As a bioethicist who studies the ethics of emerging technologies, I spend my time trying to anticipate risk and thinking about how to make policy decisions in the face of uncertainty. But being the wife of an emergency room physician during the COVID crisis has brought abstract questions of risk management directly into my home.
Last night, my husband and I discussed the situation already facing physicians in New York City: needing to intubate a COVID-19 patient emergently without proper personal protective equipment. Though my husband professed to be unsure how he would react, I know that, like all physicians, he would leap to action and intubate, despite the considerable personal risks. It would be an instinctive decision made in the heat of the moment.
But other questions bring greater uncertainty. If PPE shortages worsen, and the only alternative is continuing to work without proper protection, is there a time at which my husband should decide that showing up to work is not worth the risk? We have a two-year old son. I am pregnant, with a weakened immune system that may make me more susceptible to infection, and the effects of COVID-19 in utero, if any, are still unknown. Any workplace risk that my husband encounters directly threatens the well-being of our family and our unborn child.
The prevailing media narrative surrounding health care workers has been that of heroism, of individuals sacrificing themselves — at all costs — for the good of others. The more dangerous the working conditions, the less PPE available, the more liberally the word “hero” is slathered on.
But medical workers are not self-identifying as heroes. Many, like my husband, feel like lambs being sent to slaughter. Their attempts to protect themselves or speak out about their conditions have been met with retaliation from hospitals.
The problem with the hero narrative is that it emphasizes “bravery” for those who work under hazardous conditions — rather than outrage over the continued existence of such conditions, circumstances that are a direct result of the failed responses by federal and state governments, as well as hospitals. The hero narrative leaves little room for seeing health workers as victims whose suffering is clearly evident now — with high rates of COVID-19 infection abundant around the world. In Italy, 94 doctors and 26 nurses have died and more than 12,000 were infected as of April 7. Across Europe health care workers make up a disproportionate percentage of those who have contracted the virus. And nearly everyone knows the story of Li Wenliang, the 34-year-old Chinese doctor who in December tried to warn the medical community about the spread of the virus and succumbed to it in early February.
More perniciously, the hero narrative perpetuates the false notion of health care workers as inherently altruistic, as individuals who will accept unbridled personal risk, no matter the cost. But in the face of hazardous conditions, there may come a point at which they may not be willing to endanger their own health, nor that of their partners, children, and parents. In the absence of adequate PPE, how much risk can we reasonably ask health care workers to take on?
Within the health-care-worker-as-hero narrative, the decision not to work — or to work less, to work in a different hospital, or even in an alternate capacity, such as telemedicine — is nothing short of taboo. It is antithetical to the selfless health care worker stereotype.
Yet health care workers are considering questions such as these, albeit under the cloak of anonymity on online outlets and Twitter accounts. One wrote: “If I walk away from this nightmare, I will be accused of patient abandonment. If I don’t walk away however, I am risking my health, my life. Does no one care?”
Health care workers did not sign up to risk their lives at all costs. Their line of work is heroic, both in times of crisis and outside it, because they have devoted their lives to helping save others. But we should not call them heroes because they are being compelled to work in dangerous conditions without the proper protective equipment.
The hero narrative helps maintain the notion that there will always be an endless stream of do-gooder health care workers who will selflessly fall on the grenade for the greater good — no matter how poorly they are treated. But health care workers are people, and people have personal risk limits; if hospitals continue to retaliate against their workers, if governments continue to fail to protect them, the sharper these limits will come into focus.
And while the media may be lauding their heroism, health care workers and their families are probably having the same quiet conversations that my husband and I are having, wondering if — and when — a time will come when enough is enough, when the risk will be too great, when they need to out themselves as humans and not heroes.
Anna Wexler is an assistant professor of medical ethics at the University of Pennsylvania Perelman School of Medicine.
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