Ethics in Times of Plague: Home Care, Obligations to Treat, End of Life, and Public Policies

Almost exclusively, clinical bioethicists pose and answer questions in the context of day-to-day, medical practice in the West. This setting abounds with therapeutic procedures, drugs, and other resources to restore comfort and health to persons who suffer. In making moral judgments, we focus on patients, attend at times to their families, and—most rarely—consider the well-being of the rest of society as it is affected by particular treatment decisions.

Although this approach has resulted in a measure of moral progress with respect to our standard, clinical setting, it all but neglects the unique and compelling questions that arise in the context of an outbreak of a highly-virulent, infectious disease. In this setting—which I call the plague context—illness is acute, often violent and incurable, and persons who are infected necessarily pose a grave danger to those around them. In this paper, I examine a range of ethical questions in relationship to such an outbreak. Some of these questions are concerned with personal relationships (e.g. marriage, friendship) in the plague context. For example, when one member of a personal relationship is infected and the other is not, what is the specific nature of the responsibilities of each person in this situation? I argue that home care—which is the non-infected person’s caring for her infected loved one in the home—is consistent with the responsibilities that are entailed by their relationship. Furthermore, I contend that, under certain circumstances, their engaging in home care would be respectful toward the interests of the community and, as such, might be sanctioned justifiably by public policy. Next, I seek to assess the moral responsibilities of health professionals in the plague context, giving special attention both to the likelihood that their care will be effective and to the risks that their providing care would bring upon themselves. I propose that health professionals have no standing obligation either to treat or to comfort infected persons. However, I argue that it would be morally good (i.e. supererogatory) of health professionals to enter a contractual obligation to provide such care. This conclusion has implications for the ways in which health officials and administrators should prepare for outbreaks; these I address as well. Finally, I evaluate various courses of action that are open to an infected person as he nears the end of his life. I contend that, whenever it appears that he can avoid infecting others, he does not have a duty to take his own life. However, in light of the threat that he poses to others, there are many reasons that it would be morally good for a dying, infected person to commit suicide.