This year’s horrifying Ebola outbreak raises a thicket of ethical issues, many of interest to philanthropists. How much philanthropic support should be redirected from management of other, much more common lethal diseases—such as malaria, which killed 627,000 people in 2012—to support care for Ebola patients, who still number less than 2,000 this year? In this crisis, is it ethical to allow people to take experimental drugs that have not been vetted for safety and efficacy? If so, who should receive scarce doses of experimental drugs? If Ebola comes to America, what rules should govern quarantines?
One way to approach these ethical issues is through literature and art. The Academy-award-winning Dallas Buyers Club, for example, dealt with the permissibility of allowing people to take experimental drugs to treat lethal illness.
Another terrific piece for thinking about these issues—terrific both in the sense of utterly terrifying and powerfully instructive—is Daniel Defoe’s relatively unknown work A Journal of the Plague Year.
Defoe’s Journal is the fictional journal of a saddler, identified only by his initials “H.F.,” who lives through the 1665 plague outbreak in London. H.F. observes the way in which different individuals and classes, as well as the city of London as a whole, adapt as the plague sweeps through the city. Unlike Defoe’s Robinson Crusoe, which is a study of solitary man, Journal is a study of a society under enormous stress.
Sixteen sixty-five London may seem remote from 2014 America, but a common characteristic of both societies is a confident belief in scientific progress and the ability of science to confront and master crises. (It was during the 1665 plague that Isaac Newton first developed his theory of universal gravitation, which he had leisure to do since Cambridge University had sent him and other students home as a precaution against the plague.)
H.F. describes the flustering of a scientifically oriented society confounded by the inability of physicians and scientists to understand the plague that sounds a lot like how America was flustered by polio epidemics prior to the identification of the polio virus and by AIDS prior to the identification of the AIDS virus. The Ebola virus, tricky to isolate and difficult to study, has the same potential to confound us.
All of this makes the Journal potentially illuminating for us in thinking about the Ebola crisis. For example, paralleling debates today about how quarantine rules would be applied if Ebola arrived in the United States, issues of whom should be subject to quarantine and under what conditions run throughout the novel, particularly after H.F. himself is appointed to be an “examiner,” who orders and enforces quarantines. (One of the things that makes H.F. an interesting character is that he is not always noble—he is supposed to be an examiner for at least two months but buys his way out after three weeks!)
H.F. also testifies to what we’ve seen already among the physicians, nurses, and others who have stepped up to care for patients in Africa (as well as the handful outside of Africa): that although many or most people will be held back by their understandable fears, there will be philanthropists of “immovable affection, pity, and duty”:
This was a time when every one’s private safety lay so near them that they had no room to pity the distresses of others; for every one had death, as it were, at his door . . . self-preservation, indeed, appeared here to be the first law. For children ran away from their parents as they languished in the utmost distress. And in some places, though not so frequent as the other, parents did the like to their children. . . .
It is not, indeed, to be wondered at, for the danger of immediate death to ourselves took away all bowels of love, all concern for one another. I speak in general, for there were many instances of immovable affection, pity, and duty in many. . . .
In this terrible Ebola crisis, we can certainly be thankful for those few who risk all to care for stricken people.