health ethics in resource poor settings Flashcards
What are the rates of death from childbirth in the UK and in sub-Saharan Africa?
1 in 8,400 women die from childbirth in the UK however, in Sub-Saharan Africa 1 in 37 women die from childbirth.
How does the number of oncologists vary between low-income and middle-income areas?
In Honduras, there are 20 oncologists for the 8 million residents, however in Ethiopia there are 4 oncologists for the 80 million residents.
Can we currently address the issues of deprivation in low-income areas?
In a world where trillions of dollars of income is received yearly, we could very easily address the issue of deprivation in developing countries, however there exists a huge divide between poverty and the rich; the amount of money needed to address this issue is easily available.
Should lower cost treatments (than those associated with normal standard of care in the high income world) be offered in resource poor settings?
Firstly, I think numerous factors need to be considered such as whether patients will have access to any alternatives if these lower cost treatments are not provided; if there are no other alternatives for them then the lower cost treatment may be better than nothing, despite it not being the optimal treatment available. Secondly, we should consider whether the lower cost treatment is significantly lower in cost than the standard of care. For example, cervical cancer screening programmes in the UK cost millions of pounds a year to carry out (short of 100 million). Therefore, this is not likely able to be provided to resource-poor settings, particularly as they would also need extra infrastructure and doctors, etc. to set up, increasing the cost drastically. The alternative currently used in Botswana is visual inspection with acetic acid and cryotherapy for suspicious lesions, in comparison to the usual Pap cytology given in the UK. Whilst this alternative may be extreme and very unpleasant, the current standard regime in UK is not suitable for roll out in Botswana and other developing countries, particularly due to the extremely high cost of our programme and the significantly lower cost of the methods currently used in Botswana.
It is often argued that local resource constraints should be considered when deciding what to provide.
What are the distinct challenges and obligations for researchers in resource-poor settings?
There is a lack of availability of resources, such as journals, articles, internet, in low-income countries, in comparison to high-income countries.
There is also difficulty with disparities between researcher and participant relationship, e.g. illiteracy, poor general health are barrier to gaining correct fully informed consent for patients in low-income countries - taking part in the trial might be the only form of healthcare access for the patient, therefore it can be seen as coercion in some cases.
Is post-trial access to care an inducement to participate?
Whilst it may be considered a factor for inducing patients into a trial, it would be unethical to prevent patients from receiving a treatment for which they are responding well to, in which case their condition would deteriorate. This is extremely unethical as we should always act in the best interest of the participant/patient. To try and overcome the potential coercion, it should be very clearly stated to the patient the risks associated with the trial so decision are not primarily based on the positive outcome.
Why are some areas resource poor?
Benefit and tax reforms! Austerity has become normalised. This is a political choice. It is therefore the duty of the healthcare professional to resist and oppose the economics of our time.
