The policy and principles we propose bear relevance beyond the EVD epidemic, offering guidance for the care of patients with other highly contagious, virulent, and lethal diseases. The policy establishes (1) a Limited Code Status for confirmed or suspected EVD patients. Limited Code Status means that a Code Blue will not be called for patients with confirmed or suspected EVD at any stage of the disease; however properly protected providers (those already in full protective equipment) may initiate resuscitative efforts if, in their clinical assessment, these efforts are likely to benefit the patient. The policy also requires that (2) resuscitation not be attempted for patients with advanced EVD, as resuscitation would be medically futile; (3) providers caring for or having contact with confirmed or suspected EVD patients be properly protected and trained; (4) the treating team identify and treat in advance likely causes of cardiac and respiratory arrest to minimize the need for emergency response; (5) EVD patients and their proxies be involved in care discussions; and (6) care team and provider discretion guide the care of EVD patients. We discuss ethical issues involving medical futility and the duty to avoid harm, and propose a utilitarian-based principle of triage to address resource scarcity in the emergency setting.
PMID: 25855946 [PubMed - as supplied by publisher]