Examines the opposition to public health measures in a major Ebola epidemic.
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Socio-cultural and anthropological accounts fail to consider ethical dimensions.
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Trust and respect for patients' autonomy are ethically and practically important.
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Current legal and ethical safeguards against coercion in epidemic control are limited.
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From an ethical perspective, facility isolation is as problematic as quarantine.
Abstract
The 2014–2015 Ebola crisis in West Africa has highlighted the practical limits of upholding human rights and common ethical principles when applying emergency public-health measures. The role of medical teams in the implementation of quarantine and isolation has been equivocal, particularly when such measures are opposed by communities who are coerced by the temporary suspension of civil liberties. In their encounters with Ebola victims, outreach teams face moral dilemmas, where the boundaries are unclear between coercion, persuasion and appeals for self-sacrifice. For those teams, we propose a set of practical recommendations aimed at respecting the autonomy of epidemic victims and easing tensions within communities. We recognize that some of these recommendations are progressively achievable, depending on the specific stage or setting of an outbreak. Yet with the increasing availability of experimental treatments and research interventions, weighing patients' autonomy against the common good will become an even more pressing ethical obligation.
