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Bioethicist: 10 Things America Needs to Do About Ebola

What would an ethics analysis reveal about what has been done and what still needs to be done? Here are the top 10 from bioethicist Arthur Caplan.
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Given the growing concern about the national response to Ebola, President Barack Obama canceled a fund-raising trip to meet with his top advisers on the epidemic. The notion of a time-out to take stock is a good one since public fear over Ebola is causing turmoil for travelers, the stock market, nursing unions, college admissions officers and West Africans who have been living in the United States for decades.

So what would an ethics autopsy reveal about what has been done and what still needs to be done? Here are my top 10.

1. The best way to respond to Ebola is still to stamp out the epidemic in West Africa.

There the health systems have collapsed or are collapsing. Without more beds and education and equipment, there are going to be many more deaths there and more cases leaking out to the rest of the world. So, an even bigger, internationally coordinated effort is needed to get the epidemic under control. The way to do right by Americans is to do what is right for West Africa.

2. Ebola needs to be treated in the U.S. with an expert, regional response.

The notion that every hospital can deal with Ebola has been shown wrong by the events in Dallas. Every hospital cannot deal with Ebola. But many can. They have the training, the equipment, the experience with other infectious diseases and the skilled personnel to engage Ebola safely. Pride about what any hospital can do must yield to the reality that having a moonsuit does not mean everyone is trained properly in how to put it on and take it off. So let’s designate the national 100 hospitals that can take Ebola patients, figure out how to get them there safely and stop creating more anger among health care workers who we are asking to take unnecessary risks in dealing with infectious patients.

3. Let's figure out what quarantine means.

Does it mean you try to stay home or you must? Does it means if you come out the door the cops Taser you and you lie there until a HAZMAT team comes to drag you back inside? Does it mean your pets stay there too, or must they be euthanized at a shelter if there is no way to keep them from putting others at risk when they go outside?

4. Americans should go first.

We are sending troops there and more health care workers. If they get sick, they come home. This is not discrimination, it is moral common sense — we take care of our own citizens first. Others may get to come here for care, but those who go to fight the epidemic from here have a claim on health care resources if they get sick trying.

5. We will use experimental drugs, vaccines and treatments in a compassionate manner.

Normally we wait for randomized trials to show safety and efficacy. With an infectious disease with a 70 percent death rate, treatments are going to be given if they are shown to be safe in animals and people and have some reasonable basis in science for being possibly efficacious, and we make every effort to follow patients who get them to see what happens. Some may be tried here as last-ditch therapies. Some may be tried in West Africa as first-line preventive agents. Science should not go out the window, but the ethics of testing needs to bend a bit in the context of a lethal epidemic.

6. Spend time outing and debunking nonsense.

There are plenty of charlatans with elixirs waiting to make a buck off Ebola panic. Call them out and if possible arrest or fine them. Also, take on right away the idea that Islamic terrorists sent Ebola, people trying to get into the United States from Mexico or Cuba are carrying Ebola, President Obama is trying to kill his opponents with Ebola saboteurs and my favorite despicable canard, the pharmaceutical industry created Ebola so we will all buy Ebola vaccines.

7. Get us a surgeon general.

There is one waiting in the wings, Harvard’s Dr. Vivek Murthy. He is hung up in Congress over a feud over gun control. If those in Congress let us go through this Ebola crisis without a surgeon general, they ought to be out of Congress.

8. Spend more money on infectious diseases.

There is a lobby for getting money for cancer, heart disease, asthma, ALS but there is no group pressing for funds for Ebola, pandemic flu or West Nile virus. Government needs to do better in making sure these scourges get research funding too.

9. There is no reason to panic and there still won’t be as the next 10 or 20 cases appear in the United States.

We see a new case right after being told there is nothing to worry about, and many think, uh-uh, I don’t trust authorities or the media message not to worry. So let's not be surprised by more Ebola cases — more are coming, and if they are properly quarantined and cared for they pose far less risk to Americans than not getting a flu shot

10. Get a flu shot.

The symptoms of flu overlap the early signals of Ebola. Emergency rooms will soon be overflowing with flu patients, many of whom will think they have Ebola. Don’t be one of those.