February 28, 2015

Presidential Bioethics Commission Reviews Federal Response to Ebola Virus Crisis

The Presidential Commission for the Study of Bioethical Issues (Bioethics Commission) has released a brief, titled Ethics and Ebola: Public Health Planning and Response, following its consideration of specific ethical questions that emerged while the U.S. government was responding to the Ebola virus outbreak in western Africa. Ebola virus cases in the U.S. began to appear last fall, the but Guinea, Sierra Leone and Liberia experienced significant outbreaks during 2014, and the World Health Organization reports an ongoing struggle in these countries. The commission advanced several recommendations to improve international responses, as well as the U.S. domestic response and capabilities: 
Strengthening the capacity of the World Health Organization to respond to global health emergencies through the provision of increased funding and collaboration with other international, national, and non-governmental public health organizations. 

Identifying and empowering a single U.S. health official accountable for all federal domestic and international public health emergency response activities. 

Strengthening the deployment capabilities of the U.S. Public Health Service, including by streamlining command structure for deployment and providing appropriate resources to train and maintain skills needed for emergency response.
The Commission also highlighted the need to embed ethical considerations into disease management and responses in a coordinated ethics framework: 
In addition, the Bioethics Commission recommend[s] that ethical principles be integrated into timely and agile public health decision making processes employed in response to rapidly unfolding epidemics. It call[s] for qualified public health ethics expertise to be readily available to identify ethical considerations relevant to public health emergencies and responses in light of real-time available evidence. Specifically, it recommends that a single U.S. health official should be accountable for ethics integration. 
While recognizing that public health measures can compromise individual liberty in emergency situations, the Commission addressed the need for possible quarantine
On the contentious issue of quarantine and other policies related to movement restrictions, the Bioethics Commission recommend[s] that governments and public health organizations employ the least restrictive means necessary—based on the best available scientific evidence—when implementing restrictive public health measures. 
The Commission recognized that clinical trials during a public health emergency can pose ethical choices regarding trial design, and particularly regarding the use of placebos, but did not rule out their use
Clinical research during a serious communicable disease epidemic creates a stark ethical dilemma: On one hand, using placebo controls appears to deny some patients the possibility—however small and uncertain—of a benefit from experimental interventions; on the other hand, research that does not yield conclusive results about an intervention’s safety or effectiveness could exacerbate the tragedy of the epidemic by providing misleading and potentially harmful information. Navigating this tension requires careful analysis of the range of possible trial designs coupled with a commitment to core principles of research ethics. 
In upcoming work, the Bioethics Commission will further consider “the importance of democratic deliberation and public education in bioethics.” While the role of the Bioethics Commission is deliberative and advisory, it has a broad and singular mandate to consider how the government ethically responds to the emergence of new life science technologies and ethically reacts to medical or health crises that necessitate competent and agile federal involvement.

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