title: Ethical and practical considerations in providing critical care to patients with Ebola virus disease.
abstract: Infectious disease epidemics in the past have given rise to psychologic and emotional responses among health-care workers (HCWs), stemming from fear of infection during patient care. Early experiences in the AIDS epidemic provide an example where fear of contagion resulted in differential treatment of patients infected with HIV. However, with a deeper understanding of AIDS pathogenesis and treatment, fear and discrimination diminished. Parallels exist between early experiences with AIDS and the present outbreak of Ebola virus disease in West Africa, particularly regarding discussions of medical futility in seriously ill patients. We provide a historical perspective on HCWs' risk of infection during the provision of CPR, discuss physicians' duty to treat in the face of perceived or actual HCW risk, and, finally, present the protocols implemented at the National Institutes of Health to reduce HCW risk while providing lifesaving and life-sustaining care.
authors.affiliation: Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD. Electronic address: torabiparizip@cc.nih.gov.
authors.forename: Parizad
authors.initials: P
authors.lastname: Torabi-Parizi
authors.affiliation: Clinical Research Section, Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD.
authors.forename: Richard T
authors.initials: RT
authors.lastname: Davey
authors.affiliation: Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD.
authors.forename: Anthony F
authors.initials: AF
authors.lastname: Suffredini
authors.affiliation: Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Chertow
mesh_terms: D002985:Clinical Protocols / Q000592:standards; D003198:Computer Simulation; D003422:Critical Care / Q000941:ethics* / Q000523:psychology*; D015658:HIV Infections / Q000628:therapy / Q000635:transmission; D006282:Health Personnel / Q000193:education / Q000523:psychology; D019142:Hemorrhagic Fever, Ebola / Q000628:therapy* / Q000635:transmission*; D006801:Humans; D017758:Infectious Disease Transmission, Patient-to-Professional / Q000517:prevention & control*; D028681:Moral Obligations; D009316:National Institutes of Health (U.S.); D010348:Patient Care Team; D012307:Risk Factors; D014481:United States