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Ethical considerations in the management of Ebola virus disease

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The current Ebola virus disease (EVD) outbreak in West Africa is the largest since the disease was first described in 1976. By the end of March this year, it had caused more than 10 000 deaths, including 495 among health care workers (HCWs).1,2 Twenty-four patients with EVD have been admitted to hospitals in high-income countries.3 The nurses who were infected while looking after Thomas Duncan in Dallas, Texas, highlighted the risk of transmission of EVD to HCWs, even in well resourced hospitals. HCWs in Australia were quick to compare this with an outbreak of severe acute respiratory syndrome (SARS) in a Toronto hospital in 2003, when a single case led to an epidemic in which nearly half the cases occurred in HCWs.4

The public response after a doctor who became infected while treating patients with EVD in Africa returned to the United States, and the ostracising of HCWs at the hospital where he was treated, reflected community concerns about EVD.5 The unpredictable nature of EVD, the infection of carers and the high case-fatality rate in Africa have generated fear of the disease.

HCWs have raised concerns about appropriate clinical management of patients with EVD and the need for a clear ethical framework to guide decision making.6