The recent Ebola virus outbreak has resulted in over 1,229 deaths, and 2,240 infected cases in the Western part of Africa- Nigeria, Guinea, Liberia and Sierra Leone. What makes the virus deadly is the very high mortality rate, it kills almost 90% of those who contract the infection of which there is yet no ‘known cure’ or registered intervention for. Of late though, an experimental trial drug-ZMapp has been developed as a treatment for it but a ‘randomized controlled clinical trial’ has not been conducted yet to ascertain its’ effectiveness for the general public, as at this time. A beneficiary of ZMapp is Dr. Kent Brantly, who has already being discharged from Emory’s Infectious Disease Unit in the US and confirmed cured, a development which offers a glimmer of hope for many.
Usually, victims experience as symptoms, high fever, headaches, sore throat, general weakness as well as pain in the stomach, a lack of appetite for food, muscle aches and as the disease intensifies severe bleeding from the nose, eyes and ears occur. It is also reported to damage the immune system in the human body. This list is not exhaustive. As at August 20, 2014 Nigeria has the lowest death incident of 5 persons, this includesDr Ameyo Adadevoh, a consultant Physician and Endocrinologist of First Consultants Medical Centre, Lagos. The Nigerian Minister of Health, Prof. Onyebuchi Chukwu in response highlighted her efforts in tackling the menace, and specifically for supporting Mr Patrick Sawyer an American-Liberian who came into the country and was in need of health service after being infected with the virus in Liberia- the first reported case; also especially for her efforts in restraining Mr Sawyer when he became violent and sought to escape from detention. She contracted the virus in the process.
Questions arise in responding to the Ebola virus epidemic. The extent and existence of the duty of care owed by virtue of a fiduciary relationship, a principle tested in the Supreme Court of Nigeria in the case of United Trust Bank (Nigeria) v Ozoemena, which has its roots from the English Common Law. In this context, by health professionals to their patients. Another issue for deliberation is patients’ responsibility not to intentionally or recklessly transmit viruses. In the UK, developed conversations in criminal law and decided cases revolving around HIV transmission could also apply to some degree in the ‘Ebola deliberations’ to curtail desperate or vindictive conducts by infected or non-infected persons who act in a manner that endanger others, with specific regard to public health and safety. However, in this blog, I would urge governments in the affected region to be thinking of a broader spectrum of safeguards that protect not only patients but health workers. Safeguards that embrace the legal, ethical, psychosocial, economic, biosecurity, cultural and political dimensions of the problem.
A report submitted by an advisory panel to the World Health Organisation (WHO) has recognised the current epidemic as the ‘largest, most severe, most complex outbreak of Ebola virus disease in history’. The more the case for a thorough technique. With regard to the ethical conundrum of prescribing medications not yet tested in humans, though it has shown‘promising results in laboratory and animal models’ for the purpose of treatment. Individual governments, ECOWAS and WHO it seems would have to weigh the credible available options, strengthen existing legal safeguards and clinical risk assessments, to see if they can make such commitments in light of the ethical implication of a possible unregistered intervention’s use.
The right to dignityof the patient must be upheld, as well as preserving the need for informed consent. The choices are not clear-cut for Ebola patients with a 90% chance of death, the future might look just as bleak without exploring possible cures.
The lessons of the past could provide some direction. After a previous Ebola outbreak in 1995 which lasted from January to June in Kikwit village of Democratic Republic of Congo (Central Africa), a study was carried out amongst some survivors, of which out of 34 contacted by the surveyin July 1995 it was found out that 80% showed levels of anxiety and communicated this to their family members or other persons in the initial stages of the sickness, while 50% nursed fear of falling seriously ill. Interestingly, 35% attempted to escape from their community and family, though 85% admitted to have received good support from medical staff and family. An important piece is the fact that 100% of the survivors- ‘all patients’ contacted, reported to have been helped by their belief in God through the crisis. The research highlights the need to understand the psychosocial element of the Ebola outbreak, and how to deal with the ‘epidemics of fear, stigmatisation, blame and discrimination’. In other words to prevent escapes from recovery detention centres measures must be put in place to allay fears that these patients have been checked into death waiting rooms or as though they are specimens of some sort.Their life must be handled as valuable and sacrosanct, and allowed the chance to fight, with relevant professional help for the 10% probability of survival rather than excluded with a predetermined death label, perhaps not out of prejudice, but a defeatist cynicism of the tough ratio of survival. As the battle is against the virus not the patient, perspective becomes crucial especially in context of cases of previous survivals.
The government would have to make tough ethical decisions but with regard to the broad spectrum of other factors for public health safety and wellbeing. The protection of the rights of the patients and health professionals would both need to be taken into consideration.