Ethical planning and response

There are a lot of ethical issues that will arise as a result of interventions that will be implemented to control Ebola spread. Ethical planning for, and emergency response to, Ebola is a relatively new challenge that the country must face, even in peacetime. The growing threat of Ebola demands the rapid reorganization of the health service operatives notwithstanding recalibration of the ethical issues that will be encountered. Medical practitioners and Ebola experts will be faced with decisions relating to resource prioritization and allocation. To make the best use of limited health-care resources available and achieve cumulative benefits in this under-resourced country, utility considerations must be fair and largely popular. Although the criteria to establish priorities that promote equitable access are important, prioritization protocols to ameliorate ethical problems in these circumstances must be developed. 

Ethical problems are likely to originate from the particular tasks of public health and medicine. For example, ethical problems will arise if medical professionals decide not to work at the bedside due to fear of contracting the disease or if they feel obliged to stay at home and look after their families. Sometimes, lack of transport to ferry patients or health workers to locations, such as main hospitals, can cause ethical concerns. Ethical issues are likely to emerge as a result of irrational decision-making and failure to balance individual freedoms against the common good, fear for personal safety against the duty to treat sick people, and economic losses against the need to contain the spread of a deadly disease. To address a number of ethical issues raised in reference to the authorities’ failure to act, acting inappropriately, lack of cooperation and intrusive public health measures, I propose an ethical framework to be developed as part of National EVD policy.

 Conclusion 

While Malawi is in the process of developing its plan to respond to Ebola, progress remains slow. The developing plan must be consolidated quickly and shown to the public. All the assumptions within the National EVD Preparedness Plan must not take the position that planned interventions will address the Ebola outbreak in a straightforward manner. Discrepancies are expected in any planning at the local and national scene due to the uncertainty associated with the Ebola transmission dynamics. It is, however, important to have a consistent basis for planning, especially if it is to be applied at the local and national level alike. I acknowledge the existence of some disconnect between what is planned and what is implemented. Planning assumptions are not the predictions of what exactly will happen during the Ebola epidemic, but there will be indicators of what could happen. I do not anticipate Ebola to be unpredictable; therefore Ebola scenarios in the plan should be flexible and adaptable to a wide range of potential scenarios based on three tiers: i.e. mild, modest, and severe. 

References

[1]   World Health Organization. Ebola Response Roadmap Update, October 25, 2014.

http://apps.who.int/iris/bitstream/10665/137185/1/roadmapupdate25Oct14_eng.pdf?ua=1  Accessed October 25, 2014.

[2]   Dixon M G, & Schafer I J. Ebola Viral Disease Outbreak — West Africa, 2014– West Africa, 2014. Morbidity and Mortality Weekly Report, 2014; 63(25): 548-549.

^** The author holds a PhD in Epidemiology and Public Health from the University of Nottingham (UK). He is the current Chairperson of the Malawi Public Health Forum (MPHF), an advocacy group that influence public health policies in Malawi.  The author has recently taken up the position of Research Fellow at the University of Witwatersrand (Wits) in South Africa. All views expressed in this article are those of the author and do not necessarily represent the views of, and should not be attributed to, MPHF or Wits. Feedback to: mcxes2@nottingham.ac.uk.