Medscape I'm Art Caplan, from the Division of Medical Ethics at the New York University (NYU) Langone Medical Center. What do you think the biggest source of controversy has been about the Ebola epidemic? Is it whether we have enough resources deployed in West Africa to contain the epidemic? Is it arguing back and forth about whether a travel ban makes sense? It's none of those.
The actual point of controversy that drove the most Internet traffic was the euthanasia of a dog, Excalibur, in Spain. The dog was part of a quarantine order in Spain when a person came down with Ebola who had been treating a patient who had the disease. This person was at home with her dog, and Spanish authorities decided that the dog might get Ebola so they put the dog down. That has literally caused a storm of criticism and complaint on the Internet. People were outraged that the dog had been killed.
Before I go further, I have to say that I have a dog. I have had this dog for 12 years. She is definitely a family member and I certainly wouldn't want to see her put down or harmed, or wind up on the wrong end of an Ebola order. But I was a little upset and morally outraged that the dog had received so much attention, more than children in West Africa, more than the plight of people whose nations are collapsing and falling apart. The dog really pulled the attention of people in the developed world more than the plight of people living in these poor countries.
We have to keep our moral priorities straight. I love my pets and I consider them family members. But if a dog poses a threat of transmitting Ebola to humans, then we have to take steps to make sure that that doesn't happen.
Whether we always have to put the animal down isn't as clear. I have talked with several experts. Some say that there are situations in which a dog is kept outside; you don't have to worry about its waste or any other excretions. So, could it put anybody else at risk? A dog in an apartment building in a major urban city—that was the situation in Madrid—might pose a different story. In that case, it's not so much that the dog is going to lick or get near anybody, but you have to take it out, you have to let it toilet; you have to give the dog a little bit of external environment. If you can't do that, the dog could pose a risk to others. The dog could pose a risk to others if it had an accident coming in or out of the building. So, we probably don't have a moral rule of "one size fits all." In some situations, you probably can manage the pet. In others, you may not be able to do so, and you might have to destroy the pet.
This leads me to an examination of a question that hasn't gotten enough attention. What do we mean by "quarantine" anyway? Clearly, we tell people that if we think they have Ebola or we are worried that they have been exposed to someone who was infected with Ebola, then they might have Ebola too. We tell them they will be quarantined. What does quarantine mean? Aside from what we are going to do about pets, does it mean that you stay inside as long as you can take it, but then you can wander out? We saw an NBC news reporter come back from Africa, be quarantined, and show up at the supermarket looking for soup. I don't think that is a strict quarantine. We have to understand that if quarantine is the tool to handle a public health crisis, it means you stay indoors.
That leaves us with a final set of unanswered questions. If you try to come out of your house, do we taser you? Do we shoot you? Do the cops put on a hazmat suit and tackle you on the front lawn? In other words, we haven't had a discussion of what it means to violate a quarantine and how tough we would be in enforcing it. I don't have those answers, nor should I. It's public policy. It's part of a public debate. So, whether it's what to do with your pet and letting people understand how that is going to be managed, or what to do with you if you decide to come out the front door—whether there is a cop sitting out there and what the response is going to be—if we are going to talk about quarantine, we all must understand what that entails.
