The Ebola outbreak in West Africa is the largest and deadliest on record, and the crisis is evolving rapidly. More than 2,200 people have been infected in Sierra Leone, Liberia, Guinea, and Nigeria, and more than half have died. The response to the epidemic has raised ethical questions about the fair allocation of scarce resources, the appropriate use of unproven medicines, obligations to health care workers who volunteer for dangerous assignments, and international obligations to invest in adequate public health infrastructures.
Two excellent commentaries this week by Hastings Center Fellows explore these questions, analyze structural problems that are contributing to the present crisis, and offer recommendations for public health planning.
Nancy Kass, writing in Annals of Internal Medicine, addresses three questions: Was it ethical to airlift two infected American health care workers to the United States for treatment? Was it ethical to give them a “highly experimental” drug? And if it was ethical to give them this treatment, should Africans infected with Ebola receive it too?
Kass argues that the airlift was ethical. While mindful of the duty not to abandon patients, she points out that few health care workers would ever volunteer to care for Ebola patients in West Africa, and “traveling to help patients with an illness both highly contagious and usually fatal is what ethics calls “supererogatory”–above and beyond usual norms of good ethical conduct.” (In a recent interview Joanne Liu, president of Doctors Without Borders, said that recruiting health care workers for West Africa is more difficult than for war zones.)
Given the danger that these health care professionals were willing to face, Kass says it would have been “unconscionable” not to assure them that, “should they contract Ebola, they would be airlifted home to receive the best care available.” (Both have recovered and been released from Emory University Medical Center.)
Kass also thinks that a decision to give a highly experimental treatment to health care workers at imminent risk of dying “seems more reasonable” than a decision to give such a treatment to an entire community, assuming sufficient quantities of the drug were available (which is not the case ).
The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.