Burial practices and Ebola outbreak in West Africa

UC Berkeley, ETHICS

During 2014 and 2015, scenes of conflict were frequent in Guinea, Sierra Leone, and Liberia, the three countries hardest hit by Ebola, as medical authorities tried to separate the dying and the dead from their communities. The Dead Body Management Team within the Red Cross was in charge of separating the bodies from their loving families to ensure the infectivity stopped there. Ambulance drivers and burial teams were attacked with stones. Villagers often retreated with ill relatives into the forest, where they could hide, and where the deadly virus then quickly spread.

WHO published the guidelines for safe burial practices based on the understanding that viral levels are highest after people die with Ebola, making handling of bodies one of the highest transmission risks. From the utilitarianism perspective, WHO is concerned with outcomes and the aggregate benefit to society, stopping the transmission could save lives in village of the deceased and furthermore, will prevent the exponentially expansion of Ebola transmission to other cities, and other countries. In fact, the healthcare professionals working around the clock to stop these epidemics are from developed countries, with the goal of stop the epidemics and prevent it from coming to their developed countries. Traditional funeral practices, such as touching and washing the bodies of loved ones, are among the factors that led to the early spread of the disease in West Africa. The utilitarian would say “the end justifies the means”, and to stop the transmission of Ebola, we need to take action and bleach the bodies, incinerate and bury them, under no circumstance anyone should come near the deceased body without protection, and in fact, it is too risky to let anyone approach to it. This theoretical approach overlaps with beneficence because it looks to protect people from getting sick, however, in the context of global health, the utilitarian approach may be more appropriate because it has a great economical component.

On the other hand, the locals from Guinea, Sierra Leone and Liberia, with a literacy of 35% or less, want to maintain their religious and cultural rituals; it dignifies their loved ones. Based on the principle of respect for autonomy the healthcare professionals and the WHO need to take into consideration the individual's right to choose and decide how to bury their relatives. Maybe the young mother who just lost her 3-year old boy wants to touch, and kiss the body of her son, for the last time, regardless of her loosing her life too. Who are all these people who come from far away, without understanding this mother’s cultural roots and beliefs? Why they want to take the deceased boy away from her? The villagers might ask themselves: Why do they claim to know better than us? If they are so knowledgeable and powerful, why they didn’t come and help before our sons, mothers, brothers die? Why shall we trust them?

I selected this topic because while the utilitarianism is my first option as scientist, however, ruling how to mourn and bury a loved one, causes such clash in my thinking.

Could the utilitarian approach be so “right” that we may need to override the autonomy of the villagers in these countries? How one dares to suggest a mother, a son, a wife, to let go of their loved one? How do we let villagers continue their rituals, bury their love ones with dignity and respecting their cultural and human rights?

On the other hand, letting people those villages continue their burial practices in order to respect their autonomy are going to worsen the health situation for them and potentially many people globally. Both approaches have limitations, and only developing appropriate policies and including cultural competent professionals to work on it, could help us to reach goals that are beneficial for everyone.

In trying to find a balance for utilitarianism and respect for autonomy, I would suggest that our role is also to educate the villagers and the health professionals in their village. In the field of Global Health, we should act with compassion and prepare to encounter these situations. Ideally, with education and planning ahead of time, public professionals from developed countries won’t show up to these villages for the first time when people are dying and the goal is to stop spreading the disease, in particular to the developed countries where we live.

If I was to write a longer analysis, I would like to include more about human rightsthat encompass burial practices. Passing of family and relatives is a sensitive event, regardless of our cultural background or economical status.

References:

• http://www.who.int/csr/resources/publications/ebola/whoemcesr982sec7-9.pdf

• http://www.cidrap.umn.edu/news-perspective/2015/01/probe-ebola-burial-practices-pinpoints-risks-triggers-changes

• http://news.nationalgeographic.com/2015/01/150130-ebola-virus-outbreak-epidemic-sierra-leone-funerals/

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