Military Medical Ethics – Scenario Database

Treatment Eligibility (Ebola mission)

ID/Number: 84
Last updated: 06 Apr, 2020
Revision: 2
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You are a military doctor in charge of a small Ebola treatment unit (ETU) during a major Ebola outbreak in a low-income country. The ETU was established to guarantee that affected healthcare workers would get care. It is believed that this measure will instil confidence in both the local and international communities, so that personnel continue to work or will come to the affected area to help care for the sick and contain the spread of the disease. The recently opened Unit is staffed by military healthcare workers and currently has one Ebola infected patient (about to be evacuated) and two patients potentially infected with Ebola (which may or may not be confirmed).

You are contacted by a local Ebola treatment facility (LETF) and asked to admit a 16 year-old woman with confirmed Ebola. She is the sole surviving member of her family. She has nursed each family member, starting with her mother (a nurse who is believed to have contracted the virus whilst treating patients in the LETF) then her younger siblings and finally her father. The worker at the local unit believes the daughter of his deceased colleague will survive if she can be given intravenous fluids – not an option available in his local unit. You would like to admit this patient. Your reasons are that staff in the unit need to begin to implement and 'test' their practices and policies. Moreover, the local worker has a great deal of experience and his judgement that this patient has a good chance of survival you believe to be reliable.

It will also be a good opportunity to build up trust with the local community. Another member of ETU staff disagrees, arguing that admitting this patient would create a precedent for admitting other non-eligible patients. This would also undermine the mission which retains 'ring-fenced beds' solely for healthcare workers.

The Medical Rules of Eligibility afford some (limited) discretion to admit those who are not automatically eligible but your colleague has made a valid point nonetheless. There is also the balance of risks to staff to consider.

Questions for the discussion of this scenario

Should you admit the patient?
Which arguments speak in favour and against the admission?

Source: This scenario is taken from material produced by the research project "Military healthcare professionals' experiences of ethical challenges whilst on Ebola humanitarian deployment (Sierra Leone)". The project was funded by the UK ESRC and the Royal Centre for Defence Medicine (Academic & Research).
See external links below to access the original material which also contains an analysis of the scenario.

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Triage Disaster Level of care Medical Rules of Eligibility
This scenario is also listed in the following categories
folder Military Medical Ethics Scenarios -> Dual loyalty and/or mixed obligations -> Conflicting roles

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