The ethics behind the Ebola treatment serum

Excerpted from "Ebola outbreak prompts ethical questions," BioEdge. August 9, 2014 — The worst-ever Ebola outbreak has prompted bioethical discussion on two fronts. The viral disease has killed about 1,000 people in West Africa, mostly in Guinea, Sierra Leone and Liberia. A few cases have been diagnosed in Nigeria. The chances of dying in this outbreak are about 50 percent. Newspapers in Western countries like the U.S., the UK and Australia are highlighting the possibility of their own epidemics.

The first issue, as bioethicist Arthur Caplan points out, is that developed countries only worry about exotic diseases like Ebola when it threatens them: “The harsh ethical truth is the Ebola epidemic happened because few people in the wealthy nations of the world cared enough to do anything about it. We do need headlines about Ebola ... A public health policy that ends at our borders is not fair, just or even smart.”

The second is equitable distribution of a vaccine. There is no approved vaccine at the moment. A small American company, Mapp Biopharmaceutical, has been testing a vaccine called ZMapp on animals. But no one knows whether it is safe or effective on humans. Only a handful of doses at the moment and scaling up production to thousands of doses would take months. However, two white American medical missionaries, Kent Brantly and Nancy Writebol, who contracted the disease in Africa have been given two precious doses of ZMapp and seem to be improving. Why were they chosen instead of Africans? Apparently it is regarded as good practice to treat "first responders" first because of a social responsibility to help those who help others.

The WHO has convoked a gathering to discuss the ethics of providing an untested vaccine. “We are in an unusual situation in this outbreak,” says Dr Marie-Paule Kieny, of the WHO. "We need to ask the medical ethicists to give us guidance on what the responsible thing to do is.”

Commentary

CMDA CEO David Stevens, MD, MA (Ethics): “I’ve debated Art Caplan on TV and radio on a wide range of bioethical issues. As I do with his comments in this article, we have agreed on some points and disagreed on others.

“He is absolutely correct when he says, ‘A public health policy that ends at our borders is not fair, just or smart.’ The danger in a country where people worship financial, physical and emotional security is that our claim of ‘compassion’ is merely a slushy sentimentality, a loose veneer barely covering our selfishness. At the first hint that a health crisis killing more than a thousand people could affect us, that thin veneer is quickly ripped to shreds. We’ve already seen that. Ann Coulter publically claimed Dr. Kent Brantley was “idiotic” for going to Liberia and that the U.S. should focus on its own problems. Others, including a few Christian leaders, decried bringing Dr. Kent Brantley and Nancy Writebol back to the U.S. for treatment.

“On the other hand, Dr. Caplan’s comment on providing untested treatment to Ebola sufferers puts us in an artificial binary trap of ‘treatment’ or ‘public health.’ It is obvious that the good public health practice is what is needed to contain and ultimately stop the epidemic. But that begs the question about whether an unproven experimental drug should be used to treat seriously ill Ebola victims. With Ebola’s mortality rate, no other alternatives and a deteriorating condition, I would have taken the drug just as Kent Brantley did. He showed marked improvement in hours. It is not good to take an untried drug, but it is the lesser of two evils when you are about to die and an unproven drug has showed promise in animal trials. What’s more, to prohibit its import to other countries if their medical experts desire to use it is paternalistic.

“Many called Kent and Nancy ‘heroes’ for their self-sacrifice for the good of others. “Greater love has no one than this: to lay down one’s life...”(John 15:13, NIV 2011). We should admire their faithfulness to deny themselves, take up their cross and follow Jesus by doing exactly what He would do, but I think Kent and Nancy would not want to be thought of as heroes. They consider what they did as ‘normal Christian behavior.’ So should we.

“For more than two milleniums, Christians have laid down their lives for others. If we seek security, we will never find it. If we give up our security to follow Christ, that is when we find real security in Him. Then true compassion wells up from our souls.”

Resources

CMDA News Release on Dr. Kent Brantly, with a live interview with Dr. David Stevens
USA Today interviews CMDA on Ebola
CMDA Resources on International Healthcare