Hostname: page-component-586b7cd67f-t7fkt Total loading time: 0 Render date: 2024-11-26T18:59:59.018Z Has data issue: false hasContentIssue false
  • English
  • Français

Ebola, Quarantine, and the Scale of Ethics

Published online by Cambridge University Press:  09 October 2015

Tom Koch
Tom Koch*
Affiliation:
Department of Geography, Medical, University of British Columbia, Vancouver, British Columbia, Canada.
*
Correspondence and reprint requests to Tom Koch, PhD, University of British Columbia, Department of Medical Geography, 1984 West Mall, Vancouver, British Columbia, Canada (e-mail: [email protected]).
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

The West African Ebola epidemic has raised fundamental questions about the ethical and practical use of quarantine measures during infectious disease events.

Methods

This article first reviews the idea of containment in response to disease and the means by which containment has been perceived. It then proposes that disaster medicine, whose focus is the individual, and public health in its focus on populations have related but distinct ethical imperatives. The means by which both were deployed in the West African Ebola epidemic are considered.

Results

The argument is made that a narrow focus on the individual patient or community prevented an early recognition of the potential for disease expansion. In this case, a broad public health perspective was overshadowed by localized attention.

Conclusions

In the future, a public health perspective is a necessary and ethical priority and thus the use of isolation and containment in conjunction with the imperative to treat that is the focus of medical ethics. (Disaster Med Public Health Preparedness. 2016;10:654–661)

Keywords

epidemicsepidemiological monitoringdisaster medicine
Type
Original Research
Information
Disaster Medicine and Public Health Preparedness , Volume 10 , Issue 4 , August 2016 , pp. 654 - 661
Copyright
Copyright © Society for Disaster Medicine and Public Health, Inc. 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Liu, J. Finish the fight against Ebola. Nature. 2015;524(17):27-29.CrossRefGoogle ScholarPubMed
2. Lang, T. Embed research in outbreak response. Nature. 2015;524(17):29-31.CrossRefGoogle ScholarPubMed
3. Koch, T. What the ‘game-changer’ Ebola vaccine says about Canadian R&D. Globe and Mail. http://www.theglobeandmail.com/report-on-business/rob-commentary/what-the-game-changer-ebola-vaccine-says-about-canadian-rd/article25866635/. Published August 7, 2015. Accessed August 7, 2015.Google Scholar
4. Barbisch, D, Koenig, KL, Shih, F-Y. Is there a case for quarantine? Perspectives from SARS to Ebola. Disaster Med Public Health Prep. 2015;9(1):doi:http://dx.doi.org/10.1017/dmp.2015.38.CrossRefGoogle Scholar
5. Center for Law and the Public’s Health at Georgetown and Johns Hopkins Universities. The Model State Emergency Health Powers Act (MSEHPA). http://www.publichealthlaw.net/MSEHPA/MSEHPA.pdf. Published December 21, 2001. Accessed August 9, 2015.Google Scholar
6. Burkle, FM Jr. Operationalizing public health skills to resource poor settings: is this the Achilles heel in the Ebola epidemic campaign? Disaster Med Public Health Prep. 2015;9:44-46.CrossRefGoogle ScholarPubMed
7. Rosen, G. A History of Public Health, Expanded Edition. Baltimore, MD: Johns Hopkins University Press; 1993:43-45.CrossRefGoogle Scholar
8. Defoe, D. A Journal of the Plague Year, Etc. Norwalk, CT: The Heritage Press; 1722/1968.Google Scholar
9. Daws, G. Holy Man: Father Damien of Molokai. Honolulu, HI: University of Hawaii Press; 1984.Google Scholar
10. Haggett, P. The Geographical Structure of Epidemics. New York, NY: Oxford University Press; 2000:99-103.Google Scholar
11. Bailey, NT. The Mathematical Theory of Infectious Diseases and Its Applications. London, United Kingdom: Griffin; 1975.Google Scholar
12. Koch, T. Cartographies of Disease: Maps, Mapping and Medicine. Redlands, CA: ESRI Press; 2005:8.Google Scholar
13. Tomalin, C. Samuel Pepys: The Unequalled Self. New York, NY: Penguin Books; 2003:168.Google Scholar
14. Tine, RR. A Simulation Study of the 1967-68 Foot-and-Mouth Epizootic in Great Britain [dissertation]. Bristol, United Kingdom: Department of Geography, University of Bristol; 1972.Google Scholar
15. Koenig, K. Ebola triage screening and public health: the new ‘vital sign zero.’ Disaster Med Public Health Prep. 2015;9(1):57.CrossRefGoogle Scholar
16. Koch, T. Hubris: the recurring pandemic. Disaster Med Public Health Prep. 2015;9(1):51-56.CrossRefGoogle ScholarPubMed
17. Arrieta, F. Raggualio historic del contagio occurso della provincial de Bari negli anni 1690, 1691, 1692. Napoli: Dom. Ant. Parrino e Michele Juigi Mutii; 1694.Google Scholar
18. Sutherland, J. Introduction. In Defoe D.. A Journal of the Plague Year, Etc. Norwalk, CT: Heritage Press; 1968:ix-xi.Google Scholar
19. Marks, G, Beatty, WK. Epidemics. New York, NY: Charles Scribners & Sons; 1976:197.Google Scholar
20. Koch, T. Disease Maps: Epidemics on the Ground. Chicago, IL: University of Chicago Press; 2011:107-108.CrossRefGoogle Scholar
21. History of the rise, progress, ravages, etc. of the blue cholera of India. Lancet. 1831;17(429):251-284.Google Scholar
22. Toner, E, Adalja, A. A primer on Ebola for clinicians. Disaster Med Public Health Prep. 2015;9(1):33.CrossRefGoogle ScholarPubMed
23. Donnelly, C, Dye, C. Ebola virus disease in West Africa—the first 9 months of the epidemic and forward projections. N Engl J Med. 2014;371(16):1481-1495.Google Scholar
24. Luge, T. GIS Support for the MSF Ebola Response in Guinea in 2014. Geneva: Médecins Sans Frontières Logistics Department; 2014.Google Scholar
25. McNeil, DG. Using a tactic unseen in a century, countries cordon off Ebola-racked areas. New York Times. http://www.nytimes.com/2014/08/13/science/using-a-tactic-unseen-in-a-century-countries-cordon-off-ebola-racked-areas.html?_r=0. Published August 12, 2014. Accessed July 30, 2015.Google Scholar
26. Nicol, M. Ebola lockdown: British plan to send 3,000 UK troops into Sierra Leone to set up military blockades to restrict movement in attempt to stop the virus spreading. Daily Mail. http://www.dailymail.co.uk/news/article-2798713/3-000-uk-troops-germ-warfare-style-ebola-blockade-plan-sierra-leone.html. Published October 24, 2014. Accessed September 18, 2015.Google Scholar
27. Burkle, FM, Burkle, CM. Triage management, survival, and the law in the age of Ebola. Disaster Med Public Health Prep. 2015;5(1):38.CrossRefGoogle Scholar
28. Sack, K, Fink, S, Belluck, P, et al. Ebola’s deadly escape. New York Times. December 30, 2014:D1-D8.Google Scholar
29. Roy-Macaulay, C. Sierra Leone struggles in attempt to isolate Ebola. Toronto Star (Associated Press). http://www.thestar.com/news/world/2014/09/20/sierra_leone_struggles_in_attempt_to_isolate_ebola.html. Published September 20, 2014. Accessed September 18, 2015.Google Scholar
30. O’Carroll, L. Ebola: Sierra Leone village in lockdown after 31 new cases recorded. The Guardian (UK) http://www.theguardian.com/world/2015/feb/27/ebola-sierra-leone-village-lockdown-31-new-cases. Published February 27, 2015. Accessed August 2, 2015.Google Scholar
31. Carroll, MW, Matthews, DA, Hiscox, JA, et al. Temporal and spatial analysis of the 2014–2015 Ebola virus outbreak in West Africa. Nature. 2015;524(7):97-102.CrossRefGoogle ScholarPubMed
32. Pigott, D, Goulding, N, Myne, A, et al. Mapping the zoonotic niche of Ebola virus disease in Africa. eLIFE. http://elifesciences.org/content/3/e04395.full. Published September 8, 2014. Accessed August 11, 2015.Google Scholar
33. Beauchamp, TL, Childress, JF. Principles of Bioethics, 7th ed. New York, NY: Oxford University Press; 2012.Google Scholar