Outbreak: Ethical Questions for the Next Great Plague

YiQi asked me to write something about Outbreak. You might have heard of it. The film takes place in Africa where a dreadful disease could be the next great plague of humankind. There are naughty little monkeys in it....and Dustin Hoffman. I haven't seen it in a while, but to be honest, movies like that always make me cringe becuase 1) That kind of thing probably would never happen and dramatizations are always so sensationalistic, and 2) I'm terrified of the off-chance that it could.

The film, to my knowledge, was the first Hollywood attempt at discussing some tough issues related to national security and where the right for the healthy to survive supercedes that of the sick. Outbreak's timing was pretty important too... it came out about 6 years after the US had its own epidemic of Ebola, now known as Ebola Reston.

I was about 8 at the time, so I don't remember much about the mood of the nation or even how the media publicized the fact that the Ebola virus had been imported into the United States from the Phillipines via cynomolgus macaques and infected 12 people (thank you Tara's Ebola Site). The good news is that the version of Ebola the humans caught did not make them sick.

They say there are no atheists in fox holes and I tend to believe there are no atheist virologists. Say what you like, but the fact that the bengin Ebola Reston and wicked Ebola Zaire are virtually indistinguishable under an electron microscope leads me to believe there are more things on heaven and earth than are dreamt of in our philosophy.

But Ebola's, ahem, fatal flaw is that the virus is exceedingly good at what it does. Ebola replicates too quickly and kills too quickly to have any real staying power. So it comes out every once in a while, takes lives, and goes back into hiding. Even the unfortunate tourist to catch the disease on safari and bring it outside of its natural habitat to Europe or somewhere else in Africa, so far, have not assended to Patient Zero status. They are usually ushered into a cold hospital room, quarantined as much as possible, and most often die.

Let's not forget, while we're talking about this that there are real people faced with the resurgence of this dreadful disease every day. They have lost loved ones to one of the most horrible deaths I can imagine. It's easy to talk about things in such a detached way, living in an industrialized country, as I do, where a victim would have a chance in hell to survive given our excellent acute and infectious disease care.

But Outbreak, and many other films after it, have raised an uncomfortable question about how we, as Americans may be asked to deal with a dreadful plague that could happen at any moment. Now more than ever, as we share airplane rides with patients infected with XDR-TB, clean up cruise ships from norovirus, and pray our spinach is safe from cattle and pig waste, we are keenly aware we may one day need to decide what should be done if an epidemic is serious and pervasive enough to threaten our homeland security.

Most people, when faced with the terrifying threat of your entire body (cells, tissues, organs and all) hemorraghing in one final bloody death shudder--see Richard Preston's Hot Zone--would probably say "Lock them up, kill them! I don't care, just don't let them near me!!"

And if that person clutching at life is your neighbor, your best friend, or your spouse? What then?

Sadly, the United States learned an awful lesson about humanity with the 1918 flu epidemic. Partly becuase Americans had no information about the disease, thanks to gag orders on the press by President Wilson and partly because people were literally dropping dead in the street, many ill people died because their friends and family members literally abandoned them to dehydration and starvation among other things (Thank you John Barry).

Mary Mallon, doomed forever to be known as "Typhoid Mary" never understood why she was forced to spend most of her life exiled to an island and publicly shamed for the deaths of her employers. Living in the late 19th and early 20th century, when even the greatest scientists had a limited understanding of typhoid, Mary couldn't comprehend how she could carry a disease that made people sick if she wasn't ill herself. Perhaps if her legacy has taught us anything, it's that the same moral obligations and concerns we have about genocide and slavery apply to how we treat victims of disease.

Is humankind really worth saving if we don't value human life? Is one life or a town of a hundred people worth potentially 10,000 of lives? Is the quick and painless death of an innocent at the hands of a well-meaning government, truly in the best interest of the people?

And if we are ever damned enough to one day look at spreading cases on a map and compare numbers with our vaccine or drug stockpile, we will have to ask ourselves the real questions--the ones where statistics and numbers are no longer a useful tool for calculation. Whose lives should we value? Should we save the weakest first, the children and the elderly? Or should we save the ones who know how to turn the lights back on and protect the public?