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Zeke Emanuel Weighs In On Ethical Issues Surrounding Ebola Treatment

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"There's been a lot of news this week about the Ebola outbreak, both the thousands of cases in West Africa and a handful here in the U.S. As we record this program mid-week, all travelers from Liberia, Guinea and Sierra Leone are now required to funnel through five U.S. airports to be checked for fever and to see if they need to be quarantined. 

Two travelers were hospitalized Wednesday after they arrived in Chicago with suspicious symptoms. And now, Visa restrictions are under consideration. The new Ebola czar, Ron Klain, started his assignment to be the point man for the administration. Two drug makers, GlaxoSmithKline and Johnson & Johnson, are working on parallel tracks to develop and test a vaccine that they hope could be ready by early next year. And the freelance camera man who contracted Ebola in Liberia was released from the hospital this week and allowed to go home. When I spoke with public health expert, Dr. Ezekiel Emanuel, recently he said he still believes that U.S. cases of Ebola will remain confined."

Dr. Emanuel: I'm pretty confident that it's not easy to transmit. Obviously something has gone wrong at the hospital in Texas. You know, probably some combination of the procedures and the training and how it was implemented. I haven't been to the hospital. I haven't talked to the people. But there have been a series of situations where the ball seems to have been dropped (the original examination of the patient with a 103 temperature knew that the person was in West Africa; at least some staff did. Bad communication. Bad processing and bad connecting the dots.) So, this is a case, but remember that we've taken care of a patient at Emory and now in Nebraska, and no one has had an outbreak and the Doctors Without Borders in West Africa has had a very good record. This is very contagious, but with the right procedures we should be able to minimize or get that to zero. So, I'm not worried about a big outbreak in the United States and I do think we need to put this in perspective. It's not quiet at the hysterical level, but we need to take this extremely serious and attend to these people. Lord knows that we don't want anyone to die from this situation, but let's face it, it's much more severe in West Africa. And there, it really is a major health problem, a major societal problem and a major economic problem. And our attention really needs to be focused on getting it under control in Liberia, Sierra Leone and New Guinea where it really is threatening social and political stability. 

Lewis: Any ethical issues that could arise when it comes to treating these cases here in the U.S., whether they are isolated or in a larger number? Any ones that you are particularly concerned about? 

Dr. Emanuel: One of the positives I've seen that is that you haven't heard from anyone in the medical, nursing or other health care professions: "It's not my obligation to care for these patients." Everyone recognizes that we have an obligation to care for patients, even if they have serious and contagious illness. We also recognize that institutions and the entire health care structure has obligations to put in place, systems and safety equipment, to minimize the risk to health care workers. I think that dual arrangement where health care workers have an obligation to treat the sick and the system has an obligation to protect health care workers to the maximum extent are very important to fulfill and obviously the serious worry is that that wasn't being done at the Texas facility. This is very different, I would remind people from 30 years ago when the AIDS epidemic broke out and there was a big national discussion. And unfortunately, there were a lot of people who said "I'm not going to treat those AIDS patients. I'm not going to risk my life for these patients." Well, you don't hear that today. And I think we settled that issue 30 years ago in the HIV case, and I think that's a reassuring maturation of the philosophy of health care workers. So, I think that's a very different (and positive) evolution in the ethics of this. 

  • Dr. Emanuel is chair of the Department of Medical Ethics and Health Policy at the University of Pennsylvania.