Ebola, quarantine, and the need for a new ethical framework
Quarantine is a broad public health strategy used to control infectious diseases outbreaks. An arguably most aggressive public health intervention, quarantine limits the asymptomatic individuals’ liberty and can result in significant harm. Quarantine was used in an attempt to control several Ebola outbreaks during the Ebola epidemic in West Africa in 2014. The most concerning quarantine intervention occurred at West Point, a slum of 75,000 people in the capital Liberian capital, Monrovia. This work critically reviews present ethical frameworks in public health for the examination of outbreaks in West Africa. This work utilizes the nine public health ethical principles described by Kerridge, Lowe and Stewart to argue that the quarantine at West Point was not ethically justified; and, it concludes that a new ethical framework for quarantine is required to address future outbreaks in the West African context.
Upshur R. The ethics of quarantine. Virtual Mentor. 2003 Nov 1;5(11): virtualmentor.2003.5.11. msoc1-0311.
Koch T. Ebola, quarantine, and the scale of ethics. Disaster Med Public Health Prep. 2016;10(4): 654-61.
Harris J, Holm S. Is there a moral obligation not to infect others? BMJ. 1995; 311(7014):1215-7
Solano T, Gilbert GL, Kerridge IH, Nayyar V, Berry A. Ethical considerations in the management of Ebola virus disease. The Medical Journal of Australia. 2015; 203(4): 193-5e.1.
Upshur RE. Ebola virus in West Africa: waiting for the owl of Minerva. J Bioeth Inq. 2014; 11(4): 421-3.
Omonzejele PF. Ethical challenges posed by the Ebola virus epidemic in West Africa. J Bioeth Inq. 2014;11(4): 417-20.
Anonymous. WHO: Statement on the 1st meeting of the IHR emergency committee on the 2014 Ebola outbreak in West Africa. [cited on 2020 August]; Available from: https://www.who.int/mediacentre/news/statements/2014/ebola-20140808/en/
Thompson AK. Bioethics meets Ebola: exploring the moral landscape. British Medical Bulletin. 2016; 117(1): 5-13.
Folayan MO, Haire BG, Brown B. Critical role of ethics in clinical management and public health response to the West Africa Ebola epidemic. Risk Manag Healthc Policy. 2016; 9: 55-65.
Folayan MO, Haire B. History, culture and social norms: implications for Ebola drug and vaccine clinical trials. In: Evans NG, Smith TC, Majumder MS, eds. Ebola’s Message: Public Health and Medicine in the Twenty-First Century. USA: The MIT Press; 2016.
Degeling C, Johnson J, Mayes C. Impure politics and pure science: efficacious Ebola medications are only a palliation and not a cure for structural disadvantage. Am J Bioeth. 2015; 15(4): 43-5.
Eba PM. Ebola and human rights in West Africa. Lancet. 2014; 384(9960): 2091-3.
Rothstein MA. From SARS to Ebola: legal and ethical considerations for modern quarantine. Indiana Health Law Review. 2015;12(1): 227.
Anonymous. UN: International covenant on civil and political rights. [cited on 2020 August]; Available from: https://www.ohchr.org/en/professionalinterest/pages/ccpr.aspx
Anonymous. United Nations, Economic and Social Council, Siracusa: Principles on the limitation and derogation provisions in the international covenant on civil and political rights. [cited on 2020 August]; Available from: http://www1.umn.edu/humanrts/instree/siracusaprinciples.html
Rothstein MA. Rethinking the meaning of public health. J Law Med Ethics. 2002; 30(2): 144-9.
Letts J. Ethical challenges in planning for an influenza pandemic. NSW Public Health Bulletin. 2006; 17(9-10):131-4.
Rothstein MA. The moral challenge of Ebola. Am J Public Health. 2015; 105(1): 6–8.
Rothstein MA. Ebola, quarantine, and the law. Hastings Cent Rep. 2015; 45(1): 5-6.
Stocking B, Muyembe Tamfun JJ, Shuaib F, Alberto Banatin C, Frenk J, Kickbusch I. Report of the Ebola Interim Assessment Panel. [cited on 2020 August]; Available from: https://www.who.int/csr/resources/publications/ebola/report-by-panel.pdf?ua=1
Garbuglia AR. Ebola epidemic of 2014–2015: unresolved ethical issues. Indian J Med Ethics. 2016;1(2): 104-9.
Cole A. Experts question wisdom of stockpiling oseltamivir. BMJ. 2005; 331(7524): 1041.
Kamradt-Scott A. Securing Indo-Pacific health security: Australia’s approach to regional health security. Australian Journal of International Affairs. 2018; 72(6): 500-19.
Upshur RE. Principles for the justification of public health intervention. Canadian journal of public health. 2002; 93(2): 101-3.
Kass NE. An ethics framework for public health. Am J Public Health. 2001; 91(11): 1776–82.
Gostin LO, Bayer R, Fairchild AL. Ethical and legal challenges posed by severe acute respiratory syndrome: implications for the control of severe infectious disease threats. JAMA. 2003; 290(24): 3229-37.
Singer PA, Benatar SR, Bernstein M, et al. Ethics and SARS: lessons from Toronto. BMJ. 2003; 327(7427): 1342-4.
Baum F. The New Public Health (Medicine). 4th ed. Oxford: Oxford University Press; 2006.
Calman KC, Downie RS. Ethical principles and ethical issues in public health. In: Detels R, McEwen J, Beaglehole R, Tanaka H. Oxford Textbook of Public Health. 4th ed. Oxford: Oxford University Press; 2004. p. 387-99.
Liang BA. Ethical and legal challenges posed by severe acute respiratory syndrome: implications for the control of severe infectious disease threats. Survey of Anesthesiology. 2004; 48(4): 217-8.
Kerridge IH, Lowe M, Stewart C. Public health In: Kerridge IH, Lowe M, Stewart C. Ethics and Law for the Health Professions. 4th ed. Australia: The Federation Press; 2013.
Ortmann LW, Barrett DH, Saenz C, Bernheim RG, Dawson A, Valentine JA, et al. Public health ethics: global cases, practice, and context. In: Barrett DH, Ortmann LH, Dawson A, Saenz C, Reis AB, Bolan G, eds. Public Health Ethics: Cases Spanning the Globe. Switzerland: Springer; 2016.
Markel H, Lipman HB, Navarro JA, et al. Nonpharmaceutical interventions implemented by US cities during the 1918-1919 influenza pandemic. JAMA. 2007; 298(6): 644-54.
Delaporte E, Wyler Lazarevic CA, Iten A, Sudre P. Large measles outbreak in Geneva, Switzerland, January to August 2011: descriptive epidemiology and demonstration of quarantine effectiveness. Euro Surveill. 2013;18(6): 20395.
Anonymous. WHO: Update 58 - first global consultation on SARS epidemiology, travel recommendations for Hebei Province (China), situation in Singapore. [cited on 2020 August]; Available from: https://www.who.int/csr/sars/archive/2003_05_17/en/
Weed DL. Underdetermination and incommensurability in contemporary epidemiology. Kennedy Inst Ethics J. 1997;7(2):107-27.
Komesaroff P, Kerridge I. Ebola, ethics, and the question of culture. Journal of Bioethical Inquiry. 2014; 11(4): 413-4.
Drazen JM, Kanapathipillai R, Campion EW, et al. Ebola and quarantine. N Engl J Med. 2014; 371: 2029-30.
Presidential Commission for the Study of Bioethical Issues. Ethics and Ebola: Public Health Planning and Response. USA: Create Space Independent Publishing Platform; 2016.
Hoffman S. Preparing for disaster: protecting the most vulnerable in emergencies. UC Davis Law Review. 2009; 42: 1491-547.
Rothstein MA, Gabriela Alcalde MG, Elster NR, et al. Quarantine and isolation: lessons learned from SARS: a report to the centers for disease control and prevention. [cited on 2020 August]; Available from: https://stacks.cdc.gov/view/cdc/11429
Gostin LO, Berkman BE. Pandemic influenza: ethics, law, and the public's health. Administrative law review. 2010; 59(1).
Gutmann A, Thompson D. Deliberating about bioethics. Hastings Cent Rep. 1997; 27(3): 38-41.
Anonymous. WHO: Global alert and response, guiding principles for international outbreak alert and response. [cited on 2020 August]; Available from: http://www.who.int/csr/outbreaknetwork/guidingprinciples/en/
CDC. Use of quarantine to prevent transmission of severe acute respiratory syndrome--Taiwan, 2003. MMWR. 2003; 52(29): 680-3.
Anonymous. SARS assistance and recovery strategy act 2003. [cited on 2020 August]; Available from: https://www.ontario.ca/laws/statute/03s01
Hatzenbuehler ML, Phelan JC, Link BG. Stigma as a fundamental cause of population health inequalities. Am J Public Health. 2013; 103(5): 813-21.
Davtyan M, Brown B, Folayan MO. Addressing Ebola-related stigma: lessons learned from HIV/AIDS. Glob Health Action. 2014; 7: 10.3402/gha. v7.26058. 56.
Maduka O, Odia O. Ethical challenges of containing Ebola: the Nigerian experience. J Med Ethics. 2015; 41(11): 917-9.
Sandora M, Hartocollis A. In New York, protections offered for medical workers joining Ebola fight. New York Times. 31 October 2014.
Pomerantz A. Ethics of Ebola quarantines. Sound Decisions. 2015;1(1): 5.
Tangwa GB. The traditional African perception of a person. some implications for bioethics. Hastings Cent Rep. 2000; 30(5): 39-43.
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