After news broke of Liberia’s aggressive quarantine of a slum in Monrovia, GHN associate editor Dayna Kerecman Myers had a few questions for Nancy E. Kass, the Phoebe R. Berman Professor of Bioethics and Public Health at the Johns Hopkins Berman Institute of Bioethics.
Is it ethical for Liberia to quarantine of tens of thousands of people in the West Point slum?
Quarantine should only be considered if other, less restrictive measures have failed; and only if implemented equally to any population that does not comply with public health authorities. Ebola can be contained if public health directives are followed, including directives regarding handling of sick persons or of those who have died. When people do not trust and thus do not follow government directives, however, quarantine may be viewed as a last resort to prevent further spread; but public health must be viewed as on the side of the people rather than as punitive or aggressive.
Under what conditions is quarantine an ethical measure?
Quarantine is an ethical measure when there are not less restrictive ways to protect the public from a threat, when those quarantined are given what they need (food, shelter, water), and when it is applied equally to all at risk persons, regardless of social standing or class. In the context of the Liberian slums, the president clearly felt the situation was getting out of control. While her need to act is understandable, there is also the potential for this strategy to backfire if government attention is now devoted to controlling riots rather than responding to a public health threat, and if government credibility in other communities, watching this situation, is potentially decreased as a result of this experience.
What should countries not yet affected by the virus do to prepare for such situations from an ethical perspective?
What is good for public health is good for ethics. In this epidemic, part of the spread is the result of the inadequate public health infrastructure existing in many affected regions; but also from a lack of acceptance of public health messaging. Work must be done now to determine, in other potentially affected regions, what types of communication messages, and from whom, will be most successful in different types of communities in ensuring more public health cooperation while also allowing individuals to feel their government is helping address what they need.