Ethics and epidemics.

In 166 AD, an epidemic of smallpox struck Rome, Italy. The Greek physician Galen, who had already acquired a reputation for his dissections, fled the city (Nutton 2002). The abandonment of patients during epidemics was not necessarily frowned on by fellow physicians, or, for that matter, the population at large. During the Middle Ages, however, chroniclers started to criticize physicians for abandoning patients during severe and widespread epidemics. When the plague reached Venice, for example, physicians fled in flocks to avoid contagion. In 1382, the problem had reached such proportions that the city passed a law forbidding physicians to flee in times of plague, and other major European cities followed suit shortly thereafter (Zuger and Miles 1987). The very existence of these laws indicates the extent of the practice. Similar examples of physicians fleeing afflicted cities or hospitals are easily found, right up to modern times. In 1976, an outbreak of Ebola hemorrhagic fever erupted in Yambuku, a small town in the Democratic Republic of the Congo (DRC). Eleven of the 17 hospital staff died from the disease. When Ebola hit Kikwit General Hospital (DRC) in 1995, hospital personnel were not so devoted. Tom Ksiazek, of the Special Pathogens Branch of the Centers for Disease Control and Prevention (Atlanta, GA), arrived at the hospital to find 30 expiring patients, some sharing beds with the deceased (1999). All the physicians and nurses had fled. The bottom line, it seems, is that history provides little guidance on what constitutes the ‘duty to treat’. Daniel Fox (1988) writes: