THE BLOG

The Ethics of Ebola Treatment: Who Gets What and Why?

10/22/2014 01:02 EDT | Updated 12/22/2014 05:59 EST
ASSOCIATED PRESS
FILE - In this Thursday, Oct. 16, 2014 file photo, a healthcare worker dons protective gear before entering an Ebola treatment center in the west of Freetown, Sierra Leone. (AP Photo/Michael Duff, File)

Despite being intricately connected to each other, political philosophy is rarely mentioned in disaster management study and practice. Disaster management is the preparation for, mitigation of, response to, and recovery from adverse events that transcend 'regular' emergencies while political philosophy asks the 'big' questions about power in society -- who gets what, and why? The former seems bureaucratic and process-driven, 'mere logistics,' while the latter requires three degrees and a pouch of pipe tobacco to think it all through. Never the twain shall meet. Except for when disaster actually strikes.

During the 2009 H1N1 pandemic, there were precious few degrees of separation between the mechanics of vaccination distribution and the ethical decisions regarding, for example, who gets vaccinated first or under what circumstances -- if any -- vaccination could be refused. Mere utilitarian calculations did not easily satisfy; if children are especially vulnerable and have longer lives left, surely they should be the first vaccinated. But how can we weigh elderly citizens' lives as less valuable if they are equally vulnerable to the disease?

And to what extent do we accommodate the individual right to choose that is built into much of our political culture and legislation? The SARS outbreak in the early 2000s saw governments in China and Singapore use cameras in peoples' homes and the military to ensure quarantine. An electronic tag around the ankle was the price paid for breaking quarantine. The fact that these measures were effective will not make it a realistic option for disaster management in Canada.

But there are degrees to disasters, and a deadly pandemic that spreads easily may require more strenuous actions from authorities. In such cases the question becomes a deeper, existential one: never mind the interruption to daily activities or harm to the economy, can our political institutions withstand prolonged disaster? Political institutions are the structures that bind disparate people from across the country together, provide predictable and -- ideally -- fair rules for how to go about public life, and allow a sense of a connected past and mutually accountable future.

In Canada, these institutions include our federal structure that bestows different responsibilities to provincial and federal governments, the array of public service departments and agencies, and the core pieces of legislation that hold it all together, namely the Constitution and it's most famous component, the Charter of Rights and Freedoms. A widespread belief in their validity is what guarantees that disaster managers can do their jobs during floods, ice storms, pandemics, etc.

An extensive study on social isolation measures used in the United States during the 1918 influenza pandemic determined that public belief in the legitimacy of government actions was central to the success of quarantine measures (Markel et al 2006). Compliance required authorities to be representative of institutions that had 'buy-in' from the public. Rarely mentioned in disaster planning, widely supported and internalized political institutions are one of our most valuable resources.

Zombies aside, end-of-the-world TV shows hit the nail on the head when they explore the ethical dilemmas that flourish when human systems, especially relatively stable political institutions, are put under severe stress. The risk of a non-airborne disease like Ebola spreading in Canada is still low, but researchers French and Raymond note in the Public Administration Review that "the existing literature suggests that a future influenza pandemic is inevitable" (2009). And when a fatal disease without a known cure moves rapidly from human to human it's not just about food supplies and First Aid Kits -- the question of who gets what, and why, becomes central.

ALSO ON HUFFPOST:

  • James and Tamah Mulbah
    John Moore via Getty Images
    Ebola survivor James Mulbah, 2, stands with his mother, Tamah Mulbah, 28, who also recovered from Ebola in the low-risk section of the Doctors Without Borders Ebola treatment center, after a survivors' meeting on October 16, 2014 in Paynesville, Liberia.
  • Benetha Coleman
    John Moore via Getty Images
    Ebola survivor Benetha Coleman, 24, stands in the low-risk section of the Doctors Without Borders Ebola treatment center after attending a survivors' meeting on October 16, 2014 in Paynesville, Liberia. She said that her husband and two children died due to the disease.
  • Jeremra Cooper
    John Moore via Getty Images
    Ebola survivor Jeremra Cooper, 16, wipes his face from the heat while in the low-risk section of the Doctors Without Borders Ebola treatment center on October 16, 2014 in Paynesville, Liberia. The 8th grade student said he lost six family members to the Ebola epidemic before coming down sick with the disease himself and being sent to the MSF center, where he recovered after one month.
  • Zaizay Mulbah and Mark Jerry
    John Moore via Getty Images
    Ebola survivors Zaizay Mulbah, 34, and Mark Jerry, 30, right, stand together before their shifts as nurse's assistants at the Doctors Without Borders Ebola treatment center on October 12, 2014 in Paynesville, Liberia. Jerry was a money changer and Mulbah a delivery driver before they caught the disease and went to the center, where they recovered. Doctors Without Borders hired them afterward to counsel and comfort others stricken by the disease.
  • Eric Forkpa
    John Moore via Getty Images
    Ebola survivor Eric Forkpa, 23, stands in the low-risk section of the Doctors Without Borders Ebola treatment center after meeting with fellow survivors on October 16, 2014 in Paynesville, Liberia. The college student, who is majoring in civil engineering, said he thinks he caught Ebola while caring for his sick uncle, who died of the disease. He spent 18 days at the center recovering from the virus.
  • Emanuel Jolo
    John Moore via Getty Images
    Ebola survivor Emanuel Jolo, 19, stands in the low-risk section of the Doctors Without Borders Ebola treatment center after a survivors' meeting on October 16, 2014 in Paynesville, Liberia. The high school student lost six family members and believes he caught the disease while washing the body of his father, who died of Ebola.
  • Sontay Massaley
    John Moore via Getty Images
    Ebola survivor Sontay Massaley, 37, smiles upon her release from the Doctors Without Borders Ebola treatment center on October 12, 2014 in Paynesville, Liberia. Massaley, who spent 8 days recovering from the disease in the center, said she worked as a vendor in a market before contracting the virus.
  • Victoria Masah
    John Moore via Getty Images
    Ebola survivor Victoria Masah, 28, stands in the low-risk section of the Doctors Without Borders Ebola treatment center on October 16, 2014 in Paynesville, Liberia. She said her husband and two children died of Ebola.
  • Abrahim Quota
    John Moore via Getty Images
    Ebola survivor Abrahim Quota, 5, stands outside the JFK Ebola treatment center after recovering from the disease on October 13, 2014 in Monrovia, Liberia. He had arrived at the treatment center 10 days before with his parents, who both died there from the virus. The Ministry of Health was to deliver him home after his release to live with relatives.
  • Lassana Jabeteh
    John Moore via Getty Images
    Ebola survivor Lassana Jabeteh, 36, smiles before his shift as a nurse's assistant at the Doctors Without Borders Ebola treatment center on October 12, 2014 in Paynesville, Liberia. He said that he previously worked as a taxi driver and that he thinks he caught Ebola when he transported a sick policeman who vomited in his car on the way to the hospital. Doctors Without Borders hired Jabeteh after he recovered in their treatment center and he now counsels and comforts others stricken by the disease.