By Annie Zhu
The McMaster Health Forum Student Leadership Team recently had the pleasure of hosting Dr. Lisa Schwartz for a talk about the ethical lessons learned from the Ebola epidemic. The presentation was engaging and covered important topics such as the ethical issues surrounding the use of mass surveillance during epidemics and the treatment of high volumes of patients with drugs that are still in clinical trials. Some of the key questions raised included:
- Is there an obligation to treat?
- What happens when there isn’t a treatment for the disease?
- Where do we go from here?
We discuss each of these questions in turn below.
Do we have an obligation to treat?
Do physicians have a duty to help even if it means risking their own safety? While initially there was fear that health professionals would stay away from regions afflicted with Ebola due to the perception of a high risk of contracting the virus, this was quickly proven wrong. Médecins Sans Frontières actually had a waiting list of health professionals who were eager to help those in need. Health professionals that volunteered to travel to Ebola-stricken regions and treat Ebola patients were promised immediate evacuation and treatment if required. This raised an ethical dilemma, as local health professionals and patients were not provided the same standard of care.
What happens when there isn’t a treatment for the disease?
During the Ebola epidemic, there was no FDA-approved vaccine or treatment. This highlighted an important ethical consideration – is it appropriate to treat patients with drugs lacking sufficient evidence about efficacy? For the first time, a World Health Organization (WHO) advisory panel decided that these non-evidence interventions were okay. While most drugs undergo rigorous testing in the form of clinical trials and the use of control groups, it was ethically challenging to administer the same tests under these circumstances. How fair is it to give an individual with Ebola a placebo? Should a potential treatment be withheld until full trials are done? Can individuals make informed decisions if there is only one untested drug available? These questions raise a broader discussion of whether or not ethical research can be conducted when the need for a drug is so pressing. Given that there weren’t many options available to these individuals, the matter of informed consent is a grey area. In addition, as there isn’t an FDA-approved treatment for a disease that kills up to 80% of those inflicted with it, it raises the question of whether palliative care specialists should have also been deployed. As humanitarian efforts are often thought of as valiant efforts to save lives, palliative care may be interpreted as admitting failure. However, given the lack of treatment available, the Ebola crisis serves as a prime example of the importance of giving humanitarian care workers some preparation in palliative care.
Where do we go from here?
The Ebola epidemic was an awakening, but as Dr. Schwartz pointed out, this was not the first time the Ebola virus claimed lives. In fact, scientists have known about the deadly nature of Ebola since 1976. Thus, how do we avoid repeat the same inadequacies in response to future outbreaks, and how do we move forward in implementing policies and responding to these situations?
Lisa Schwartz presented many ethical concerns that the epidemic brought forth; but many short-term and long-term solutions could be implemented to improve future responses. For instance, designing transparent hazmat suits could help improve trust between physicians and their patients by reducing the stigma and depersonalization of health workers. In regards to long-term approaches, strengthening the health systems of developing countries is crucial.
While the Ebola epidemic is no longer widely a focus in the media, there are still many residual effects. How can the global community support Ebola survivors in overcoming the stigma associated with the disease? Are there proper infrastructure and accessibility measures in place in the case of relapse? What about the children that have lost their parents to the Ebola epidemic?
Ultimately, the epidemic was caused by the spread of a virus, but as Dr. Schwartz rightfully implied, it was also a disease of poverty and dysfunctional health systems. For this reason, communication, trust, and involvement of community leaders are as important as understanding the pathology of the disease.
While there were many tough lessons learned during the Ebola epidemic in terms of ethics, communication, governance and health infrastructure, hopefully these will translate to the better management of future threats. The rapid response to the Zika virus and potential spread of other mosquito-borne diseases is encouraging, but there remains much to be done.