Ebola Virus Disease: A Lesson in Science and Ethics

Abstract The largest ever outbreak of Ebola virus disease (EVD), which began in December 2013, profoundly impacted not only the West African countries of Guinea, Sierra Leone, and Liberia, and to a lesser extent Nigeria, but also the rest of the world because some patients needed to be managed in high-resource countries. As of March 29, 2016, there were 28,616 confirmed, probable, and suspected cases of EVD reported in Guinea, Liberia, and Sierra Leone during the outbreak, with 11,310 deaths (case fatality rate of 39.5%). An unprecedented number of healthcare workers and professionals, including physicians, nurses, logistic and administrative personnel, housekeepers, epidemiologists, statisticians, psychologists, sociologists, and ethics experts in many countries, were directly or indirectly involved in the care of EVD patients. The provision of medical care to critically ill EVD patients would have been challenging in any setting but was especially so in the remote and resource-limited areas where patients were stricken by EVD. Limited health personnel, medical supplies, and equipment, along with inadequate knowledge and skills for minimizing the risks of transmission to healthcare workers, could have led to the de-prioritization of patient care. However, ethical considerations demanded aggressive patient care (intensive care, dialysis, central vascular catheter indwelling, etc.) to produce positive outcomes without increasing the risks to healthcare workers and caregivers. A major ethical consideration was that healthcare workers have a double obligation: while providing the best medical care to improve EVD patient survival, with symptom relief and palliation as required, they must also protect themselves and minimize further transmission to others, including their colleagues. During the 2014–2015 EVD epidemic, another ethical and clinical problem arose in relation to the management of healthcare workers deployed in Africa who acquired EVD while caring for infected patients. As of June 24, 2015, a total of 65 individuals had been evacuated or repatriated worldwide from the EVD-affected countries, of whom 38 individuals were evacuated or repatriated to Europe. The need for evacuation and repatriation, together with associated ethical issues, is discussed in this chapter.