By Alan Regenberg

The continuing outbreak of Ebola in West Africa highlights a daunting set of ethical challenges for nurses (and others, particularly health professionals – though, nurses administering direct patient care are in a particularly challenging position). What are nurses’ responsibilities when faced with extraordinary risks, like those presented by deadly infectious diseases like Ebola? How much personal risk of harm should nurses be expected to face, as a function of the ethical obligations that come with their profession?

In 2006, the ANA issued a position statement on risk and responsibility in providing nursing care. This document emphasizes the importance of individual reflection and careful ethical analysis. Encouraging nurses to analyze “the balance of professional responsibility and risk, including moral obligation and options, in particular situations in order to preserve the ethical mandates of the profession”. And the ANA takes the position that nurses are “obligated to care for patients in a non-discriminatory manner, with respect to all individuals.” But they also recognize that there “may be limits to the personal risk of harm nurses can be expected to accept as an ethical duty”. Perhaps most relevant to the current Ebola outbreak, the guidance further states, “Each individual nurse when faced with a potential for harm, therefore, must assess risk. Accepting personal risk exceeding the limits of duty is not morally obligatory; it is a moral option.”

This in mind, consider what other factors will have an impact on the moral math for deciding when personal risk outweighs moral obligations? For example, how should we think about nurses who are pregnant (or may become pregnant) during the crisis? Should they be less obligated to face risk? How does the extent of a nurse’s training play into this? For example, what level of risks are nursing students obligated to face? Students will be more likely to make mistakes that could result in their being harmed. If we accept this rationale, does it also apply to the obligations of less experienced licensed nurses as compared to those with more experience? What about considerations of age, distinct from experience? Are there reasons why younger or older nurses may be more or less obligated to face risks of personal harm? What other factors might be relevant?

Still more challenges: Nurses will typically be working in the context of institutional support. What do institutions owe to nurses who choose to accept personal risks in providing nursing care? What resources are institutions obligated to provide; resources that will likely have a direct impact on the personal risks that nurses will face? So, for example, what sort of safety equipment, training, staffing (tired nurses are more likely to make mistakes), etc. are institutions obligated to provide to minimize harms to nurses?

When nurses choose to accept personal risks, what do we, as a society, owe to those who remain in harm’s way and are then harmed? There has been a great deal of discussion in the media about the American health care workers who received extensive care after contracting Ebola while working to combat the outbreak in Liberia. Do we, as a society, owe it to these health care workers to do everything we can to provide treatment in an attempt to remedy harms received while they were engaged in supererogatory acts? What about nurses who die while combating this outbreak? What do we owe to their families and loved ones? To their legacies?

The timing of the Nursing Ethics Summit, next week, is ideal to confront this particular batch of tough questions. And this is just one among the many sets of pressing challenges facing nurses. I’m really look forward to reviewing the summit products.

What are your thoughts about risks and responsibility in providing nursing care?

Alan Regenberg, MBe, is not a nurse. He is the Director of Outreach and Research Support at the Johns Hopkins Berman Institute of Bioethics. Among other things, he is working on developing and implementing strategies to use social media as a tool for broad public engagement around issues in bioethics. You can follow him: @aregenberg, and he curates the twitter feed: @bermaninstitute

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