Health Care Workers’ Obligations in CBRNE Crises

Health care workers (HCWs) often suffer the brunt of injuries during chemical, biological radiological, nuclear and explosive (CBRNE) events. Throughout history, those caring for the injured, dying and dead put themselves at risk of harm, infection or contamination. Recent events include the 2014–2016 infectious outbreak of Ebola virus disease in West Africa and the targeting of health facilities in the conflict in Syria. Decisions by HCWs to care for others in the face of such risks have been lauded as heroic whether undertaken for personal moral reasons or in response to an ethical duty to care. However, some have questioned whether such a duty to care is ethically obligatory in the face of some CBRNE events. Ethical analysis of the SARS outbreak found that additional ethical reflection was needed on HCWs’ obligations during CBRNE events. The ethical arguments used to justify the duty to care are reviewed in this chapter. However, other duties exist for HCWs which may conflict with the duty to care. The World Health Organization’s guidance on ethics in pandemics notes that the duty to provide care in pandemics is not unlimited, and that employers and governments have reciprocal obligations to provide training and protective equipment to HCWs during CBRNE. Empirical research raises questions about whether health care organisations are adequately prepared for CBRNE, particularly for the ethical decision-making that will be required. Rather than taking a regulatory or legal approach to this issue, this chapter will argue that the ethical virtues of courage and volunteerism should be fostered in HCW training. In keeping with a virtue ethics approach, leadership takes on an important role in ethical decision-making, as well as praising those who respond to CBRNE by caring for others in spite of the personal risks and their conflicting obligations.