Ethics and Ebola: Recommendations from the Presidential Commission for the Study of Bioethical Issues

The 2014 Ebola epidemic in western Africa highlighted many ethical issues related to public health practice, research, and infrastructure.  The Presidential Commission for the Study of Bioethical Issues examined U.S. engagement in the global response to the Ebola epidemic, focusing on what lessons might be drawn from the recent U.S. response to Ebola at home and abroad.  It made recommendations that support policies and practices that enable a proactive response to public health epidemics.  It considered the public health emergency response to Ebola in three areas: 1) rationale for U.S. engagement in the global response to the ongoing western African epidemic; 2) the ethical use of liberty-restricting public health measures such as quarantine to control the epidemic, with particular attention to the implications of their use for the ability of health care workers to continue to perform their professional duties; and 3) research ethics, focusing on randomized placebo-controlled trials as well as collection, use, and international sharing of biospecimens.  The Commission recommended that the government, researchers, and public health organizations should integrate ethical inputs into public health preparedness planning before such emergencies occur to ensure ethical solutions to acute events and their longer-term consequences; should employ the least restrictive means necessary—based on the best available scientific evidence—when implementing restrictive public health measures such as quarantines; and should employ methodologically rigorous research capable of generating results that are clearly interpretable, acceptable to the host communities, and, to the extent possible, minimize delays to completing the research.