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Canadian Nurses Association

Ethical Considerations for Nurses in a Natural or Human-Made

Disaster, Communicable Disease Outbreak or Pandemic

Historically and currently, nurses provide care to those in need, even when providing

care puts their own health and life at risk (for example, when they work in war-

torn areas, places of poverty, places with poor sanitation, etc.). Nurses also

encounter personal risk when providing care for those with a known or unknown

communicable or infectious disease. However, disasters and communicable disease

outbreaks call for extraordinary effort from all health-care personnel, including

nurses. The



During a natural or human-made disaster, including a communicable disease

outbreak, nurses provide care using appropriate safety precautions in accordance

with legislation, regulations and guidelines provided by government, regulatory

bodies, employers, unions and professional associations. (A9)


duty to provide care

refers to a nurse’s professional obligation to provide persons

receiving care with safe, competent, compassionate and ethical care. However,

there may be some circumstances in which it is acceptable for a nurse to withdraw

from providing care or to refuse to provide care (CRNBC, 2017b; CRNNS, 2014).

Unreasonable burden

is a concept raised in relation to the duty to provide care and

withdrawing from or refusing to provide care. An unreasonable burden may exist

when a nurse’s ability to provide safe care and meet professional standards of

practice is compromised by unreasonable expectations, lack of resources or ongoing

threats to personal and family well-being (CRNBC, 2017b).