Wednesday, July 02, 2014

Bring out your infected!

Public health emergencies reveal a brutal survivalist ethic within societies that normally lies suppressed. Normally, we are supposed to care about the individual choices of fellow citizens and protect their rights, but when an easily transmissible, life-threatening and incurable disease spreads in communities and exceeds our control efforts, rights and choices are transformed into dangerous niceties. That is when the sharper tools in the public health toolbox get pulled out: the involuntary interventions for the common good, the isolation, the quarantine, the mandatory testing. This all sounds routinely ethically justified in a robust, hard-headed, no-nonsense utilitarian sort of way. But there is a plot twist: you don't want the sharp tools to scare or alienate the population so much that they run alway from (or sabotage) public health efforts altogether. Tough love can have perverse outcomes.

Which reminds me of Ebola. As an educator in bioethics, whenever you want to provide an example of a disease that seems to ethically justify industrial-strength public health actions, Ebola fits the bill  even better than HIV or TB. Easy to contract, impossible to cure, and associated with a nasty clinical presentation and a very high mortality rate, Ebola evokes extreme fear that makes extreme responses to it seem commonsensical. This seems to be the case in Liberia at the moment. West Africa is undergoing an Ebola epidemic, and for its part, Liberia has had 61 cases in the past few months, with 41 deaths. The response? Liberia President Ellen Johnson Sirleaf has declared that anyone caught hiding suspected Ebola virus disease (EVD) patients will be prosecuted under Liberian law.

Will this way of 'being serious about the epidemic' help with disease control or quite the opposite? Families and religious organisations currently taking care of/harboring those with Ebola-like symptoms will probably need to be reassured that these patients will be given respectful, effective care. Shouting at caregivers of the sick may not work, particularly when you realise that when you hand someone with Ebola over to the health authorities, it may be the last you see of them.

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