The Business Day
By Annabel Raw
THE outbreak of Ebola in West Africa has caused global hysteria and fear. Human rights should be our focus instead.
In recent weeks, two Ebola-infected US missionaries were chosen to receive “compassionate” doses of an experimental serum, ZMapp, as their patients languished with little more than paracetamol and rehydrants. When the two Americans were flown back to the US to receive further care, the Centers for Disease Control and Prevention was flooded with e-mails and phone calls from people appalled that it would allow these conduits of disease back into the country.
We have learnt the hard way with HIV/AIDS that this type of dehumanising discourse is one of the most harmful phenomena in dealing with an epidemic effectively. This hysteria worsens stigmatisation, ignorance and superstition and drives people in need of treatment and care into the shadows, away from the knowledge and resources needed to reduce harm to themselves and others.
Individual human rights protections are necessities not hindrances to advancing public health during emergencies such as the Ebola epidemic.
Bioethicist George Annas argues that where involuntary quarantining was used to control the outbreak of severe acute respiratory syndrome, it was largely ineffective because it caused people to mistrust authorities and to stay away from treatment facilities. Medical practitioners and aid workers working with Ebola in West Africa have reported great difficulty in earning the trust of local communities. They see that people die when they go to quarantine and treatment facilities. If submission to quarantine was forced in this climate of fear, it must be assumed that it would only drive vulnerable people further away, which would curb the abilities of healthcare professionals to control the virus’s spread. It is vital to respect voluntary submission to treatment as a right of the sufferer, incited through education and compassion, not force and stigma.
Human rights also give us a framework to understand how the denial of seemingly unconnected rights and freedoms to some communities heightens our collective insecurity. Epidemics such as Ebola highlight how globalised public health has become. Like HIV, Ebola magnifies our greatest weaknesses, thriving off the intersections of poverty, race, political, social and geographic isolation, poor education, and broken medical economies. For as long as some of us remain excluded, we are all vulnerable. This means we need to look at power, not only between patient and caregiver, but more globally too, if we hope to prevent future crises.
Human rights law provides opportunities to manage potential conflict between individual rights and public health aspirations and sets boundaries for ethical debates in a time of crisis.
A human rights discourse informs our discomfort when two white Americans receive potentially life-saving treatment. While there are many medical-ethical questions to consider in the provision of untested and unapproved medicine during an epidemic, our starting point in that debate must be equality, not discrimination on the basis of origin and race.
A rights-based approach to public health further demands that where we are confronted with a conflict between the free will of an informed individual and the health and wellbeing of the group, any restrictions on the individual’s rights must be considered through the measured lens that human-rights law provides. This means forced treatment or quarantine in the height of a health emergency requires a high level of justification. It means the least restrictive means must be applied in the execution of a rights-infringing method of control and the right of individuals to contest decisions being applied against their will must be respected.
Human rights in the time of Ebola demand that we actively stand against what US bioethicist Paul Wolpe has described as the “second epidemic”: the disintegration of compassion. Compassion is a difficult disposition to retain in a climate of crisis, hysteria and exceptionalism. The insistence on treating everyone with dignity and due regard for their autonomy is a reflex that obedience to the discipline of keeping human rights in the picture will help us to master.
Human rights are indispensable tools in global public health emergencies such as the Ebola epidemic. A discourse of rights and a compassionate understanding of our shared vulnerabilities is the most pragmatic approach to resolve these types of crises and prevent epidemics.
- Raw is HIV/AIDS Project lawyer at the Southern Africa Litigation Centre.