Global Health Ethics

Question 1

Why are infectious diseases are an important area in global health ethics?

Answer 1

• ‘unrivalled consequences’ (all countries are co-dependent)
• violation of important rights
• right to freedom of movement
• right to privacy
• right to informed consent
• justice

Question 2

What are the six conditions that would have to be met for the use of enforced isolation or quarantine to be employed ethically?

Answer 2

• 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 a fair manner
• must be minimally burdensome
• those contained must receive compensation (coercive)

Question 3

Name key international documents (conventions and declarations) which refer to health as a human right

Answer 3

• WHO constitution 2006
• Universal Declaration of Human Rights UN 1948
• International Covenant on Economic, Social and Cultural Rights 1976

Question 4

Why is it important to carry out research and clinical trials in developing countries?

Answer 4

• global health inequalities
• disproportionate burden of disease
• value of research

Question 5

What are some difficulties when carrying out research and clinical trials in developing countries?

Answer 5

• less stringent ethical standards (less resources, committees etc)
• cost
• number of participants, particularly drug-naive

Question 6

Describe the problem, highlighted in the 1997 AZT trials, that can be posed by the “control” used in some international drug trials

Answer 6

• AZT drug shown to be efficacious in response to HIV/AIDS in studies in Europe and North America
• more work needed to build evidence base
• developing countries due to the reason that their current standard treatment for HIV was no treatment, thought that justified doing placebo control trials
• harming people by not treating them for their HIV
• people not given intervention subject to additional risks

Question 7

Describe some of the ethical issues encountered during the medical response to the 2014 Ebola outbreak

Answer 7

• health and human rights:
• highlighted inequalities and issues around justice
• affected poorer countries that lacked basic gealthcare facilities and basic disease infrastructure
• quarantine/isolation
• justice: access to medication
• promising drugs and treatments but haven’t been safety and efficacy checked
• is it ethical to administer without knowing adverse effects?
• how to determine who should receive priority

Question 8

How can medical students deal with ethical issues they encounter on placement in developing countries?

Answer 8

• stay within your competence
• maintain ethical standards
• develop cultural competence
• minimise burden on host country and healthcare system