Ethics, Policy & Environment

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Ebola Needs One Bioethics

Paul B. Thompson & Monica List

To cite this article: Paul B. Thompson & Monica List (2015) Ebola Needs One Bioethics, Ethics,
Policy & Environment, 18:1, 96-102, DOI: 10.1080/21550085.2015.1016957

To link to this article: http://dx.doi.org/10.1080/21550085.2015.1016957

Published online: 24 Apr 2015.

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 Ethics, Policy & Environment, 2015
Vol. 18, No. 1, 96–102, http://dx.doi.org/10.1080/21550085.2015.1016957

Commentary

Ebola Needs One Bioethics

PAUL B. THOMPSON & MONICA LIST
Department of Philosophy, Michigan State University, East Lansing, Michigan, USA
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ABSTRACT Bioethics coverage of the recent Ebola outbreak neglected the ethical issues associated
with aspects of the outbreak having environmental significance. The neglect of environmental
dimensions is symptomatic of the way that the current institutionalization of bioethics as a field of
inquiry separates medical and environmental expertise. As visionaries who are recognizing the need
for better integration of human and veterinary medicine with environmental health are starting to
call for “One Health”, it is now time to recognize the need for “One Bioethics.”

The deadly Ebola virus wreaked devastation in the African countries of Guinea, Liberia,
and Sierra Leone in 2014. By the end of that year, an estimated 20,000 cases of Ebola had
occurred in these three countries, with in excess of 7500 fatalities (CDC, 2014). Coverage
of the outbreak in Western media was extensive, but increased dramatically when Eric
Duncan died from Ebola Hemorrhagic Fever in a Dallas hospital. Not surprisingly, media
coverage of the African outbreak and the drama of Western physicians, nurses, and
journalists who were treated for the disease after exposure either in Africa emphasized the
medical aspects of the phenomenon. Both the outbreak and the Western response have
been the subject of commentary and intervention from the perspective of bioethics, yet as
we discuss below, environmental ethics has been missing in action thus far. Does Ebola
raise questions for environmental ethics and environmental policy? Below we present the
argument for an affirmative answer through a brief summary of topics that have been
neglected so far. We conclude this paper by appealing for a more deliberate and concerted
effort to bridge the fields of environmental philosophy and medical bioethics.

The Environmental Ethics of Ebola

The 2014 Ebola outbreak did not escape the attention of philosophers working in the fields
of medical ethics and public health. The ubiquitous bioethics expert Arthur Caplan
prepared several reports on Ebola through his cooperation with NBC News, including one
listing the reasons against quarantine of individuals returning from infected zones (Caplan,
2014).In addition, both the African outbreak and the isolated Western cases have received
attention from other key sources in bioethics. The Berman Institute for Bioethics at Johns
Hopkins University created a special webpage for Ebola at http://www.bioethicsinstitute.
org/announcements/untested-interventions-and-the-ebola-outbreak, with links to news
stories, op-eds, and video clips featuring Hopkins bioethicists making comments and

Correspondence Address: Paul B. Thompson, Department of Philosophy, Michigan State University, 503 S.
Kedzie Hall, East Lansing, MI 48824-1032, USA. Email: thom@anr.msu.edu

q 2015 Taylor & Francis

 Ebola Needs One Bioethics 97

offering opinions or recommendations. A similar website at https://bioethics.georgetown.

edu/ebola/ was created by the Bioethics Research Library at Georgetown University, with
links to a variety of scholarly articles, blogs, and news clips, as well as to other relevant
websites.
These early responses have been followed up by the rapid assembly of an ethics
research agenda for Ebola. The Presidential Commission for the Study of Bioethical Issues
posted a blog on December 8, 2014, calling for responses from the bioethics community
on seven topics:
. Ethical and scientific standards for public health emergency response;
. Ethical and scientific standards that guide the use of quarantine or other
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movement restrictions during public health emergencies;

. The impact of quarantine or other movement restrictions on the availability
or willingness of health workers to volunteer to contain the epidemic in
disease-affected areas;
. The impact of quarantine or other movement restrictions on public fear and
anxiety about potential threats to public health;
. How US public policy and public health response to the current Ebola virus
disease epidemic might or should affect public attitudes to, and further US
policy and public health response to, other current and future public health
issues and emergencies;
. Ethical and scientific standards for placebo-controlled trials during public
health emergencies;
. Ethical and scientific standards for collection, storage, and international
sharing of biospecimens and associated data during public health
emergencies (Kittle, 2014).
These seven topics nicely summarize the scope of bioethics responses to Ebola in 2014.
While there is little question about the appropriateness of these topics, one would not infer
several key points that would be of immediate relevance to an environmentally oriented
ethicist from these topics, nor from any of the entries on the Johns Hopkins or Georgetown
websites.
The most obvious point of relevance for environmental philosophers is that Ebola is a
zoonotic disease. After many years of veterinary research, Ebola is now believed to be
harbored in bat populations. The zoonotic reservoir is widely distributed across central
Africa and covers an area inhabited by some 22 million people (Pigott et al., 2014). Once a
crossover to the human population occurs, the virus can be transmitted through direct
physical contact with bodily fluids, as has been widely reported. Yet the key vulnerability
of human populations resides in the relationship between populations of human and non-
humans. The avenues for possible cross-species contagion involve physical contact
between human beings and a number of non-domesticated species (not only bats). There
has been speculation that the virus can be contracted through consumption of bushmeat,
for example (Wolfe, Daszak, Kilpatrick, & Burke, 2005). Only as 2014 was drawing to a
close did news services recognize the connection between the Ebola outbreak and the
reservoir in non-human animal populations (Roberts, 2014).
The fact that Ebola is a zoonosis was generally recognized within the public health
community and certainly well recognized among veterinarians. It also raises important
questions that can be raised from an environmental ethics perspective. First, the potential
 98 P. B. Thompson & M. List

for crossover of zoonosis into human beings links to the large question in environmental
philosophy about humanity’s relationship to wild nature. Environmental ethics is in
important respects the rejection of an assumption that humans can simply dominate nature,
including non-human species, without raising any ethical concerns. Such an attitude would
have simply advocated aggressive eradication of any non-human animal population that
posed risk to human beings, yet after Aldo Leopold, such a suggestion is at least
questionable. Responses to Ebola that imply eradication of vector species will meet
opposition from environmental philosophy on familiar grounds. Do the fruit bats that are
now thought to harbor the virus have intrinsic value as a species? Even if they do not, do
they as a vertebrate species have moral standing that should be taken into consideration
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when efforts to control the virus are developed? And finally, even if the answer to these
questions is negative, how should we take the bats’ role in African ecosystems into
account in developing vector control programs when we approach Ebola strictly from an
anthropocentric perspective?
Second, there are questions about the impact of Ebola on non-humans. Although it is
perhaps understandable that recent reporting would have emphasized the impact on human
beings, Ebola has had significant impacts on African wildlife, including gorillas and
chimpanzees (Walsh et al., 2003). Wildlife biologists have noted that the 2014 outbreak
may have the effect of bringing greater public attention to the impact of Ebola on these
charismatic species (Leroy, Labouba, Maganga, & Berthet, 2014). Furthermore, concerns
about zoonotic risk and impact on non-human animals extend to our closest domestic
animal companions, dogs. During the 2001– 2002 Ebola outbreak in Gabon, a team led by
Lois Allela and Olivier Bourry studied serum samples from 439 domestic dogs living in
high-exposure areas. Their findings report that while none of these animals developed
clinical infection, 31.8% presented antibodies to the Ebola virus. The source of the
infection was believed to be meat from Ebola-infected wild animals, as these dogs’ main
source of food is scavenging and hunting, as well as bodily fluids from infected humans
(Allela et al., 2005). Allela and colleagues also reported that pigs, goats, and horses
experimentally infected with Ebola virus developed an antibody response while remaining
asymptomatic or presenting mild symptoms.
Yet none of the medical bioethicists who have commented on the recent outbreak have
seen fit to recognize the impacts of the disease beyond human populations; in fact, one of
the only references to these impacts came, again, from Art Caplan, who decried the
protests and social media campaigns that followed the decision of Spain’s authorities to
mandate the euthanasia of a dog belonging to an Ebola-infected Spanish nurse, Teresa
Romero Ramos (http://www.nbcnews.com/storyline/ebola-virus-outbreak/bioethicist-
ebola-dog-deserves-sympathy-so-do-humans-n222126). While Caplan recognizes that
the loss of the dog’s life was sad, he claims that the acts of protest following his death seem
to indicate a concern for animal lives over and beyond that for human lives, and
furthermore, that this is morally reprehensible because it disvalues the lives of humans
who were simultaneously at risk and dying. The false dichotomy between the valuing of
human and non-human lives brought up by Caplan is a well known topic for
environmental ethicists, and is a textbook example of the dysfunctionality of artificially
isolated communities of ethicists that fail to produce synthetic ethical analyses of
complex issues involving human, animal, and environmental health. A more sensitive
environmental ethics approach to this question might have noted that this approach to
controlling the disease may have been every bit as unreflective of appropriate veterinary
 Ebola Needs One Bioethics 99

health measures as were some of the more draconian human health measures (such as
denying entry to travelers from Africa) that were suggested in the popular press.
Finally, there are climate change and sustainability issues associated with the Ebola
outbreak. Environmental decline in Africa is almost certainly increasing the type of
contact between human populations and infected wildlife that creates opportunity for the
virus to cross over into human populations. Decline of traditional food animal species in
Central and West African countries has spawned hunting and butchering of new species
for bushmeat. The collapse of traditional game species has many causes, of course, but
most relate to more intensive pressure on wild ecosystems from human beings (Kamins
et al., 2011; Mbete et al., 2011). Needless to say, bushmeat itself is a complex topic for
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environmental philosophy, and the implications of declining resource availability for rural
Africans must be taken into account in future discussions of the topic. Climate change
cannot be ignored as a component of the problem. Indeed, a short piece on Ebola published
in the September 2014 New England Journal of Medicine notes the connection to impact
from climate (Frieden, Damon, Bell, Kenyon, & Nichol, 2014), and might well be a better
guide to the issues for bioethicists than the research agenda published by Presidential
Commission on Bioethics three months later.

A Better Bioethics?
Contrary to Van Rensselaer Potter’s vision of a unified bioethics, environmental and
biomedical ethics have become institutionalized as distinct areas of multi-disciplinary
inquiry. Potter saw bioethics as a newly emergent domain that would probe the concepts of
progress and human betterment in light of the then recent work in ecology and
environmental science, on the one hand, and medical advances that were prolonging life
spans albeit with sometimes questionable impact on quality of life (ten Have, 2012). Some
40 years after the publication of Bioethics: Bridge to the Future (Potter, 1971), the term
‘bioethics’ is largely associated with studies housed in medical schools or medically
oriented research institutes. It is pursued by individuals with training in philosophy,
sociology, anthropology, politics, and economics, as well as disciplines of medical
science. Scholars whose work emphasizes the moral standing, use, and preservation of
non-humans and of eco-systems similarly combine work from philosophy and the social
sciences with insights from ecology, climatology, forestry, and other environmental
sciences. They are housed either in their traditional disciplinary homes or in
environmental studies and sustainability programs. Medical bioethicists have increasingly
focused on the distribution and impact of health care, especially novel therapies and
technologies that have significant impacts on the beginnings and endings of human life.
Environmental ethics has conducted a several decade debate over eco-centric, intrinsic
value approaches and anthropocentric, instrumental value approaches to environmental
axiology. Seldom do practitioners from these fields find occasion for professional
cross-talk.
There are reasons to resist this model, however. In 2012, Thompson argued that the key
ethical significance of synthetic biology would reside in the emergence of biological
platforms that could be quickly and relatively cheaply adapted to a very large and highly
diverse range of technical and commercial applications. Whether seen in terms of
biological building blocks or synthetic genomes, synthetic biology’s technical significance
lies in the ability to create a functioning micro-organism that can be predictably and easily
 100 P. B. Thompson & M. List

transformed through the inclusion or elimination of functional genes. This would change
biotechnology from a largely one-off type of innovation process, where each novel
application is essentially a craft project isolated from every other application, into an
industry much more like computing, where standardized platforms such as Android,
iPhone, Microsoft Windows, and Apple OS X permit simultaneous innovation in highly
diverse areas of the information economy (Thompson, 2012). Standardized biological
platforms could be readily adaptable to drug development, environmental chemistry,
biofuels, agriculture, and to areas such as personal fitness, dietetics, and cosmetics, where
the costs of developing genetically engineered organisms currently precludes innovation.
The bioethics community, however, is hardly ready for this kind of rapid and cross-
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sector change in biological systems. To the extent that synthetic biology is conceptualized
as having medical and environmental implications that are conceptually discrete and
addressable through the institutionally balkanized sub-specializations of medical and
environmental ethics, ethicists would be limited to a sequential and unconnected critique
of specific applications from synthetic biology. Synthetic biology would be seen merely as
a generalized ‘tool’, meaningful only with respect to its implications in separate and
distinct areas of utilization. While it would certainly be an error to deny the importance of
synthetic biology’s applications, Thompson argued that the unification of these technical
domains was itself ethically significant and even troubling to the extent that it invites rapid
innovations by anyone having the technical expertise for manipulating the biological
platform. Unlike biotechnologies (which have had their own problems, to be sure)
platform technologies truly could create opportunities for ‘tinkering with nature’ by
individuals, firms, and research groups having little to no understanding of the social or
biological context in which their inventions will be realized (Thompson 2012). Thompson
argues that this situation calls for a ‘synthetic bioethics,’ though as argued below, ‘one
bioethics,’ might be a more suggestive and accurate term.
There is a sense in which the 2014 experience with Ebola could not be more different
from synthetic biology in both the way that it disturbs our disciplinary silos and in the
nature of the philosophical problems it presents. Nevertheless, the summary of topics
listed above also illustrates the need for better integration among philosophers working in
medical and environmental areas of expertise. Responses to the Ebola outbreak from
professional communities and official agencies provide examples how the complex
problems presented by a socio-environmental phenomenon such as the Ebola outbreak are
broken down into smaller issues, whose analysis and solution often lose track of broader
social and technical implications.

One Health, One Bioethics

Within medical circles, the call for greater awareness about the connections between non-
humans, the broader environment and the traditional concerns of human medicine goes
under the banner of ‘One Health’. The idea of integrating human and animal medicine is
often attributed to Rudolph Virchow, whose work in cellular pathology established that
disease processes were similar in humans and other animals (Zinsstag, 2011). However,
medical technologies such as those used by Virchow to point out the value of integrated
approaches to medicine had quite the opposite effect, enabling the development of
increasingly specialized subfields of medicine, and resulting in an even larger gap between
veterinary and human medicine. The idea of integration was much later revisited by Calvin
 Ebola Needs One Bioethics 101

Schwabe, a veterinarian at UC Davis. Schwabe, who also held degrees in public health and
parasitology, worked closely with African pastoral communities in the 1980s and 1990s; it
was while working with these communities, through an observation and understanding
of their holistic world view that Schwabe consolidated his concept of ‘One Medicine’,
which focused on a common core of basic scientific knowledge for all the medical
science (Zinsstag, 2011). Intergovernmental organizations, such as The World Health
Organization, and the Food and Agriculture Organization keenly adopted the One
Medicine concept, but according to Zinsstaag (2011), the concept’s scope is limited
mostly to the public health aspects of veterinary medicine, leaving out broader
connections between health and environment. Concepts like ‘eco-health’, ‘ecosystem
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health’, and of course, One Health are an attempt to include the broader environmental
dimensions of health and healthcare.
Research identified as One Health has remained largely focused on zoonotic disease,
which is, as exemplified by the Ebola case, an increasingly important concern in our
globalized world. This body of research has come almost exclusively from the medical and
natural sciences, with a notable absence of participation from the humanities and social
sciences, which, according to Lapinski, Funk, & Moccia (2014) is surprising given the
central role of human behavior in One Health problems. In important respects, our vision
of ‘One Bioethics’ is considerably more ambitious, and has the potential to significantly
strengthen One Health initiatives in important ways.
More narrowly, the immediate objective of this paper is modest—perhaps only to
establish the need for broader, more inclusive bioethical frameworks and point to a
handful of issues that would need to be addressed by such frameworks. Some of these
issues might include those identified by Brody (2009) as new directions for bioethics,
including cross-cultural ethical relativity and global-scale resource allocation for the
prevention and mitigation of international health crises. As a general directive, Brody
establishes two criteria that should guide future directions in bioethics; first, bioethics must
prioritize topics that have been historically neglected by the field. Second, the addressing
of these topics should, in Brody’s words, ‘enhance the possibility of real intellectual
advance’ in bioethics.
Our claim is that Ebola shows why it is also time to begin thinking about One Bioethics.

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