in their review recently published in critical care , anantham and coworkers outline the ethical framework that forms the basis of the professional obligations of physicians who respond to health care emergencies , such as an influenza pandemic . bearing in mind the high mortality rates reported for the sporadic human cases of h5n1 avian influenza and experiences gained confronting the recent sars ( severe acute respiratory syndrome ) epidemic , many health care professionals will wonder whether we are well prepared to cope with the anticipated influenza pandemic . worldwide , health authorities and many individual institutions have undertaken substantial efforts to plan and prepare for such a catastrophic event . confronted with the predicted magnitude of a pandemic in reports presented by the mass or professional media , most physicians might feel at least some unease , if not outright fear , about the duties and associated risks they will have to face in the event of an influenza pandemic . after decades of low personal risk for contracting lethal diseases while providing care to patients , physicians -at least in developed countries  are suddenly facing the possibility that occupational risk will increase substantially . if they are not confronted before the onset of an influenza pandemic , these feelings of unease and fear could profoundly hinder individual physicians in fulfilling their professional duties ; they could therefore undermine institutional and societal preparations [ 4 - 8 ] . hence , a reappraisal of the ethical basis of our professional duties as physicians and of justifiable or nonjustifiable limits to these duties should be an integral part of pandemic preparedness efforts , not only for professional organizations and health authorities , but also for individual physicians . in their review , anantham and coworkers   provide explanations of the basic principles of ' the rule of rescue ' , the ' free choice of the profession ' and the implicit ' contract of the medical profession with society ' , which help us to understand the inevitability of accepting professional risk as a physician . more important than the discussion of these basic principles are the authors ' comments on nonlegitimate and legitimate limits to professional risk . sheer heroism will not solve the problems that will be encountered during a pandemic , because high - risk behaviours ( for example , failure to use universal precautions ) might further aggravate problems by rapidly diminishing the numbers of available physicians . although society has the right to demand service from physicians during a health care crisis , physicians have the reciprocal right to demand sufficient institutional support ( for example , protective equipment , chemoprophylaxis and , if available , vaccination ) . in addition to these logistical provisions , society and institutions will also have to address broader issues , including plans for child and elder care , transportation to work or lodging , and provision of adequate compensation to families of physicians succumbing to disease . addressing these and other related issues in advance will help institutions to ensure adequate turnout of the medical workforce in the event of a pandemic . although anantham and coworkers provide a good overview of the ethical issues that arise while preparing for an influenza pandemic , they do not give a detailed ' recipe ' for institutions or physicians planning to embark on or to intensify their efforts for pandemic preparedness . national guidelines and reviews are available for many of the logistical and organizational issues that health care systems and individual institutions must address [ 10 - 13 ] . however , the evidence suggests that we can not assume that health care workers will universally accept the increase in occupational risk associated with fulfilling their professional duties during an influenza pandemic . more research into and reports of successful interventions to improve the acceptance of increased professional risk among health care workers physicians in the fields of emergency medicine , pulmonology , intensive care and infectious diseases  will be among the first to confront a pandemic , the article by anan - tham and coworkers should remind us of our professional obligations and enhance our willingness to fulfill those despite associated risks . otherwise , as the authors concluded , ' influenza will run it 's course ... leaving entire populations ravaged and the history will judge ( us ) harshly . '
after decades of low personal risk for contracting lethal diseases , physicians are suddenly facing the possibility of a substantial increase in occupational risk during an influenza pandemic . 
 if they are not confronted before the onset of an influenza pandemic , feelings of unease and fear or ignorance about physicians ' professional obligations could profoundly hinder individual physicians in fulfilling their professional duties . 
 such feelings could therefore undermine institutional and societal preparations . in their review published in critical care , anantham and 
 coworkers outline the ethical framework that forms the basis of the professional obligations of physicians who respond to health care emergencies , such as an influenza pandemic .