Dilemmas

Ethics and the Ebola Crisis

By Richard Boudreau, M.D.
Illustration by Felix Sockwell

“The Dilemma” is a feature of LMU Magazine in which we ask a member of the faculty for ethical advice about a complex question. Send your moral quandary to magazine@lmu.edu with the word “dilemma” in the subject line. We’ll pick one, put it to a faculty member and give you an answer in the next issue.

When two American aid workers who contracted Ebola virus disease were rushed home for treatment in U.S. medical centers in September 2014, a recurring ethical dilemma in medicine came to the fore: What priority should be given to people or groups when too few drugs or treatments exist for all those who are symptomatic?

There are many occasions when there are too few resources to provide what people need to survive. Ebola is a horrific virus that spreads and kills. More than 5,100 deaths have occurred in West Africa as of November 2014, when this was written, and more people will die. In the United States, eight cases have appeared, with one death: Thomas Eric Duncan, who came from Liberia. An experimental drug exists that may cure the disease, but it is new and has been manufactured in small quantities. Let us discuss the question of how to prioritize the distribution of a treatment or cure through the prism of Catholic moral beliefs and Catholic ethics.

Utilitarian ethics as promoted by John Stuart Mill is a form of consequentialism and states that an action is right if it brings about the best outcome of the available choices. Utilitarianism defines “good” as pleasure without pain. A simplistic explanation of this ethical method is that the action must bring the greatest good to the most people. Catholic moral theory argues that all life is sacred. But how is that ethic to be applied when there are not enough resources to meet the need? Like it or not, the distribution of vaccines and medicines that will treat or cure the disease must be prioritized. The Hastings Center, a bioethics research institute in Garrison, New York, points out that hard choices must be made, which means trade-offs must be accepted. Rationing is inevitable and must be done in an ethical manner that will serve justice and save lives. But what does that mean?

Some ethical options include: prioritize distribution to prevent new infections; prioritize the lives of essential medical and scientific personnel who have the training and duty to care for the sick; prioritize support for health and safety infrastructure, which includes, for example, ambulance drivers, police, pharmacists and sanitation workers; prioritize the greatest medical needs among patients; prioritize based on life cycle — in other words, a patient’s age must be considered; prioritize equitably such that low-income and/or isolated communities are included; and prioritize based on the global location of the most rapid spread of the virus. Furthermore, there must be transparency about how distribution is determined.

Each of these guidelines would be in line with Catholic moral beliefs because they include all types of people and reflect that every life is valuable regardless of class.

Another important ethical issue in this crisis concerns the morality of distributing in Africa a drug or treatment that is experimental. Generally, federal agencies have been reluctant for ethical reasons to approve drugs before thorough testing has been completed, a process that can take months if not years. (Some drug companies, in fact, have announced plans to fast-track trials.) But the Ebola outbreak has occurred rapidly, causing pharmacists in Conakry, Guinea, for example, to argue that drug treatments should be distributed quickly. African medical professionals are aware that the outcomes of new drugs may be unknown, but they want access to drugs nonetheless.

Complicating issues is the fact that Western aid workers diagnosed with Ebola have been quickly transported home for treatment. Africans believe they have been discriminated against in receiving treatments because they are black. This issue is so “hot” that officials with the United Nations have met with ethicists, infectious disease experts, patient representatives and representatives of Doctors Without Borders to deal with the question.

In this case, companies can ethically provide experimental drugs on a “compassionate basis” prior to drug approval by the FDA. In terms of Catholic moral theory, we return to the statements that every life is sacred and we must do what is necessary to prolong life. If every life is sacred and if the Catholic moral belief is to preserve and prolong life by any means, then it would hold that distributing an experimental drug would be within those parameters.

Biography
Richard Boudreau, M.D., is a facial reconstructive surgeon, attorney and bioethicist, who serves as an affiliate faculty member with the LMU Bioethics Institute in the Bellarmine College of Liberal Arts. Boudreau holds a master’s in arts in bioethics from Loyola Marymount University as well as several other degrees including a D.D.S. and an M.B.A.
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