The three primary ethical challenges in preparing for public health emergencies - addressing questions of rationing, restrictions and responsibilities - all entail confronting uncertainty. But the third, considering whether people and institutions will live up to their responsibilities in a crisis, is perhaps the hardest to predict and therefore plan for. The quintessential example of a responsibility during a public health emergency is that of health care professionals' obligation to continue caring for patients during epidemics. Historically, this 'duty to treat' has sometimes gone unrecognized or ignored, but it has also famously been adhered to, including during the recent SARS epidemic. And non-crisis examples of health professionals working in the face of personal risk are very common. The duty to treat should be circumscribed by several considerations, including the levels or risk and benefit at issue, the degree of public reliance on health professional action, and the nature of the individual health professional's acceptance of greater than usual risk. Examining the professional duty to treat and the legitimate questions it raises can provide insight into other actors' responsibilities. Public health ethics as well as professional ethics can help frame answers to some key questions: How strong are ethical responsibilities during crises? To whom do they apply? Should they be more explicit - and hence more circumscribed - or less explicit and hence largely aspirational? And how can public health policies encourage responsible actions?

译文

:在应对突发公共卫生事件时,面临的三个主要的道德挑战-解决配给,限制和责任问题-都面临不确定性。但是考虑到人和机构在危机中是否能履行自己的职责,第三点也许是最难预测和计划的。突发公共卫生事件中最典型的责任示例是卫生保健专业人员在流行病期间继续照顾患者的义务。从历史上看,这种“治疗义务”有时未被认识或忽略,但在最近的SARS流行期间也一直坚持执行。面对个人风险的卫生专业人员的非危机案例非常普遍。治疗的责任应由几个考虑因素来界定,包括所考虑的水平或风险和利益,公众对卫生专业人员行为的依赖程度以及个人卫生专业人员接受比平常更大的风险的性质。审视治疗的专业责任及其提出的合理问题,可以洞悉其他行为者的责任。公共卫生道德规范和职业道德规范可以帮助回答一些关键问题:危机期间的道德责任有多强?他们向谁申请?他们应该更明确-从而受到更多限制-还是不那么明确并因此大有抱负?公共卫生政策如何鼓励采取负责任的行动?

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