From Ebola to Disease X: A Survey of Clinical Leaders on the Ethics of Treating Patients Infected with Special Pathogens

Abstract: If the United States suffers an outbreak of viral hemorrhagic fever or the emergence of an unknown, highly lethal “Disease X,” 13 hospitals designated as Regional Emerging Special Pathogen Treatment Centers (RESPTCs) will lead the clinical response. Clinical ethics in “special pathogen” treatment pits clinicians’ right to safety against their duty to treat, a duty often grounded in clinicians' implicit consent to assume a degree of risk. But if there is a social contract governing the balance between safety and duty in the treatment of patients infected with special pathogens, its terms remain ambiguous. With limited recent U.S. clinical experience and dated and conflicting professional guidelines, the standard of care for special pathogens is poorly defined. To inform the delineation of ethical norms in this space, we conducted a comprehensive survey of physician, nurse, and pediatric leaders from every U.S. RESPTC. We examined their perspectives on offering or withholding interventions for patients infected with highly virulent pathogens across various scenarios: from chest compressions to ECMO to open abdominal surgery. Factors such as comorbidities, age, and pregnancy were considered. Our presentation unveils survey findings highlighting areas of consensus and stark differences in opinions among clinical leaders of U.S. RESPTCs. By analyzing these results, we aim to shed light on the development of ethical standards for treating patients afflicted with special pathogens. This exploration not only underscores the complexities inherent in such decision-making processes but also emphasizes the need for clear, cohesive ethical guidelines in this critical medical domain.

Sharon Huyn, BS – Georgetown University School of Medicine; Nina Roesner, JD HEC-C – Clinical Ethicist, John J. Lynch, MD Center for Ethics, MedStar Union Memorial Hospital