PPE ‘ethical imperative’ for front-line health workers: Dr Elizabeth Fenton, Ethicist, University of Otago

Dr Fenton questions whether healthcare institutions are fulfilling their reciprocal obligations to protect their most vulnerable staff with personal protective equipment

Personal protective equipment for front-line health workers is an ethical imperative, says Dr Elizabeth Fenton, Ethicist, University of Otago.

In a blog published in the Journal of Medical Ethics website, Dr Fenton questions whether healthcare institutions are fulfilling their reciprocal obligations to protect their most vulnerable staff with personal protective equipment (PPE) from gloves and masks to respirators and face shields.

“Many staff are being advised to wear PPE only when caring for patients with confirmed or suspected cases of COVID-19.  But if infected patients who are not symptomatic (and who therefore may not have been tested, so are neither suspected nor confirmed) can spread the virus, this advice suggests a potentially dangerous underuse of PPE.”

Dr Fenton’s research interests include the ethical, political and social dimensions of public health and health policy. Her blog was published yesterday prior to the Government’s announcement that more PPE would be made available to front-line health workers and she is grateful for the Government’s action.

“If healthcare workers do not feel protected by the type of quantity of PPE provided, we can no longer expect them to come to work,” says Dr Fenton.

“Our healthcare institutions must give their staff the best chance of protecting themselves from the most severe forms of COVID-19.”

She points out that in Italy about 9 per cent of COVID-19 cases are health workers and at least 37 doctors have died from the disease. In China, an estimated 3000 health workers have become infected and at least 13 have died, thought that number may be higher.

COVID-19 is highly infectious in hospital settings and some settings are much more dangerous than others, Dr Fenton explains.

“Operating theatres, for example, are particularly problematic because the virus can be widely distributed through the intubation process and also through the spread of the patient’s bodily fluids around the room.

“Aerosol spread means the virus will remain on surfaces in the room, including the walls and ceiling. It is not surprising that surgeons are concerned about the implications for risk-exposure in theatre. One surgeon from the UK notes that ‘very soon all our operating theatres will be covered in COVID-19.”

It is critical during a public health emergency that the ethical value of ‘reciprocity’ is maintained, Dr Fenton says.

“It is the value that underpins our individual responsibilities to help one another, and to fulfil professional responsibilities we have to our society. But reciprocity also means providing the support necessary to ensure those with professional responsibilities can fulfil them safely, without taking on undue risks,” she says.

“The expectation that healthcare workers will turn up to work during a pandemic depends on hospitals and the institutions that govern them meeting their reciprocal obligation to minimise the risks to which those workers are exposed.”