The Morality of Action and the nuns of Yambuku

The Morality of Action and the nuns of Yambuku

The Outbreak

Deep in Central Africa, there is a village called Yambuku. It sits in the Northerly part of what was then Zaire and is now The Democratic Republic of Congo. That tiny village, with no electricity or running water, muddy trackways instead of tarmacked roads, all but disconnected from the modern World, in 1976 was the epicentre for the outbreak of a virus that quickly killed 280 people and continues to reappear to this day.

https://edition.cnn.com/2014/04/11/health/ebola-fast-facts/index.html

When people started mysteriously dying no one knew what the cause was, it quickly became apparent that it was contagious with mourners at funerals of those had already died being struck down by the same disease. Samples were sent for testing and ended up in a lab in Antwerp where a scientist by the name of Peter Piot was dispatched with his team to Africa to further study and understand the mode of infection.

This was the first documented case of the Ebola virus, so called after the Ebola river which runs through the region. Working with the local people, doctors and nurses tried to establish patterns of infection. It wasn’t only funerals, but also infections seemed strongly linked to the small, basic, hospital in Yambuku.

Pregnant mothers seemed especially susceptible. Although not exposed to the infected or areas where care to them was given they were still falling victim to the terrible disease. And ebola truly is a terrible disease. The mortality rate was 90%, there is still to this day no known cure. Once infected your most likely path of progression starts with simply headaches and muscle pain and progresses through vomiting and diarrhoea, ending with both internal external bleeding.

http://www.independent.co.uk/voices/comment/ebola-outbreaks-i-discovered-this-virus-in-1976-its-frustrating-that-we-still-know-too-little-to-9218620.html

It is one of the most infectious, incurable and unpleasant natural threats a person can face.

Upon inspecting the hospital the team found a jar, with 4 or 5 glass syringes in it. Interviewing the ageing nuns who staffed and ran the hospital revealed these were used throughout each day to inject every pregnant woman with a mixture of vitamin B and Calcium gluconate. Between each use they were rinsed with sterile water and then were ready to be used again and draw once more from the shared jars of vitamins and calcium gluconate. Calcium gluconate of course having little effect but to give a temporary rush of energy and being of no medical value to the pregnant women injected. Each night they were then quickly boiled ready for the next day of use.

http://www.sciencemag.org/news/2014/08/part-two-virologists-tale-africas-first-encounter-ebola

The thing is Ebola may be extremely infectious, in that it only requires exposure to a very small amount of the virus to prove fatal, but it is actually not particularly contagious. This means that with a basic knowledge of infection control and medical safe practice, which has been in our possession for many years before the outbreak. Through nothing but their own ignorance and lack of proper training the nuns had been giving out largely pointless injections that doomed pregnant women and their unborn children to a horrible death and further spread the Ebola virus.

Unintended consequences

Were the nuns good or bad? Can we separate out the actions they took from the morality? I’ve broken an action down into 4 possible ways of viewing its morality:

  • The intended action
  • The actual action
  • The intended outcome
  • The actual outcome

So let’s apply the same to the nuns of Yambuku.

The intended action was to simply give an injection of vitamins and glucose. The actual action was still to give that shot. Nothing about their practice changed from what they had been doing for years without harm.

The intended outcome was to simply ensure the health and well-being of the women that entered their care. Interviews with them showed they deeply cared about these people and there is no reason to think these women who had sacrificed their lives in the service of the betterment of others should have suddenly developed mal intentions. However, the actual outcome was far different from what was intended. Instead of providing care they directly caused the horrific death of the very people they were attempting to care for. Something they had done for many years without problem was now in effect a death sentence.

So here we have a case where the action is the same, it’s not as if they didn’t intend to put those poorly sterilised needles into the arms of those pregnant women. It was the case that they did not appreciate what the consequences of their action would be. Nothing about their actions changed, only the environment in which they took place.

The tragedy is that with just better training and understanding they would never have acted in the way in which they did. So although they did a terrible thing, they did it with a clear conscience. They had no foreknowledge of the consequences of their actions.

It may be apparent to the observer that anyone acting within a medical capacity, who is giving such injections, should take it upon themselves to make sure they are properly trained. But these were not medical professionals and they would have interacted with various doctors and nurses that were. Yet they were never educated or trained differently. It is the ‘unknown unknown’ which is the most difficult to predict and the nuns themselves had no way of knowing precisely what they did not know. However, they must take some share of the blame for not keeping up to date within the medical field, even without seeking this particular knowledge they would have surely come across it with some basic training.

The wider environment

So this then brings into focus the idea of the wider environment playing a part in the morality of our actions. How can we blame someone for something for which they had no way to be aware of the consequences of that action. If they were nurses operating in a hospital in a major city or were provided the proper training, the morality of those nuns actions would be clear. They should have known better, the gap in their knowledge would be down to willful ignorance and punished in society by law.

However in the isolated environment they were in they didn’t have that training, they didn’t have the knowledge to know what training they were lacking. The context in which an action takes place must always be considered as part of judging it’s morality over and above what the action was, intended to be, did or intended to do.

Moral particularism tells us there are no universal moral principles, that every action must be judged on its own merits. In other words, that the complexities of any environment are so great there is no way to judge an action without understanding the framework it occurs within. Ultimately our own moral values tend to be plastic, changing as the environment demands. Even those who adhere to rigid ethical frameworks might change their interpretation of those values as the environment demands.

The nuns of Yambuku show there are no easy answers. How we judge the morality of what took place is not in a vacuum. Whilst we can still believe in moral principles, we must accept that the interpretation or application of these is dependant on the situation. At the end of this I don’t know how I would judge the nuns, I do know one thing for sure though. I wouldn’t want them treating me. Well unless of course I was in the middle of nowhere with no other medical assistance available…