Shabih H. Zaidi  ( Otolaryngologist & Ethicist, National Health Service (NHS), England. )

Coronavirus, COVID-19 emerged on the horizon, out of the blue and engulfed the mankind like the biblical plagues. The humanity is fighting a battle of its very survival in the spring of 2020. The superpowers which never yielded to the mightiest of powers, have all but succumbed to a nano particle. A nano particle which is incapable to reproduce itself nor survive on its own except through a medium. Human arrogance is brought down to earth in a jiffy! Many an ethical question have cropped up during this global challenge. None more obvious than the moral question of duty of care by the health professionals. Well, we are all under a life time professional oath. Active or retired, a health professional can always be called to duty to save lives. As we have just seen in the U.K. and elsewhere. National Health Service (NHS), England took the necessary steps as early as January 2020 to bring about the awareness of the impending viral diseases. China was suffering, humanity was dying, and the whole world stood watching in horror and bracing for action as it swept across the mountains, oceans, deserts and the ice covered peaks like a Mexican wave to invade one after another country. The world is taken by surprise. Not one nation was ready for it. Personnel, equipment, hospital beds, food supplies, daily needs, everything fell short of demand. Panic buying and profiteering showing the greed and evil face of humanity yet again. Health services are manifold in the world. NHS (National Health Services) is perhaps the most efficient if not the best, to cope with health and social care of the people. Undoubtedly it is not the same as it was couple of decades ago. Rising cost, and the added burden of social care specially for to the care of the sick has made it almost pale and anaemic. National elections of 13, December 2019, brought the ailments of the NHS to the front. The Corona virus has further exposed its deficiencies and forced the government to pump in large sums of money. Despite the gigantic efforts, there is an acute shortage of supplies. Ventilators are grossly deficient in number and the PPEs are hard to obtain. Talking to the front line doctors it is so worrying that many of them did not have proper PPEs, and make shift arrangements had to be made. New York is worse. We saw the pathos in Italy and Spain where many health professionals succumbed. In the U.K., at least 100 health professionals have already passed away and several are struggling on ventilators or in HDUs. So the question of morality that bothers one is very basic. What does Deontology, or Ulitrarianism or even Virtue ethics say of the care of duty in such unusual circumstances. Virtue ethics, is Platonic. It concentrates on character building rather than a sense of duty or to serve greater number of people. It's cardinal pillars are Courage, Compassion, Phronesis /practical wisdom and Justice. In the current circumstances Deontology seems to be the driving force as is the Consequestionalism. We have however, seen many retired health professionals to volunteer as a sense of moral obligation and out of good nature. One such physician passed away after catching the virus. He must have been virtuous. Historically we find that even the great physician like Galen defected out of Rome during the monumental plague of AD 165, which lasted almost 15 years. Likewise the Venetian physicians in the 14th century did the same and the authorities had to impose a ban on movement of doctors out of plague afflicted areas.¹ Not so long ago we saw similar pictures during the early days of HIV aids when many physicians avoided if not totally refused to touch a patient. We had to wear double gloves and special theatre gowns which were immediately discarded in clearly marked bins. Operating on an HIV positive patient meant a red light burning outside the theatre. Ebola of Congo was a glaring example of physicians and nurses hiding away. Yes, health workers are duty bound to serve the sick, but is it justified for them to suffer themselves and worse infecting their families? There are many examples of bravery in the conflicts and battles in various parts of the world. The child who was saved from dating and rescued from the rabbles in northern Syria only a few years ago, or the serving food and blankets to the victims of earthquakes in Northern Pakistan and many such examples are almost like folk stories of bravado. But, the danger to a person doing an act of kindness was limited, or negligible. So for instance if the earth quake hits an area, no one enters the region until the shock waves have settled down Contagion is different. It is instant, it is lethal and it is uncontrollable. So what is the answer? It is necessary for a health worker to save a life, but it is also mandatory that personal safety must be kept in the fore front in all situations as we are taught in the BLS and CPR training. First thing is to check for your safety before approaching a patient. Here the onus of responsibility falls upon the competent authority commanding the health care worker to enter a danger zone to save life. Just as health workers are morally obliged to do their duty either as a call of duty or as sort of their built in character to jump to help when needed, the governments are also morally bound to provide the health workers with all the necessary equipment they need for personal protection. Just as a ventilator is essential for a Corona patient struggling to breath, a PPE is vital for a health worker. No government can send a soldier to fight a battle without a rifle. So no government can send a health care worker to fight a battle against deadly Corona virus without providing them the necessary gadgets. Health workers are dying and may continue to do so, but is there a thing called Conscience in the governments to send them unprepared. That is a moral question that only the heads of the states can answer. An ICU nurse in NY posted her video on social media, on 3 April, as she resigned from the job indeed profession because she feared for her life and of her family due to the lack of equipment. Not even a mask was available to her and she bought one for herself. What are the world leaders doing? The Nobel prizes are given every year in recognition of their contribution to the world (not always rightly, one might add). What are those brainy fellas doing? One can only lament as it could be one's own last sigh!

Reference

1. Online [Cited 2020 April 13]Available from URL: http://www.nytimes.com/2020/ 04/92/opinion/coronavirusdoctors- duty.html.