I do not believe it is unethical to treat the refugees for additional conditions, especially when treatment is straightforward and does not take away vital resources from patients seeking cholera treatment. I think the decision would be questionable if treating a patient for meningitis required a significant amount of Dr. Asadour’s time, and he could no longer perform his duty to treat cholera patients. However, it seems from the information given in the case study that Dr. Asadour feels confident that he can balance caring for both cholera patients and for several patients with other serious, but treatable conditions.
Dr. Asadour acknowledges that he has emergency medical supplies to save the lives of those with non-cholera conditions. It sounds like the local hospital cannot easily access such supplies. By treating such conditions, Dr. Asadour is relieving the local hospital from expending additional time and limited precious resources. This will allow the local hospital to care for a higher number of other patients. It seems just to me that a greater number of patients overall are accessing care. Also, since these patients are also refugees, they might encounter obstacles to accessing care at the local hospital.
Dr. Asadour feels obligated to treat a patient with a serious condition who is already on his door step. However, his staff and current resources could not meet the needs of an influx of other patients. Dr. Asadour should create an informal agreement with each of these patients not to advertise the cholera station as a tent to treat all conditions. It would be unethical for the healthcare team to fail to meet the needs of the cholera patients they formally agreed to treat.
Since cholera is communicable, it would be unethical to directly and knowingly expose a non-cholera patient to a cholera patient. Yes, Dr. Asadour feels a duty to treat the patient he faces at the admissions tent. However, a line must be drawn at the point where the risks of contracting cholera outweigh the benefits of receiving treatment at the tent for another condition. Above all else, Dr. Asadour must not do any harm, so nonmaleficence is also part of the argument.
If a patient presents with a serious condition that Dr. Asadour can treat with the available medical supplies (which are not readily available at the local hospital), Dr. Asadour must first be confident that the patient will not contract cholera in the designated treatment space. This is critical – if this patient contracts cholera, he or she can spread the illness further into the community. In this case, Dr. Asadour’s beneficent act of treating the initially non-cholera patient would be highly unjustified.
I do not believe it is unethical to treat a patient who has no other options. However, due to the principle of justice, I do believe it is unethical to prioritize the health of one individual over the health of tens of others.
As long as he does not harm others in the process – by neglecting to properly treat the cholera patients who arrive at the tent – I do not believe Dr. Asadour’s attempts to provide additional care for needy, non-cholera patients will be morally questionable. This additional care, however, should be at the expense of additional clinic time from Dr. Asadour, to ensure that he is delivering the level of care that he promised to deliver to cholera patients. I write this because first and foremost, Dr. Asadour’s professional duty is to cholera patients. Then, with available time and resources, Dr. Asadour can tend to other serious conditions.
After noting further experiences and observations at the tent clinic, Dr. Asadour can advocate to the donors to either expand the pool of money for treating serious, non-cholera patients who cannot receive adequate care at the local hospital, such as meningitis patients, or to fund the clinic as a horizontal aid program, so that Dr. Asadour and his staff can meet the shifting needs of their patients more holistically.
Thomas, John, Wilfrid J. Waluchow, and Elizabeth Gedge. “Case 8.2 Ethics and Humanitarian Aid: Vertical Aid Programs.” Well and Good A Case Study Approach to Health Care Ethics. 4th ed. Ontario, Canada: Broadview, 2014. 267-68. Print.
I absolutely agree with your post, and I believe that his obligations are primarily to the patients who have cholera. As per the WHO, the main treatment for cholera involves rehydration and salts. This form of treatment is very cheap relative to the medication necessary for other diseases. An example would be pneumonia that requires antibiotics, which are expensive. Therefore, as you mentioned, although Dr. Asadour has the supplies to treat non-cholera health issues, the need for more of those supplies would prevent him from attending to more cholera patients. Treating cholera patients was his ultimate goal, and since the cholera treatment is so cheap, he would be violating the non-maleficence principle by harming more people by also attempting to treat everyone else. With respect to justice, Dr. Asadour should also attend primarily to the cholera patients to effectively treat as many individuals as he can with the resources that he has. It is of course unfortunate that Dr. Asadour must make this difficult decision, but there will regularly be people who need medical care. Thus, as a physician, his goal should be to save as many patients as possible, so in this case, that would be accomplished by focusing on the patients with cholera.
Source: http://www.who.int/topics/cholera/treatment/en/
I agreed with your post and think it is very well argued and considers multiple ethical considerations. This dilemma is very hard to reason, especially since it involves emergency international care that is very different from issues that arise in the US health system. I think that Dr. Asadour is right to treat other patients, but that he needs to be incredibly transparent about this to the NGO organization. It would be unfair to use their money and resources towards a cause they did not agree to support.
Hey Beatrice,
Thank you for your post. I agree with some of your statements about Dr. Asadour’s obligation to treat the cholera patients first. However, I question the feasibility of your proposal of the informal agreement. Although an individual may “agree” to not tell other people about the resources for non-cholera patients, the agreement will not last long. In a refugee setting where people travel in families and communities, individuals will share “life-saving” knowledge with others. Thus, the informal agreement will not function well, and the clinic will receive an influx of non-cholera patients. Therefore, the clinic should implement a more formal screening process or “agreement” instead of an informal, possibly verbal agreement.