Can Health Workers Refuse to Treat Ebola Patients? Maybe.

Hospitals across the country are working hard to make sure they're ready if a patient with Ebola walks through their doors.  But some health care workers think they should have the right to refuse to treat anyone with the virus. You might be surprised to know that in some cases, they may just have the law and professional ethics on their side.

Though to this point in time we have no patients in Canada with Ebola, the issue of work refusal has already come up. Last week the Canadian Federation of Nurses Unions, the Registered Nurses Association of Ontario, and others said nurses have raised concerns across Canada. Jane Sustrik with the United Nurses of Alberta said a number of front line nurses there have told the union they lack proper training and equipment to look after Ebola patients without the risk of getting the disease themselves.  

According to media reports, at an internal meeting at Alberta Health Services, the issue was taken seriously enough that the health authority said that if health care workers refuse to treat a patient with Ebola, they could face disciplinary action.  Nurses in Quebec have raised similar concerns.  

And they're not the only health care workers to do so.  Housekeepers at McMaster Children's Hospital in Hamilton, Ontario, reportedly to clean up the room of a patient with suspected Ebola.

The most obvious reason why nurses are concerned about contracting Ebola is that they are among the health care workers who spend the greatest amount of time in close, repeated contact with patients. It's no wonder nurses feel vulnerable, since the first two health care workers to contract Ebola in North America are nurses. Nurses I talked to said they were stunned by the news that a second nurse at Texas Presbyterian Hospital in Dallas contracted Ebola; so was the US Centers for Disease Control director, who said the CDC is rethinking its approach as a direct result.

Here in Canada, Alberta dealt with a possible Ebola patient hospitalized in Edmonton.  The patient - who was isolated appropriately - tested negative for the virus. Still, nurses there reportedly said they were not given correct information about wearing protective respiratory masks.

By virtue of the amount time they spend at the bedside, nurses may have a lot more opportunity than other health professionals to contract Ebola.  But they aren't the only ones. Housekeepers are also at potential risk. We've seen in West Africa that MDs have also contracted Ebola while caring for infected patients.  During the outbreak of Severe Acute Respiratory Syndrome or SARS back in 2003, I know anaesthesiologists and respiratory therapists who got infected while caring for patients with SARS.

Is it legal for health professionals to refuse to treat patients with Ebola?  The answer may surprise you.
A 2010 paper written for members of the Ontario Nurses Association or ONA says provincial legislation gives health care and other workers a limited right to refuse unsafe work without fear of reprisal provided there are circumstances where the worker has reason to believe there is danger.  For instance, they can refuse to work with any equipment or device that the worker is to operate or use that is likely to endanger himself or herself and others. 
The worker can't refuse if the job is what they do ordinarily.  So, a lab technician can't refuse to handle a blood sample from a patient with an infectious disease but could refuse to handle the sample if the suspected virus is highly infectious and if proper protective clothing and equipment are not provided.  Clearly, that exception has bearing in cases of Ebola.  

The 2010 ONA report says that there was at least one case during SARS of a nurse exercising her right to refuse to care for a SARS patient until she demonstrated that she could properly don the N95 respiratory mask.
This week, a statement from Federal Minister of Health Rona Ambrose said the Minister had spoken with representatives from national nursing associations, and had emphasized that it is imperative all front line health care workers have guidance and information to deal with Ebola.

It's clear that the provinces and the federal government are pouring resources into Ebola preparedness which in an effort to demonstrate that they are protecting not only the public but front line health care workers who are essential in treating Ebola patients. In my opinion, the minister's statement is also an attempt at heading off any discussion about refusal to treat patients with Ebola.

Clearly, hospitals must put in place methods to protect health care workers from the threat of Ebola.  That means they must provide adequate gowns, disinfectants, and other equipment.. Hospitals must also train health care workers on proper procedures for handling safely patients with suspected Ebola. More than that, our public institutions must be out in front of this issue. 

For instance, Ontario has designated 10 hospitals as Ebola referral centres. Last week,Ontario's Chief Medical Officer of Health issued a directive expanding and improving training for health care workers and provide additional personal protective equipment.The new measures also state that two nurses at each hospital will now exclusively care for any confirmed Ebola patient at all times under the supervision of qualified management staff. Those nurses will be banned from caring for other hospitalized patients. 

Let's hope these precautions work.  As we have seen in the US, the CDC is re-evaluating its infection control procedures for health care workers in light of what happened at Texas Presbyterian Hospital. The more uncertain authorities are about the effectiveness of methods of protecting health care workers, the less right they have to demand that health care workers care for Ebola patients.

Dr. Brian Goldman hosts White Coat, Black Art on CBC Radio One.  His new book The Secret Language of Doctors is published Harper Collins Canada Limited.