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Critical role of ethics in clinical management and public health response to the West Africa Ebola epidemic

Authors Folayan M, Haire B, Brown B

Received 29 January 2016

Accepted for publication 12 March 2016

Published 12 May 2016 Volume 2016:9 Pages 55—65

DOI https://doi.org/10.2147/RMHP.S83907

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Mary Schmeida

Peer reviewer comments 2

Editor who approved publication: Professor Frank Papatheofanis

Morenike O Folayan1,2 Bridget G Haire3 Brandon Brown4

1Institute of Public Health, 2Department of Child Dental Health, Obafemi Awolowo University, Ile-Ife, Nigeria; 3Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, NSW, Australia; 4Center for Healthy Communities, Department of Social Medicine and Population Health, University of California Riverside School of Medicine, Riverside, CA, USA

Abstract: The devastation caused by the Ebola virus disease (EVD) outbreak in West Africa has brought to the fore a number of important ethical debates about how best to respond to a health crisis. These debates include issues related to prevention and containment, management of the health care workforce, clinical care, and research design, all of which are situated within the overarching moral problem of severe transnational disadvantage, which has very real and specific impacts upon the ability of citizens of EVD-affected countries to respond to a disease outbreak. Ethical issues related to prevention and containment include the appropriateness and scope of quarantine and isolation within and outside affected countries. The possibility of infection in health care workers impelled consideration of whether there is an obligation to provide health services where personal protection equipment is inadequate, alongside the issue of whether the health care workforce should have special access to experimental treatment and care interventions under development. In clinical care, ethical issues include the standards of care owed to people who comply with quarantine and isolation restrictions. Ethical issues in research include appropriate study design related to experimental vaccines and treatment interventions, and the sharing of data and biospecimens between research groups. The compassionate use of experimental drugs intersects both with research ethics and clinical care. The role of developed countries also came under scrutiny, and we concluded that developed countries have an obligation to contribute to the containment of EVD infection by contributing to the strengthening of local health care systems and infrastructure in an effort to provide fair benefits to communities engaged in research, ensuring that affected countries have ready and affordable access to any therapeutic or preventative interventions developed, and supporting affected countries on their way to recovery from the impact of EVD on their social and economic lives.

Keywords: Ebola, ethics, global comparison

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