Some doctors in countries hit hardest by the deadly Ebola disease decline to operate on pregnant women for fear the virus could spread. Governments face calls from frightened citizens to bar travel to and from afflicted nations. Meanwhile, the stakes get higher as more people get sick, highlighting a tricky balance between protecting people and preserving their rights in a global crisis.
The world could impose more restrictions to ward off a disease that has overwhelmed several West African countries, and exposed shortcomings in medical procedures in Texas and also Spain, where Ebola cases have been diagnosed. Such measures can be legal, lawyers say, but the challenge is to ensure that quarantines, curbs on movement and other steps do not intrude too heavily on civil liberties.
‘People would rather do more than less, and the problem is that it becomes a slippery slope in terms of rights,’ said Paul Millus, a New York lawyer who handles civil rights and employment issues.
Already, Sierra Leone, Guinea and Liberia, where the Ebola outbreak has killed thousands, are trying to implement severe controls.
Authorities have imposed curfews, lockdowns and roadblocks. They have ordered a stop to traditional funeral rites that involve touching relatives’ bodies. An entire battalion of troops in Sierra Leone is in quarantine, waiting to deploy on a regional mission to conflict-torn Somalia.
In the United States, a second Texas health care worker has tested positive for the disease. Last week, Gov. Dannel P. Malloy of Connecticut signed an order giving the state’s public health commissioner the ability to quarantine anyone believed to have been exposed to the Ebola virus.
John Thomas, a professor at the Quinnipiac University School of Law in Connecticut, said the world will be dealing ‘more and more’ with the possible conflict between health policies and civil liberties.
‘The tension here is how broadly to cast this protective net,’ he said. Thomas cited ‘the positive model’ of relatively effective quarantines during the flu pandemic that killed millions in the early 20th century, and, on the other hand, quarantines imposed ‘for no reason whatsoever’ on people in the early days of the AIDS crisis.
The World Health Organization says West Africa could see up to 10,000 new Ebola cases a week within two months, dramatically up from the 9,000 cases reported so far, about half of whom have died.
Doctors there are confronting ethical dilemmas on a daily basis.
Juli Switala, a South African pediatrician with Doctors Without Borders, said her team chose not to help some sick babies who were not newborn out of fear that staff may be infected by bodily fluids. The group’s clinic in the town of Bo in Sierra Leone similarly decided to turn away pregnant women because childbirth poses a greater threat of infection.
‘It’s very difficult to be the gynecologist who is making the decision to do a Caesarean section where there is going to be a lot of blood and a lot of body fluids, and you are putting your staff and team at risk if you do this,’ Switala said.
She noted a curfew that bars people from riding a motorbike, a common form of transport, after 7 p.m., meaning women who go into labor after that time have no way to reach a clinic. Additionally, people worry about running into police checkpoints because they are uncertain of what will happen if they are tested and found to have a fever.
There is no cure for Ebola, which has an incubation period of up to 21 days and starts with fever and fatigue and can eventually result in organ failure and massive internal bleeding. The virus can be transmitted through direct contact with the blood or secretions of an infected person, or objects contaminated with infected secretions.
Congo, where the disease was first discovered in 1976, is accustomed to periodic outbreaks. Through hard experience, the government knows how to reach out to affected villages and take over their burial ceremonies, according to health professionals.
‘People don’t fight and feel deprived because they understand it’s necessary,’ South Africa’s health minister, Aaron Motsoaledi, said while announcing health precautions.
South Africa monitors travelers from affected countries in West Africa for 21 days, following up by telephone calls. Experts warn that a travel ban on the affected countries in West Africa would be hard to enforce and could make things worse, disrupting efforts to help and undermining shaky economies.
Last month, Human Rights Watch said some Ebola quarantines there had been ineffective and did not meet human rights standards, ‘disproportionately impacting people unable to evade the restrictions, including the elderly, the poor, and people with chronic illness or disability.’
Nations fearful of Ebola face hard choices about safeguarding people’s health as well as their freedoms, said Thomas, the Quinnipiac professor.
He said: ‘It’s roughly impossible to find a precise balance.’