Abstract
The 2016 outbreak of the Zika arbovirus was associated with large numbers of cases of the newly‐recognised Congenital Zika Syndrome (CZS). This novel teratogenic epidemic raises significant ethical and practical issues. Many of these arise from strategies used to avoid cases of CZS, with contraception in particular being one proposed strategy that is atypical in epidemic control.Using contraception to reduce the burden of CZS has an ethical complication: interventions that impact the timing of conception alter which people will exist in the future. This so‐called ‘non‐identity problem’ potentially has significant social justice implications for evaluating contraception, that may affect our prioritisation of interventions to tackle Zika.This paper combines ethical analysis of the non‐identity problem with empirical data from a novel survey about the general public's moral intuitions. The ethical analysis examines different perspectives on the non‐identity problem, and their implications for using contraception in response to Zika. The empirical section reports the results of an online survey of 93 members of the US general public exploring their intuitions about the non‐identity problem in the context of the Zika epidemic. Respondents indicated a general preference for a person‐affecting intervention (mosquito control) over an impersonal intervention (contraception). However, their responses did not appear to be strongly influenced by the non‐identity problem.Despite its potential philosophical significance, we conclude from both theoretical considerations and analysis of the attitudes of the community that the non‐identity problem should not affect how we prioritise contraception relative to other interventions to avoid CZS.
Highlights
Zika virus attracted global attention in November 2015 when it was declared a public health emergency by Brazil, and shortly thereafter a Public Health Emergency of International Concern by the World Health Organization.1 While there was only limited understanding of the virus at the time of these declarations, the outbreak of infection in Brazil coincided with a surge in reported cases of severe fetal microcephaly, a condition associated with severe physical and intellectual disability later in life
Colombia, Jamaica, Ecuador and El Salvador all advised that women delay their pregnancy for up to two years to reduce the threat of Congenital Zika Syndrome (CZS).7
Contraception may be a powerful tool for reducing the cases of CZS, but it raises significant philosophical, ethical and social justice questions – since it confers its benefits by changing which people will exist in the future
Summary
Zika virus attracted global attention in November 2015 when it was declared a public health emergency by Brazil, and shortly thereafter a Public Health Emergency of International Concern by the World Health Organization. While there was only limited understanding of the virus at the time of these declarations, the outbreak of infection in Brazil coincided with a surge in reported cases of severe fetal microcephaly, a condition associated with severe physical and intellectual disability later in life. While there was only limited understanding of the virus at the time of these declarations, the outbreak of infection in Brazil coincided with a surge in reported cases of severe fetal microcephaly, a condition associated with severe physical and intellectual disability later in life. Many of the interventions that have been used in response to Zika are familiar from other mosquito-borne diseases. These measures include spraying insecticide, removing mosquito breeding sites and personal protection from mosquitos with repellent and appropriate clothing. Contraception can prevent CZS by delaying pregnancy until the risk of Zika infection is lower – either until the peak season of Zika transmission has passed, or until the outbreak has been controlled. Colombia, Jamaica, Ecuador and El Salvador all advised that women delay their pregnancy for up to two years to reduce the threat of CZS.
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