Criminalisation and “Reckless” Ebola Transmission: Theorizing Ethical Obligations to Seek Care

The Ebola Virus Disease (EVD) outbreak in Liberia, Sierra Leone and Guinea – also known as the Mano River States - was a public health emergency of international concern. We reviewed ethical discussions pertaining to the obligation of patients infected with EVD to seek medical care; and criminalisation of both “reckless” EVD transmission as well as wilful non-disclosure of disease status. We argue that where the public health care system cannot provide needed care, and there is a historical distrust of public health care systems often resulting from dysfunctional political system, it is challenging to require patients infected with EVD to seek medical care from that sector. Strengthening the public health care system to provide isolation and quarantine services, building the capacity of trusted alternative health care systems to respond to the epidemic, and the use of incentives to get people to seek medical care in public health care institution, where EVD related health care services is being offered during an epidemic, are critical for disease containment. Measures such as criminalisation of EVD transmission and non-disclosure maybe counterproductive as they may further alienate community members from health authorities. We advocate for increased efforts for community mobilization and awareness creation. These help build supportive environments that encourage collective risk-free status disclosure, as well as support for EVD management in the wake of an outbreak.