Intended for healthcare professionals

Views And Reviews

Duty to treat: where do the limits lie?

BMJ 2020; 369 doi: (Published 01 June 2020) Cite this as: BMJ 2020;369:m2150

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  1. Julian Sheather, ethics manager,
  2. John Chisholm, chair of the BMA’s ethics committee
  1. British Medical Association, London
  1. jsheather{at}

Doctors are dying. The combination of a novel virus, no existing treatment, and inadequate supplies of personal protective equipment (PPE) is putting frontline health workers at risk of serious harm. The question arises: when does work based risk become unacceptable? Does a point come when health professionals have the right not to treat seriously ill patients if their PPE is inadequate?

Doctors’ primary duty—to quote the General Medical Council—is to make the care of patients their first concern. This is a paradigm example of what moral philosophers call a “special” positive duty. It can be helpful to compare them to general positive duties. It is widely accepted that we are all under general positive duties—positive in the sense that they require some action from us. If I see a toddler struggling in a garden pool, and I can rescue her without excessive risk, then I am under a duty to do so. It would also be reasonable to criticise me for refusing. These duties are general as they presuppose no special relationship between rescuer and rescued. General duties are not onerous. If I cannot swim and see a child struggling in a torrent, it …

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