Ethics - Global Health

Question 1

why should we care about global health ethics?

Answer 1

1. it benefits us
2. humanitarian duty of assistance
3. justice

• no moral significance to country boundaries
• legacy and reparation
• human rights & global responsibility to their realisation

Question 2

WHO Constitution 2006

Answer 2

The employment of the highest attainable standard of health is one of the fundemental rights of every human being without distinction of race, religion, political belief, economic or social condition

Question 3

universal declaration of human rights (UN) 1948

Answer 3

everyone has the right to a standard of living adequate for the health and well-being fo himself and of his family

Question 4

International Covenant on Economic, Social & Cultural Rights (1976)

Answer 4

The States Parties to the present Covenant recognize the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.

Question 5

UN Convention on the Rights of the Child (1990)

Answer 5

States Parties recognize the right of the child to the enjoyment of the highest attainable standard of health and to facilities for the treatment of illness and rehabilitation of health.

Question 6

Why are infectious diseases a global ethical

issue?

Answer 6

“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

Question 7

Ethics of isolation and quarantine

Answer 7

• 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

Question 8

Good moral reasons for carrying out research in developing countries:

Answer 8

• Global health inequalities
• Disproportionate burden of disease
• Value of research in developing countries*

Question 9

However, other reasons can also play a part (often cited in relation to clinical trials):

Answer 9

• Less stringent ethical standards
• Cost
• Number of participants, particularly drug-naive

Question 10

Use of Placebo

Answer 10

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

Question 11

Research & clinical trials

Answer 11

Important considerations:
- Ethical review & protection of participants
- Healthcare infrastructure
– Let’s talk “controls” in -clinical trials
- Valid consent
- Community engagement
- Benefits to participants after trial/research is over
- The importance of collaborating with local scientists

Question 12

Disaster & war

Answer 12

identical to medical ethics in times of peace, as stated in the International Code of Medical Ethics of the WMA

Question 13

WMA Guidelines

Answer 13

primary obligation is to their parents

Question 14

The example of Ebola – Health and human rights

Answer 14

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

Question 15

BMA toolkit for “Ethics & medical electives in resource poor countries”, for example:

Answer 15

Stay within your competence
Maintain ethical standards
Develop “cultural competence” (Bowman, 2011)
Minimise burden on host country & healthcare system