- Berman Institute Bioethics Bulletin - http://bioethicsbulletin.org -

Ebola Patient’s Family Quarantined

On Wednesday evening, the Texas Department of State Health Services [1] ordered quarantine for the family of the United States’ first diagnosed Ebola patient. The patient’s partner, who asked to be identified only by the name “Louise,” remains at home with her child and two nephews. Dallas County Judge Clay Jenkins said Thursday that the patient’s family left their home against official requests [2], and that’s why a “control order” was put in place Wednesday night.

 

Anderson Cooper, who spoke with Louise, reported on CNN that the family has not been given sufficient food [3]. Sheets and towels used by the patient prior to his hospitalization remain in the apartment [4]. Ebola can be spread from person to person by contact with contaminated materials [5], including bedding, but public health officials have not arrived to remove the bedding or provide protection for the family.

 

If this account is true, then health department officials have failed in a basic moral obligation. “Under the right conditions, legally restricting a person’s movements to protect the health of others can be not only be ethically permissible, but even ethically obligatory,” says Ruth Faden [6], Dracopoulos Director of the Johns Hopkins Berman Institute of Bioethics, “But those right-making conditions include ensuring that the well-being of the quarantined person is guaranteed,” Faden continues. “This is basic public health ethics. People in quarantine need to be provided with regular access to adequate and appropriate food and drink and needed medicines and medical care. Moreover, they need to be treated with respect – they need to feel secure that their needs will be met and that they will have reliable and regular access to appropriate information about their loved one and their own risks.”

 

While fingers have been pointed [3] at the Centers for Disease Control (CDC) for failure to provide adequate food and protections for the sickened patient’s family, it is not clear that the federal agency is solely responsible for assuring appropriate supplies and protections are provided. In Dallas County, the county judge is responsible for disaster and emergency preparedness [7], under which disease containment falls. “We’ve got the best minds from the CDC, the state, and the local experts working seamlessly together on this,” Judge Jenkins said in a Fox News interview [8] Wednesday. A team of CDC officials was scheduled to embed in Judge Jenkins’ emergency operations center on Thursday – two full days after [9] the patient tested positive for Ebola.

 

The seemingly slow response follows on the heels of a dangerous error in protocol at Texas Health Presbyterian Hospital, where the patient first arrived on September 26. Although he informed a nurse that he had travelled from a West African country, the patient’s travel history was “not fully communicated” [10] to other staff members, and he was sent home with antibiotics. The patient returned to the hospital two days later and was admitted, but only after his symptoms had substantially worsened. Ebola becomes more contagious [5] as patients grow sicker.

 

“The key to successful containment of infections is good public health practice, which may at times include quarantine of those who are exposed.  But when the liberty of individuals is restricted in the name of public health, as in the case of Louise and her family, there is an ethical obligation to make sure they receive adequate food and all necessary protections and precautions,” said Jeffrey Kahn [11], Levi Professor of Bioethics and Public Poilcy at the Berman Institute.

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