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Medical Ethics |

Ebola Virus DiseaseEbola Virus Disease: Ethics and Emergency Response: Ethics and Emergency Medical Response Policy

Nancy S. Jecker, PhD; Denise M. Dudzinski, PhD, MTS; Douglas S. Diekema, MD, MPH; Mark Tonelli, MD
Author and Funding Information

From the Department of Bioethics and Humanities (Drs Jecker and Dudzinski), the Department of Pediatrics (Dr Diekema), and the Department of Pulmonary and Critical Care Medicine (Dr Tonelli), School of Medicine, University of Washington; and the Emergency Department (Dr Diekema), Seattle Children’s Hospital, Seattle, WA.

CORRESPONDENCE TO: Nancy S. Jecker, PhD, University of Washington, School of Medicine, Department of Bioethics and Humanities, Box 357120, Seattle, WA 98195-7120; e-mail: nsjecker@uw.edu


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;148(3):794-800. doi:10.1378/chest.15-0135
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Caring for patients affected with Ebola virus disease (EVD) while simultaneously preventing EVD transmission represents a central ethical challenge of the EVD epidemic. To address this challenge, we propose a model policy for resuscitation and emergent procedure policy of patients with EVD and set forth ethical principles that lend support to this policy. The policy and principles we propose bear relevance beyond the EVD epidemic, offering guidance for the care of patients with other highly contagious, virulent, and lethal diseases. The policy establishes (1) a limited code status for patients with confirmed or suspected EVD. Limited code status means that a code blue will not be called for patients with confirmed or suspected EVD at any stage of the disease; however, properly protected providers (those already in full protective equipment) may initiate resuscitative efforts if, in their clinical assessment, these efforts are likely to benefit the patient. The policy also requires that (2) resuscitation not be attempted for patients with advanced EVD, as resuscitation would be medically futile; (3) providers caring for or having contact with patients with confirmed or suspected EVD be properly protected and trained; (4) the treating team identify and treat in advance likely causes of cardiac and respiratory arrest to minimize the need for emergency response; (5) patients with EVD and their proxies be involved in care discussions; and (6) care team and provider discretion guide the care of patients with EVD. We discuss ethical issues involving medical futility and the duty to avoid harm and propose a utilitarian-based principle of triage to address resource scarcity in the emergency setting.


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