This morning, the Presidential Commission for the Study of Bioethical Issues (Bioethics Commission) turned its attention to its next report topic: deliberation and bioethics education. The Bioethics Commission advises President Obama and his administration on issues arising from advances in biomedicine and related areas of science and technology and, in so doing, educates the nation on bioethical issues. This new project will focus on the symbiotic relationship between deliberation and education as twin pillars of public bioethics. Education is required for informed deliberation, and deliberation enhances education at all levels.
The Bioethics Commission dove into its new project this morning with back-to-back sessions examining a case study in public health emergency response. Guest speakers Anthony S. Fauci, M.D., director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health (NIH), andLawrence O. Gostin, J.D., LL.D., university professor and director of Georgetown University’s O’Neill Institute for National & Global Health Law and director of the World Health Organization Collaborating Center on Public Health Law & Human Rights, brought up compelling ethical topics related to the timely debate of restriction of movement provisions in response to an epidemic.
“There are very few examples that are stronger than a global public health crisis to focus our minds and drive home the importance of public education and proactive deliberation,” explained Bioethics Commission Chair Amy Gutmann, Ph.D.
Gostin launched the discussion by describing the various sets of ethical standards that should come into play as issues like quarantine and restriction of movement are considered. Quarantine and restriction of movement is just one of the difficult ethical issues that have been brought up by the current Ebola virus disease outbreak in several western African countries.
In particular, Gostin cautioned against blanket quarantines. “When we think carefully, we should use good science and good constitutional law, both of which would require an individualized assessment of risk before limiting individual liberty,” he said.
Gostin also stressed the importance of public trust to effective public health enforcement. “Whatever decisions policymakers make, they need to be made in partnership and shared understanding with those who are most affected,” Gostin said. “If AIDS taught us anything, it taught us that the first response is social mobilization.”
Next, Fauci discussed how science should inform ethical guidance for public health decision-makers managing Ebola in the United States. Fauci has played a leading role in the national response to Ebola. He has testified before Congress and has been interviewed by national news media on the importance of a science-based approach to containing the Ebola epidemic in western Africa and minimizing risk in the United States.
Fauci also helped care for a Dallas area nurse who was infected with Ebola while caring for a patient with Ebola. This involvement, he said, puts him at low risk for infection, and, in some states, would mean that he would be quarantined. He cited a recent public health conference in New Orleans that banned participation of health care workers who had traveled to West Africa – “and those are the very people you want there.”
Blanket quarantines, he said, are not based on scientific evidence, but arise from a desire to assuage public fear. The real danger, he added, is that blanket quarantines and restrictions can undermine efforts needed to contain outbreaks such as Ebola because they discourage health care workers from providing care to those who are infected.
What’s most needed, Fauci said, is public education. He contrasted the public response to the early days of the AIDS epidemic with the current reaction to Ebola. In AIDS, “we had a growing, insidious epidemic and very few people were paying attention to it. Here we have two cases, and we have mobilized everyone, including the President of the United States.” He added, “The lesson learned is you’ve got to keep educating the public over and over again.”
Following the case study discussions, the Bioethics Commission went on to broaden its discussion to the goals and contributions of deliberation and bioethics education generally.