Sierra Leone: Opinion

President Julius Maada Bio.

The term "stigma-phobia" is a word coined by the writer (Lucky) for this particular write-up which means, the fear of stigma/stigmatization. Also, moral and ethical myopia refer to the inability to see ethical issues clearly. Coined by Minette Drum wright and Patrick Murphy, it describes what happens when we do not recognize the moral implications of a problem or we have a distorted moral vision. An extreme version of moral myopia is called moral blindness.

The popular opinion from journalists, civil society activists, medical practitioners, including Dr.Sylvia Blyden calling on the government to name names of people who have been tested positive of the novel coronavirus pandemic, has serious ethical implications.

The naming names syndrome of covid-19 patients has very ill-disposed consequences to the fight against the coronavirus endemic, which MUST be under the condemnation of this government in its strongest term. The cockamamie notion of naming names of covid-19 patients will eventually result to stigmatization, as it happened in the first case of our index covid-19 case, where we saw an exasperating floatation of the name and photos of the patient and his entirely family members on social media. If lab technicians continue with this unethical breach of patient's health confidentiality, we will reach to a situation wherein "stigma-phobic" will dominate patients' to lose confidence in medical practitioners. This will also inculcate the culture in patients to seeking medical attention in their houses order than going to hospital. Thus, it is high time we guaranteed the same health confidentialities applicable to HIV/AIDS and other illnesses to coronavirus diseases.

The 2014-2016 World Health Organization's (WHO) Guidance for Managing Ethical Issues in Infectious Disease Outbreaks, was grew out of concern at the World Health Organization (WHO) about ethical issues raised by the Ebola outbreak in West Africa in 2014-2016. Amongst the many ethical dilemmas which WHO highlighted during the Ebla outbreak, protecting the confidentiality of personal information was at the center stage. (WHO) categorically frowned at the unauthorized disclosure of personal information collected during an infectious disease outbreak (including name, address, diagnosis, family history, etc.),which can expose individuals to significant risk. (WHO) recommended for countries to ensure that adequate protection exists against these risks, including laws that safeguard the confidentiality of information generated through surveillance activities, and that strictly limit the circumstances in which such information may be used or disclosed for purposes different from those for which it was initially collected. They further recommended that the use and sharing of non-aggregated surveillance data for research purposes must have the approval of a properly constituted and trained research ethics committee.

On the other side of the pendulum, one would like to bring in philosophical arguments that justify the naming names syndrome as unethical and it will be "stigma-phobic" for covid-19 patients. Emmanuel Kant's first formulation of the categorical imperative appears similar to the Golden Rule. In its negative form, the rule prescribes: "Do not impose on others what you do not wish for yourself." In its positive form, the rule states: "Treat others how you wish to be treated". If we are to strictly go by the Kantian golden rule which says "do on to others as you want them do to you", the fallacy of equivocation of naming patients names would have been long thrown into the trash because even those who are the gospel singers of the naming names syndrome would not love to see their names published had they tested positive of the covid-19 pandemic.

Peter Corning suggests that, "Kant's objection to the Golden Rule is especially suspected because the categorical imperative (CI) sounds a lot like a paraphrase, or perhaps a close cousin, of the same fundamental idea. In effect, it says that you should act toward others in ways that you would want everyone else to act toward others, yourself included (presumably). Calling it a universal law does not materially improve on the basic concept. Kant himself did not think so in the Groundwork of the Metaphysics of Morals. Rather, the categorical imperative is an attempt to identify a purely formal and necessarily universally binding rule on all rational agents. The Golden Rule, on the other hand, is neither purely formal nor necessarily universally binding. It is "empirical" in the sense that applying it depends on providing content, such as, "If you don't want others to hit you, then don't hit them." It is also a hypothetical imperative in the sense that it can be formulated.

Furthermore, the Humanity Formula which most philosophers who find Kant's views attractive find them so because of the Humanity Formulation of the Categorical Imperative (CI). This formulation states that we should never act in such a way that we treat humanity, whether in ourselves or in others, as a means only but always as an end in itself. This is often seen as introducing the idea of "respect" for persons, for whatever it is that is essential to our humanity. In lieu of the Kantian doctrine, upholding the health confidentiality of covid-19 patients will kowtow in Kant's argument of "respect for persons".

Moreover, John S. Mill's utilitarianism is an ethical theory that holds the belief that all moral actions should be decided on the basis that they cause "the greater happiness for the greater number". A teleological approach is one which is based on consequences, and deontological approach is based on a set of rules or absolute rules. But for the purpose of this article, I will confine my argument strictly to the Rule Utilitarian doctrine. The Rule utilitarianism is similar to Kantian ethics which seems like a bit of an overstatement or at least unclear in a rather infelicitous way. The Kantian ethics isn't categorized as consequentialist but at its core it is. The categorical imperative looks for a logical contradiction in a rule, it looks at the consequences of that rule when applied universally to see if a contradiction occurs (and if so, it cannot be a moral law). What would be the result if everyone acted this way? Is the same question asked in rule- based utilitarianism and Kantian ethics? Although Kantian ethics is looking for a contradiction while rule- based utilitarianism is trying to determine the net good or bad. Unlike the Act utilitarianism, the Rule- based utilitarianism looks at the consequences of individual actions for everyone, all of society rather than just the group of people immediately affected.

In that light, let's examine this scenario from the Rule-based Utilitarian argumentative point of view, wherein someone goes to a doctor or a Lab Technician. The person is ill, experiencing pain, showing all the symptoms and dysfunctions of covid-19 diseases. The doctor or lab technician performs a series of tests and examinations and the result indicated that the person is positive of the coronavirus diseases. So, the doctor or the lab technician knowing well that the covid-19 diseases is a life-threatening pandemic, he then decided to publish the patient medical result including the names and photos to the public vie social media. Thus, because there is no patient's health confidentiality in hospitals and any other health facility in Sierra Leone, the rule utilitarian would consider what would be the long-term consequences if doctors and lab technicians were to publish positive results of covid-19 patients on social media? The rule utilitarian might calculate that people would no longer be able to trust their doctors and medical practitioners, and this would break down the confidence they need for seeking medical attention in hospitals and clinics. The RULE utilitarian might also calculate that there is far more harm in publishing the names and photos of covid-19 patients and so the GOOD is to maintain the existing patient's health confidentiality.

In conclusion, it is my credo that with all the philosophical ethical underpinnings , in addendum of the World Health Organization's (WHO) Guidance for Managing Ethical Issues in Infectious Disease Outbreaks during the Ebola virus in 2014-1016 with regards to patients health confidentiality, the naming names syndrome of covid-19 patients will tremendously demoralize the fight against the dreaded coronavirus ailments. It would be an ethical blindness for those basing their premise of naming covid-19 patients just because celebrities and top politicians have done same in other countries forgetting that there is no microcosmic synonymy in terms of civility of those countries to Sierra Leone. If we dare make any mistake to join in that bandwagon of publishing names of covid-19 patients, the "stigma-phobic" propensity would pave the way of people to frown at seeking medical attention in hospitals. It would further exacerbate a "hide and seek" game wherein suspected covid-19 patients will take to their heels as it happened in the case of those two staff at Fourah Bay College. I hope we don't want to see situation wherein it becomes a rule in Sierra Leone that anybody going for test or seeking medical attention for Tuberculosis (TB), HIV and AIDS, Ebola, Coronavirus etc. that their names and photos will be published on social media. If the medical practitioners degenerate to breaching health confidentiality, consequences as per the Rule-based Utilitarianism would be as, my very self and millions of Sierra Leoneans would rather die at home, other than allowing an ill-thought-out medical practitioner to breach my health confidentiality in the name of public health emergency. I would want to implore this government not to reiterate the silly mistake they made in the case of our first covid-19 index case wherein his name and photos of his entire family members were published on social media.

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