Heightened Vulnerability, Reduced Oversight, and Ethical Breaches on the Internet in the West African Ebola Epidemic

Ebola is a disaster, affecting the poorest countries in the world. Disasters increase the risk of ethical breaches, because of heightened vulnerability and reduced oversight. Issues of availability of drugs and health care and conduct of clinical trials have already triggered discussions about ethics, but other issues have escaped criticism. These include breach of patient privacy and public posting of photographs and details about Ebola patients on the Internet. Internet bloggers may provide health advice in areas beyond their expertise. The results can be misleading, dangerous, and unethical when human lives are at stake. This commentary explores the effect of heightened vulnerability and reduced oversight on some of the less acknowledged aspects of ethics on the Internet in the West African Ebola epidemic, and the need for an global accountability framework for medical ethics in social media. The fundamental principles of medical ethics are intended to underpin all aspects of medicine and medical research. These principles originate from the Nuremberg Code and the Declaration of Helsinki (Hanauske-Abel 1996; World Medical Association 2013) and were developed in the aftermath of Nazi medicine (Lifton 2000). The best known medical injunction, “above all, do no harm,” maintains both its normative power and its symbolic power in medical practice. Other tenets of medical ethics, including informed consent, the right to privacy, and a respect for human dignity, underscore the assertion that all decisions made in medicine must weigh the harm versus benefit to the patient or client. These principles, injunctions, and assertions are intended, without exception, to apply across all times, settings, and contexts in which medicine (and indeed all clinical activities) occurs, including on the Internet. Yet as Hurricane Katrina highlighted, disasters are catalysts for the creation of immediate ethical problems and potential breaches (Fink 2013). The use of the Internet in disasters adds a new layer of complexity to the problem. Disasters, of which the Ebola epidemic is an example, increase the risk of ethical breaches. They do so because they present a unique combination of the heightened vulnerability and reduced oversight. Disasters, by definition, are situations that exceed a community’s (region’s or country’s) capacity to respond and recover from that situation. Both the scale of the disaster and the fluidity of the situation (external factors), along with individuals’ and groups’ inherent vulnerability (susceptibility to harm, exposure, resilience, resources), contribute to their degree of risk. Nor are disasters evenly distributed. Poorer countries and poorer individuals have greater exposures and lower response capabilities to disasters. The Ebola epidemic is a case in point. It has affected some of the poorest countries in the poorest continent in the world. The gross domestic products (GDPs) of Sierra Leone and Liberia are 4.93 and 1.95, respectively, compared to 522 for Nigeria (World Bank 2014). The setting for the epidemic was therefore already in a region comprising vulnerable populations. That victims, survivors, and responders are vulnerable to physical and psychological injuries is clearly