Ethics: Global Health Flashcards
Name international documents which refer to health as a human right.
♦ WHO constitution (2006)
♦ Universal Declaration of Human Rights (UN) (1948)
♦ International Covenant on Economic, Social and Cultural Rights (1976)
♦ UN Convention on the Rights of the Child (1990)
Outline why infectious diseases are an important area in global health ethics.
• Possible unrivalled consequences (pandemics; deaths; handicapped)
• Control measures raise important questions wrt violation of important rights
– Right to freedom of movement
– Right to privacy
– Right to informed consent (in terms of treating, isolating patients)
- Justice (make it as good with everybody as it is for us)
- Do not respect boundaries
Why should we care about global health issues ? (i.e. stuff not going on in our country)
- It benefits us
- Humanitarian duty of assistance (Peter Singer)
- Justice:
a. No moral significance to country boundaries
b. Legacy & reparation
c. Human rights & global responsibility to their realisation
Give an example of violation of important rights in global health.
1) Freedom of movement:
- HIV positive people are restricted from going to certain countries
- Isolation and quarantine
Discuss six conditions that would have to be met for the use of enforced isolation or quarantine to be employed ethically.
- Must be effective at 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
List good moral reasons for carrying out research in developing countries.
- Global health inequalities (people have access to modern drugs for the first time, drugs that will actually make a difference)
- Disproportionate burden of disease (instead of producing drugs for smaller numbers of people in the UK, and for symptom control or improved QOL such as viagra and omeprazole, can affect more people in a more significant way, such as malaria medication)
- Value of research in developing countries*
List bad moral reasons for carrying out research in developing countries.
- Less stringent ethical standards (get away with actions they would not get away with in the UK)
- Cost
- Number of participants (higher because desperate for something which may help), particularly drug-naive
What are important considerations in research and clinical trials in overseas countries.
- Ethical review and protection of participants
- Healthcare infrastructure (e.g. make sure able to have reliable controls unlike 1997 AZT trials)
- Valid consent (average patient information sheet is much shorter overseas than in the UK. Doctors also still very much in position to impose consent over their patient)
- Community engagement (important in order to get higher number of participants, but problematic because for instance in HIV research the people targeted are ones that are not well engaged generally)
- Benefits to participants after trial/research is over (if positive effect found, do you withdraw the drug ? do you give them ?)
- The importance of collaborating with local scientists
State the problem, highlighted in the 1997 AZT trials, that can be posed by the “control” used in some international drug trials;
• Article underlining concerns about research about AZT and maternal-child transmission of HIV in developing countries.
• What is the correct control to use?
-placebo (nothing) v exptl treatment (4 weeks)
or
-standard treatment (076) v exptl treatment (4weeks)
- The updated Declaration of Helsinki (2013) allows flexibility with regards to this (states that you have to test effects of new intervention against those of the best proven intervention, unless “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” then you can use placebo/no intervention/less than most effective intervention.
- In the research, they compared the intervention to placebo
- This would never have been allowed in the Western World
What are the medical ethics in times of armed conflict?
internationally, medical personnel are protected under the Red Cross/Crescent/Crystal and their primary task (WMA) is to “preserve health and save life”.
Hence, deemed unethical to:
- Weaken the physical or mental strength of a human being without therapeutic justification;
- Condone, facilitate or participate in the practice of torture or any form of cruel, inhuman or degrading treatment.
Discuss some of the ethical issues encountered during the medical response to the 2014 Ebola outbreak.
1) Health and human rights
– 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
– Should Western healthcare workers working in affected countries be transferred to back to Western healthcare facilities?
– Who should receive the limited (experimental) treatments?
2) Quarantine/isolation
• Should healthcare workers returning from Ebola treatment centres be quarantined?
(e.g. Kaci Hickox was quarantined against her will after returning from West Africa, and then challenged Maine’s requirements that people who have had contact with Ebola
patients be ‘isolated’ through quarantine)
3) Justice: access to medication
• Several promising drugs and treatments, which have not yet been evaluated for safety and efficacy in humans. 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 yes but ethical standards (such as informed consent, fairness, autonomy) must be maintained
• Study design was also controversial
Discuss how best medical students undertaking electives in resource-poor countries may ethically address dilemmas they may face.
- Stay within your competence (likely to be asked to perform actions outside of your competence)
- Maintain ethical standards (of Britain)
- Develop “cultural competence” (being part of the culture)
- Minimise burden on host country and healthcare system (e.g. don’t show them something they can’t use)