title: Ethical considerations surrounding the response to Ebola: the Spanish experience.
abstract: The recent Ebola virus disease (EVD) outbreak, with 28,646 reported cases and 11,323 deaths, was declared a public health emergency of international interest by the World Health Organisation. In Spain, a single reported case triggered a public health crisis of a markedly media-centred nature. The approach to the first EVD epidemic has given rise to various ethical considerations around the world. We address the most relevant ethical considerations emanating from the management of EVD in Spain.
  
  
  
  Firstly, for reasons of global justice and humanitarian assistance, rich countries have the duty to support poorer countries in building up their core public-health capacities. Secondly, quarantine for high-risk contacts might have been a disproportionate and not properly justified measure, which could have contributed to stigmatising contacts and spreading panic. Thirdly, when the first secondary case was reported in Spain, it is doubtful whether informed consent requirements were strictly complied with when disclosing information concerning the alleged accident potentially causing the contagion. Moreover, this information was used by the Regional Health Minister to blame the patient, evading his responsibility to ensure safe medical procedures for health workers. Finally, the patient received convalescent plasma for compassionate use from a colleague of the first missionary repatriated, who also participated in a research study in Spain, despite having previously been denied the chance of being transferred to Spain to receive treatment. This fact highlights the asymmetry in the relationship between rich and poor countries.
  
  
  
  The management of this crisis highlighted the technical capacity of the health system and its professionals to respond effectively to public health emergencies caused by emerging diseases. This said, the failures in the protection of the EVD patient's privacy remind us that this aspect has to be borne in mind from the outset in crisis situations. Certain coercive measures, such as quarantine, should only be applied where there is some evidence that the benefit-risk balance could be favourable. Lastly, it is essential that research and interventions targeted at combating the fragility of the health systems in poor countries respond to reasons of global justice.
authors.affiliation: National School of Public Health, Institute of Health Carlos III, 8 Sinesio Delgado Street, Madrid, 28029, Spain. mroyo@isciii.es.
authors.forename: Miguel Ángel
authors.initials: MÁ
authors.lastname: Royo-Bordonada
authors.affiliation: National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain.
authors.forename: Fernando J
authors.initials: FJ
authors.lastname: García López
mesh_terms: D000533:Altruism; D057191:Capacity Building; D021821:Communicable Diseases, Emerging; D019049:Developed Countries; D003906:Developing Countries; D004196:Disease Outbreaks; D004630:Emergencies; D006282:Health Personnel; D019142:Hemorrhagic Fever, Ebola / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D007258:Informed Consent / Q000941:ethics*; D007391:International Cooperation; D007988:Liberia / Q000453:epidemiology; D010360:Patient Transfer; D018907:Privacy; D011634:Public Health / Q000941:ethics*; D011790:Quarantine / Q000941:ethics*; D008921:Religious Missions; D012449:Safety; D012935:Social Justice; D013030:Spain; D035703:Therapies, Investigational / Q000941:ethics; D014195:Travel
keywords: Ebola; Ethics; Global justice; Informed consent; Public health; Quarantine