Commission calls for accountable integration of ethics into emergency public health response
The Presidential Commission for the Study of Bioethical Issues (Bioethics Commission) has reported that the federal government has both a prudential and a moral responsibility to actively participate in coordinated global responses to public health emergencies wherever they arise.
"The Ebola epidemic in western Africa overwhelmed fragile health systems, killed thousands of people, and highlighted major inadequacies in our ability to respond to global public health emergencies," Commission Chair Amy Gutmann, Ph.D., said. "It demonstrated the dire need to prepare before the next epidemic. A failure to prepare and a failure to follow good science -- for example, by not developing vaccines and not supporting health care providers -- will lead to needless deaths."
Explaining why the Bioethics Commission chose to take on the topic, Gutmann said: "Both justice and prudence demand that we do our part in combating such devastating outbreaks. Once we recognize our humanitarian obligations and the ability of infectious diseases to travel in our interconnected world, we cannot choose between the ethical and the prudential. Ethics and enlightened interest converge in calling for our country to address epidemics at their source."
In its brief, Ethics and Ebola: Public Health Planning and Response, the Bioethics Commission argues that the United States must strengthen health infrastructure and emergency response capabilities, improve health communications, and integrate ethics expertise at every level of public health emergency planning and response.
"Public health preparedness requires ethics preparedness," Gutmann said. "We need to be prepared, for example, to communicate early and often during an Ebola epidemic -- drawing upon the best scientific evidence -- why not to quarantine asymptomatic individuals. Needlessly restricting the freedom of expert and caring health care workers is both morally wrong and counterproductive; it will do more to lose than to save lives."
The Bioethics Commission's seven recommendations offer targeted policy and research design suggestions. For example, the Bioethics Commission recommended that the United States strengthen key elements of its domestic and global health emergency response capabilities. These include:
- Strengthening the capacity of the World Health Organization to respond to global health emergencies through the provision of increased funding and collaboration with other international, national, and non-governmental public health organizations;
- Identifying and empowering a single U.S. health official accountable for all federal domestic and international public health emergency response activities; and
- Strengthening the deployment capabilities of the U.S. Public Health Service, including by streamlining command structure for deployment and providing appropriate resources to train and maintain skills needed for emergency response.
In addition, the Bioethics Commission recommended that ethical principles be integrated into timely and agile public health decision making processes employed in response to rapidly unfolding epidemics. It called for qualified public health ethics expertise to be readily available to identify ethical considerations relevant to public health emergencies and responses in light of real-time available evidence. Specifically, it recommends that a single U.S. health official should be accountable for ethics integration.
On the contentious issue of quarantine and other policies related to movement restrictions, the Bioethics Commission recommended that governments and public health organizations employ the least restrictive means necessary--based on the best available scientific evidence--when implementing restrictive public health measures.
"Governments and public health organizations should be prepared to clearly communicate the rationale for such measures and provide ongoing updates to the public about their implementation, with particular attention to the needs of those most directly affected," the Bioethics Commission wrote in its brief.