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Healthcare workers have been advised by the Department of Health they are under no ethical obligation to accept unreasonable risks in discharging their duty of care to patients with Covid-19.
Fresh guidelines have been issued by the department in response to concerns over the dangers posed to doctors, nurses and other healthcare staff in treating patients with the coronavirus when there may be inadequate supplies of personal protective equipment (PPE).
The guidelines state that medical staff cannot be required to assist a patient who has tested positive for the Covid-19 virus with an aerosol generating procedure without PPE as they would be directly exposed to aerosolised particles.
“In fact there are good reasons why the HCW [healthcare workers] should not participate, however well-intentioned they may be, because putting themselves at serious risk of infection is not in accordance with the goals of public health practice in a pandemic,” the guidelines state.
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They add: “Should a HCW become infected, this will not only affect their own welfare, but will also impact on their ability to provide care for others and could place patients and co-workers at risk.”
However, the guidelines said assessment of the risk-benefit situation needed to be made on a case-by-case basis.
They recommend that consideration needs to be given the acuity of the patient’s needs, the scale of Covid-19 exposure to a healthcare worker and whether there were alternative treatments that not involving the same level of exposure.
Medical staff are also advised that they should examine the possibility of delaying a particular treatment until a time when PPE becomes available.
The guidelines, which were approved by the National Public Health Emergency Team, are aimed at healthcare workers in acute, pre-hospital and community settings as well as their managers and policy makers.
They set out obligations on healthcare staff in the provision of medical care to patients in situations where there are constraints on supplies of PPE.
The guidelines state that the duty of care must be balanced against the likelihood and magnitude of the risk faced by medical staff as well as their families, co-workers and other patients.
What about the State’s obligation?
They highlight how different procedures involved different levels of risks which can also vary between different types of workers.
The guidelines recognised that staff with certain pre-existing conditions faced increased risks of serious complications if they were to become infected with Covid-19.
The document acknowledges that the State also has an obligation, under the ethical principle of reciprocity, to ensure that healthcare workers are appropriately protected from risk when discharging their duty of care.
While the department recognised that staff should be provided with the necessary PPE to safely carry out their task as well as training in the use of PPE, it also pointed out there was a global shortage of such equipment which meant the securing of supplies was challenging.
The HSE said healthcare staff should also avoid using PPE when it was not required in order to preserve stocks.
“Even with rational and appropriate use of PPE, there are likely to be times when PPE is in short supply,” said the HSE.