Ethical considerations in the review of Singapore's H1N1 pandemic response framework in 2009.

1. Duty of Care—Obligations of the healthcare profession One debatable issue that concerns the healthcare workers (HCWs) would be their “duty of care” or simply, their “obligation to treat patients” or “provide care” during an infectious disease outbreak despite the risk of infection.6-9 There is a general perception that HCWs should adhere to their duty of care and provide treatment to patients despite the risk of infection based on professional obligations and responsibilities. HCWs are perceived to accept such risks as part of their professional career and code of oath or ethics.10 They undergo special training and their expertise imposes upon them a higher burden of responsibility. They have a social contract with the public for social respect and the privilege of professional self-regulation and autonomy.10 Nonetheless, in compelling times when the pandemic posed high risks of morbidity and mortality and when HCWs have competing responsibilities to themselves and their family, can they disclaim the duty to treat without breaching clinical responsibility?10 In Singapore, most primary care physicians (PCPs) are still bounded by the duty to care, taking into consideration the various responsibilities and interests that they have to self, family, co-workers, patients and society, beyond those of the healthcare profession, without proclaiming a lack of a duty of care.11 The emergence of a novel virus in the H1N1 infl uenza pandemic raised the uncertainty of whether we would become victims or vectors (or both, at any given time), hence the fulfi llment of the duty of care ought not to be decided simply by balancing the interests of one group over the other.12 The community, institutional and social