August 11, 2014
According to the World Health Organization (WHO) we are facing an “international health emergency on Ebola.” The two countries most affected are Liberia and Nigeria. More than 1000 people have recently died from the disease.
Ebola is an extremely contagious, deadly disease that has no known cure. There are two experimental drugs that some believe might be helpful. However, these drugs have not been properly tested and therefore are not on the market. One of these drugs (ZMapp) was administered to two healthcare workers, Kent Brantly and Nancy Writebol, from Samaritan Purse, who contracted the disease in Liberia, in the humanitarian exercise of their medical profession. They are now being treated at Emory Hospital in Atlanta.
The World Health Organization is convening a meeting of ethicists to discuss the ethical dilemmas of the use in an emergency of untested drugs and also to address the issue of distribution in a limited resources situation.
Some of the questions they will most likely discuss are:
1. Is it acceptable to administer a drug that has not been tested on humans and whose benefits or harm are unknown?
2. How informed can or should the consent be? Should one administer such a drug to a population that can neither read nor write?
3. Who should be held liable if something goes horribly wrong? The WHO? The ministers of health of different countries that authorized the use of such drugs? The pharmaceutical companies that manufacture them?
4. However, in my mind, the most heart-wrenching question is who gets the drug when it is in a very limited supply? Should it be children, or healthcare providers, or the individuals who are most likely to benefit from the drug?
Bioethics is dealing with the most challenging ethical dilemmas because the choices that are made have life threatening consequences. In corporate ethics, the consequences are often about money (fines and lawsuits). In bioethics the consequences can be life or death.
In this case, we can summarily define the dilemma with the following question:
Who lives, who dies and who decides?
In facing such a question, we may have to recognize that there is no “right answer.” Any decision will be, at best, a choice of the lesser of two evils, a “wrong versus wrong” situation. There are some circumstances that require a heavy dose of humility and the admission that sometimes, we simply do not know.
I hope that the ethicists convening in Geneva this week will come up with guidelines that will help the international community make the right decisions. I sincerely hope that those guidelines will include the values of respect for human life, justice and fairness, as well as dignity.