Open Access Highly Accessed Debate

On pandemics and the duty to care: whose duty? who cares?

Carly Ruderman1, C Shawn Tracy12, Cécile M Bensimon12, Mark Bernstein23, Laura Hawryluck24, Randi Zlotnik Shaul25 and Ross EG Upshur1267*

Author Affiliations

1 Primary Care Research Unit, Department of Family and Community Medicine, Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Room E3-49, Toronto, ON M4N 3M5, Canada

2 Joint Centre for Bioethics, University of Toronto, 88 College St., Toronto, ON M5G 1L4, Canada

3 Division of Neurosurgery, Toronto Western Hospital, 399 Bathurst St., Toronto, ON M5T 2S8, Canada

4 Interdepartmental Division of Critical Care, University Health Network, 200 Elizabeth St., Toronto, ON M5G 2C4, Canada

5 Bioethics Department, The Hospital for Sick Children, 555 University Ave., Toronto, ON M5G 1X8, Canada

6 Department of Family and Community Medicine, University of Toronto, 256 McCaul St., Toronto, ON M5T 2W5, Canada

7 Department of Public Health Sciences, University of Toronto, 155 College St., Toronto, ON M5S 1A8, Canada

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BMC Medical Ethics 2006, 7:5  doi:10.1186/1472-6939-7-5

Published: 20 April 2006



As a number of commentators have noted, SARS exposed the vulnerabilities of our health care systems and governance structures. Health care professionals (HCPs) and hospital systems that bore the brunt of the SARS outbreak continue to struggle with the aftermath of the crisis. Indeed, HCPs – both in clinical care and in public health – were severely tested by SARS. Unprecedented demands were placed on their skills and expertise, and their personal commitment to their profession was severely tried. Many were exposed to serious risk of morbidity and mortality, as evidenced by the World Health Organization figures showing that approximately 30% of reported cases were among HCPs, some of whom died from the infection. Despite this challenge, professional codes of ethics are silent on the issue of duty to care during communicable disease outbreaks, thus providing no guidance on what is expected of HCPs or how they ought to approach their duty to care in the face of risk.


In the aftermath of SARS and with the spectre of a pandemic avian influenza, it is imperative that we (re)consider the obligations of HCPs for patients with severe infectious diseases, particularly diseases that pose risks to those providing care. It is of pressing importance that organizations representing HCPs give clear indication of what standard of care is expected of their members in the event of a pandemic. In this paper, we address the issue of special obligations of HCPs during an infectious disease outbreak. We argue that there is a pressing need to clarify the rights and responsibilities of HCPs in the current context of pandemic flu preparedness, and that these rights and responsibilities ought to be codified in professional codes of ethics. Finally, we present a brief historical accounting of the treatment of the duty to care in professional health care codes of ethics.


An honest and critical examination of the role of HCPs during communicable disease outbreaks is needed in order to provide guidelines regarding professional rights and responsibilities, as well as ethical duties and obligations. With this paper, we hope to open the social dialogue and advance the public debate on this increasingly urgent issue.