Self Preservation

I wonder about some choices made by Thomas Duncan, the Ebola patient who's being treated at a hospital in Dallas, and may have infected other people here.  The New York Times reports that on Sept. 15 Duncan helped carry a pregnant, 19 year old Ebola victim from a taxi to her home, where she died hours later (the hospital wouldn't admit her).  Four days later he few from Liberia to Brussels, from Brussels to Washington D.C., and from Washington to Dallas.  He must have known these things, each with some relevance to the decision:
  1. His contact with the dying woman gave him a significant chance of having contracted Ebola.
  2. Traveling by air would increase the chances that he would spread the disease, if he had it.
  3. If he had the disease, his chances of surviving in the US were much better than his chances of surviving in Liberia. 
  4. His extended family in Dallas would not have been at risk if it were not for his visit.
  5. The airfare was non-refundable or refundable only with a penalty.
To defend Duncan's decision to come to the US, you have to think that people have some sort of right of self-preservation, and that it "kicked in" in this situation. Obviously we can't do just anything to save ourselves--robbing others of their bodily organs if we need a transplant, for example--but we can subject others to the risks in question here, whether the others are strangers (as in #2) or family (as in #4).

I do think people have some sort of right of self-preservation.  For example, right now the medical care for Duncan is costing vast amounts of money, and I doubt he is in a position to pay the bills.  The same money could probably be used by Oxfam to save hundreds of lives.  I think it's fine for the man to opt for treatment rather than refusing and dying.  In that particular case, it's okay to prefer your own good to the greater good.

But in the case at hand?  Was it wrong of him to get on that plane and then interact with his extended family, knowing that if he were carrying Ebola, the alternative was dying in Liberia?  If you believe in any right of self-preservation (as I think we all do), it's hard to see where it ends.


s. wallerstein said...

I'm not sure what I'd say if I had been his seat partner on that plane.

Wouldn't he have had to be frank to others about his exposure to Ebola and to see if others were willing to run the risk of being in close contact with him?

In any case, a fascinating story, probably best discussed in a short novel.

Jean Kazez said...

I'm not sure what I think about this. As to the novel, if only I could remember more about Camus, The Plague, I'd know whether it has any relevance!

s. wallerstein said...

My memory of Camus's book is rather dim too.

If you're interested in plague literature, there is a long account of the plague in ancient in Athens in Thucydides and there's Daniel Defoe's Journal of the Plague Years.

Alan said...

There are a number of interesting issues raised by this example.

The question of treatment cost is one that I think we can legitimately discount in this case, since any citizen of a country with an advanced medical system has effectively purchased (or been given) an insurance plan that provides those resources in the rare event that they are needed. The question of whether those resources might be more effectively spent elsewhere is still interesting but is equivalent to asking the same question about whether a rich individual has the right to spend his or her riches in defense of small increments of his or her own health and welfare rather than to create larger benefits for others who are less well off.

The question of creating an infection risk for others is more problematic but it depends very much on the gestation period and transmissability of the infection. If it takes more than four days from exposure to infectiousness (or if someone who is asymptomatic is not infectious) then the fellow passengers may not have been at risk at all. But even if they were, if the transmission rate is low then there may be a net positive effect from transporting a sick individual to a zone of effective treatment even if that transport is a source of infection risk for others.

But if one *is* aware of being infectious, is there an obligation to give others the opportunity to refuse transport to safety in order to avoid even a relatively small risk to themselves? (And does that obligation persist if one thinks that the others have an exaggerated impression of that risk?)

Alan said...

Actually he's not American but Liberian, so my comment about the treatment cost was mistaken.

Also, apparently the Liberian government disapproves of his decision - not just to travel but to actively lie on a national exit questionnaire (where apparently the relevant issue is whether the young woman was a relative of Mr Duncan).
see http://www.bbc.com/news/world-africa-29467489