5. Ethics - Global Health Flashcards
What is the WHO constitution of health and human rights in 2006?
The enjoyment of the highest attainable standard of health issue is one of the fundamental rights of every human being without distinction of race, religion, pollination belief, economic or social condition
Human rights are inherent, interrelated, interdependent and indivisible
Why are infectious diseases a global ethical issue?
• “Unrivalled consequences”
• Control measures raise important questions re: violation of important rights
– Right to freedom of movement – Right to privacy
– Right to informed consent
• Justice
• Do not respect boundaries
Ethics of isolation and quarantine: Michael Selgelid lists 6 considerations
- Must be effective in controlling the disease
- If less restrictive measures achieve the same effect, use them
- Consequences of not quarantining must be severe
- Must be implemented in an equitable manner
- Must be minimally burdensome
- Those contained must receive compensation
Isolation = have disease Quarantine = exposed to disease, possibly have it
Name 3 Good moral reasons for carrying out research in developing countries?
However, name 3 factors that will play a part?
- Global health inequalities
- Disproportionate burden of disease
- Value of research in developing countries*
Factors:
• Less stringent ethical standards
• Cost
• Number of participants, particularly drug-naive
What was the key trial in the reviewing the control in clinical trials?
076 protocol (1994) of AZT and maternal-child transmission of HIV
Which is the correct control to use?
- Placebo vs experimental treatment
- Standard treatment vs experimental treatment
Participants were given placebo which violates declaration of Helsinki
What was the update to the declaration to Helsinki in 2013?
Flexibility
“Where for compelling and scientifically sound methodological reasons the use of any intervention less effective than the best proven one, the use of placebo, or no intervention is necessary to determine the efficacy or safety of an intervention”
Important considerations in research and clinical trials
• Ethical review & protection of participants
• Healthcare infrastructure
– NB controversy over “controls” in clinical trials
• Valid consent
• Community engagement
• Benefits to participants after trial/ research is over
• The importance of collaborating with local scientists
What are the medical ethics in times of armed conflict?
Identical to medical ethics in times of peace, as stated in the International Code of Medical Ethics of the WMA.
What inequalities and issues were highlighted by the ebola outbreak?
– Ebola outbreak centred around some of the poorest countries in the world
• Lack of basic healthcare facilities to treat patients
• Lack of basic disease response infrastructure
– Originally not regarded as a Western problem (until cases
emerged in the US and Spain)
– Should Western healthcare workers working in affected countries be transferred to back to Western healthcare facilities?
– Who should receive the limited (experimental) treatments?
What were the research issues associated with drug administration during the ebola outbreak?
Panel was convened by the WHO in August 2014 to determine whether it was ethical to administer these despite the potential for unknown adverse effects and to determine who should receive priority.
Concluded ebola outbreak was exceptional and it was ethically acceptable to offer unproven interventions but ethical standards must be maintained.
