Today, the Presidential Commission for the Study of Bioethical Issues (Bioethics Commission) released a brief, Ethics and Ebola: Public Health Planning and Response, to the administration and the public on ethical preparedness for public health emergency response, with a focus on the U.S. response to the current Ebola epidemic in western Africa. The brief considers what lessons the U.S. response to the epidemic has for ethics preparedness for future public health emergencies, emphasizing the role of proactive democratic deliberation in developing responses that reflect public values in a pluralistic society and an increasingly interconnected world. The brief also considers two areas of particular controversy: 1) the ethical use of liberty-restricting public health measures, such as quarantine; and 2) the ethical conduct of research during public health emergencies.
In this brief the Bioethics Commission endorsed the ongoing participation of the United States in the global response to the Ebola epidemic for both ethical and prudential reasons. Public health crises like the Ebola epidemic often occur in countries and communities least equipped to manage and control them. The magnitude of suffering caused by these crises, and global inequalities in wealth and power that contribute to them, provide a strong moral imperative grounded in humanitarianism and justice to contribute to response efforts. In addition, given the capacity of infectious diseases to travel easily in an interconnected world, addressing epidemics at their source is justified on prudential grounds. Safeguarding national health security provides a strong pragmatic reason to respond to public health emergencies where they occur, and to support ongoing efforts to strengthen capacity and public health infrastructure in affected areas.
Strong international and U.S. federal public health infrastructures are essential for responding effectively to public health emergencies and their short- and long-term consequences. In Ethics and Ebola the Bioethics Commission recommended that the United States strengthen key elements of its domestic and global health emergency response capabilities, including leadership and global collaboration, and engage actively in effective public education and communication.
Ethics preparedness for emergency response, both at home and abroad, calls for an approach to policy making that prioritizes early public engagement, building consensus, and transparency. A proactive process of democratic deliberation before the onset of a crisis can inform and facilitate the development of public health policies that reflect shared values. However, democratic deliberation can be particularly challenging in the midst of a crisis, when information is changing rapidly, and policies and their implementation might need to be reconsidered. The Bioethics Commission recommended that ethical principles be integrated into public health decision making, and that qualified public health ethics expertise be readily available in an emergency to ensure that decision makers identify and respond to relevant ethical considerations in light of real-time available evidence.
In its next project the Bioethics Commission will consider in more depth the importance of democratic deliberation and public education in bioethics. The U.S. response to the Ebola epidemic in western Africa is a timely reminder of why broader public engagement in the ethical dimensions of health decision making is critical, both now and in anticipation of the future.
The brief is available at Bioethics.gov. Look for additional blog posts about each of the brief’s recommendations to be posted to blog.Bioethics.gov.