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LectureHop: Ethical Issues in Ebola and Beyond

I sure wouldn't

Would you turn down Ebola advice from a face like this?

While he usually lives by the motto, “ball is life,” Bwog’s Ross Chapman hopped over to a lecture about Ebola and beyond, and reported back. 

A group of experts, mostly Columbians, gathered in the Satow Room yesterday to hold a panel on the ethical responsibilities and questions that arise when responding to a crisis. Using Ebola as a case study, the doctors and policymakers discussed the perceived incompatibilities between capitalism and the public health agenda, autonomy and the greater good, and science and politics. The panel was headed by Irwin Redlener, director of the National Center for Disaster Preparedness at the Earth Institute, and included Jeff Schlegelmilch, a managing director at the same Center; Arturo Brito, a deputy commissioner at the New Jersey Department of Health; and Robert Klitzman, a director of several ethics programs at Columbia.

While it was arranged as a panel, it felt more like each speaker delivered their own ideas for twenty minutes, with a little interaction saved for the very end. Irwin Redlener spoke first with the aid of a few Powerpoint slides. He posed a lot of questions without many answers. Are there crisis situations where we can call for reduced standards of care? Where should we allocate our scarce resources? And who prioritizes certain lives over others? Redlener focused more on these issues, which other speakers would address further. He believes that disaster is inevitable, and so prevention cannot be used as a complete replacement to response. He ended his speech by noting that “no decision is a decision” in a crisis. Decisions imply thought beforehand, and it’s impossible to do that in a crisis unless there was adequate planning in years prior.

Nex, Robert Klitzman put out the idea that disasters are often unanticipated consequences of technological advancement. Epidemic diseases spread the way they do today because of our complex transportation infrastructure, for example. He then moved on to talk about the politics of fear. At what point do we quarantine people, and how necessary is it, really? He remarked that fear makes governors press for medical response to something like Ebola “for the public health,” but that same reasoning can’t make some states mandate vaccines for children. Part of this fear is media coverage, which, when it comes to disease crises, often mongers fear for domestic but not international causes. Most interestingly, he called for a better social scientific approach to disease response. Anthropological studies are necessary to know how people will react to treatment. Cultural barriers can make people think that pills will give them disease, and lingual issues can make populations believe that experimental, 30% effectiveness treatments is a cure-all. This is all to say, there’s more to epidemics than just the disease itself.

Arturo Brito spoke to the governmental issues of disease control. He said of state health departments, “If you’ve seen one… you’ve seen one of them.” Apparently, New Jersey’s is just as unique as every other state’s. It’s a challenge getting resources for emergency preparedness, because even when money is allocated to the department of health, it has to get reallocated to its different branches. He talked a lot about quarantine orders, especially with individuals who aren’t (yet) symptomatic. They cost a lot of money per day, and they restrict personal liberty, but a combination of fear, scientific confusion, and perceived necessity often create more quarantines than necessary. Luckily, the incubation and contagion periods of Ebola are one of the few very well understood parts of the disease, so if large scale quarantines were ever necessary, they probably wouldn’t keep people for too long. He was defensive at times of the state’s actions, especially when the media came up. He emphasized that healthcare professionals returning from overseas are often incredibly stressed and may not have an accurate view of the actions of the government.

Finally, Jeff Schlegelmilch pulled out some theoretical knowledge. He outlined four approaches to dealing with scarce resources. One is egalitarian, where we try to provide everyone with equal access to emergency medical care. A utilitarian approach would try to maximize the public utility of the resources, sometimes with a cold-hearted, mathematical appearance and result. The libertarian thought commands the government to stay out of everything and counts on public conscience and economy to drive the distribution of medical equipment. Lastly, communitarian methods try to conform to preexisting practices within the communities they’re treating. He asked if it’s ethical to make money off of responding to crises, and had people raise their hands with their responses. “The good news is, you’re all wrong,” he replied, because it’s a complex issue. He closed by saying that science can’t do everything alone – policy, practice, and ideology matter just as much.

The discussion after the presentation was relatively mild. Brito got defensive (and a bit secretive) whenever questions about the government came up. The man sitting in front of me seemed to have a level expertise, and sometimes inserted himself into the conversation, to the distaste of one of the event ushers. Some anecdotes and amicable discussions later, they dismissed and let the newly educated audience mill about and talk about Ebola, ethics, and the future. There was water and coffee, but no snacks – work on that one, Columbia.

Irwin Redlener via his Twitter account

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