Case 8.2 Ethics and Humanitarian Aid: Vertical Aid Programs

Vertical aid programs are special programs that are created to “target a particular disease, sector or technical intervention” (PBE 267). These programs are implemented in times to sudden disaster, such as the Cholera outbreak in Dr. Armans Asadour’s case. Vertical aid programs are set out to eliminated or control the specific disease. Although this is the goal, the site in which the doctors work in often have medicine to treat illnesses. In case 8.2, “Ethics and Humanitarian Aid: Vertical Aid programs”, Dr. Asadour brings up the question of whether or not vertical aid programs should accept/help patients without Cholera, and whether or not vertical aid programs actually bring about beneficial change. I firmly believe that vertical aid programs are most beneficial if the program follows its goal. In the case of Dr. Asadour, I believe that the programs should not accept people that do not have Cholera or Cholera symptoms.

Looking from a policy standpoint, this is a tough decision both ethically as well as logistically. However, the pros out weigh the cons; the doctors should only help those that have Cholera. The doctors of the vertical aid program were sent out for a specific goal: stop the Cholera outbreak. Cholera is an infectious and often fatal bacterial disease, which is easily contracted from infected water supplies (CDC). Given the fact the outbreak occurred in a heavily dense population of refuges, the impact of such a deadly disease should be given precedent. By allowing others come for unrelated medical treatments will only waste resources when battling against time. It is more important to control the disease that can do the most harm to the most amounts of people than spreading the aid to others.

Looking from a doctor’s standpoint, I can see how this decision to turn away easily treatable injured people can be conflicting to their morals. These doctors however are not in control of the situation and must look at it from a utilitarian standpoint. The most lives can be saved by first preventing the outbreak of Cholera. That being said, the doctors working in the field are working for a NGO for a specific cause, and should respect the decision of the NGO when committing to the job.

This case specifically reminds me of the most recent Ebola outbreak. At the time a vertical aid program was establish, where people were sent into countries to contain the virus as well as money being spent to find a cure . Due to the rapid response and focused goal of preventing the spread of this disease, the transmission of Ebola in West Africa was controlled. The increase of funding to combat Ebola has given countries in the area the experience and tools to rapidly identify any additional cases and to limit transmission(CDC).

Over all, I believe that Dr. Asadour has good reasons to be wary of his and the other doctors actions; however, he is not looking at the impact of his actions in a larger picture. Before the outbreak, the population had the diseases that they are seeking help for. They were surviving and were not posing immediate harm onto others. At the time of the outbreak, people were being infected with Cholera, and the disease was spreading rapidly. It would be logically sound to control the damage of the Cholera before attempting to help everyone else. That being said, I believe only after the outbreak has been contained, should the doctors be able to help others  with non-Cholera related diseases.

Resources

Beauchamp, Tom L., and James F. Childress. Principals of Biomedical Ethics. New York: Oxford U.P., 1983. Print.

“Cholera – Vibrio cholerae infection.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 09 Nov. 2016. Web. 15 Apr. 2017.

“2014-2016 Ebola Outbreak in West Africa.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 22 June 2016. Web. 15 Apr. 2017.

https://i.reddituploads.com/16ebf7dfa4cb4a63bb1ef6ade97efa43?fit=max&h=1536&w=1536&s=43def47049db763c04ab2809cd2e743c

Beauchamp and Childress bring up a very interesting point about the value and quality of life. They show that it is possible to quantify human life. There are many different ways of analyzing the value of a human’s life. The two ways that Beauchamp and Childress argue for are discounted future earnings (DFE) and willingness to pay (WTP). DFE is an analysis of a person’s condition and then potential monetary gain that they are expected to earn if they survive. WTP is an analysis of the how much individuals would be willing to pay to reduce the risks of death – either in real life or hypothetically. Both WTP and DFE are heavily monetary based, completely sidelining the persons well being. Beauchamp and Childress then go on to talk about Quality Adjusted Life Years (QALYs), a system currently being used in the UK, to determine who gets treatment. QALY is mainly based on a cost benefit analysis: balancing the age, type/cost of the procedure, and the amount of years that can be gained if the procedure is done to the patient. (Beauchamp & Childress 237 – 241)

I appreciate the ethical concerns of QALY brought up at the end of the chapter. For the most part I do not agree with Beauchamp and Childress; I believe that life is invaluable. There is already so much inequality in the world—but to separate the value of peoples lives so blatantly only breaks down the characteristics that separate us from other animals. QALY takes a utilitarianism standpoint that heavily biases against those that are old and already impaired. The cost and benefit for treating those who are younger and healthier heavily outweigh treating the old and weak. Younger and Healthier people have more to contribute to society as well as will survive longer after the procedure.

I believe that a balance needs to be achieved, for there are many flaws on both sides. In society today there are two systems that are present: one of universal healthcare and the other of privatized healthcare. In each system respectively, QALY heavily biases the either young or the rich. If following QALY in such a universal health care system – such as in the UK— the younger, healthier generation are often treated before the older solely due to the fact that a younger person will have more of an impact in the world than an older person of the same disease. In a privatized health care system such as ours, the old is no longer biased against, rather it is the poor. Rich people can afford procedures than those who are poor. A perfect, semi-recent example of this is AIDS. Magic Mike was able to afford medication for AID at a time the cost was too great for many another people(PBS). Due to his large amount of wealth, he was able to survive while many others died. Only to further the same point… with the increase in technology the cost of the AIDs pill decreased to an affordable rate for average civilians, until 2015, CorePharma sold the U.S. rights of Daraprim to Turing, which raised the price to a whopping $750 a pill. (CNN) In privatized healthcare system, only the wealthy is safe from death while the commoners must fend for themselves. We need a system that neither is bias against the young nor the rich. We need a system that follows the spirit of the Hippocratic oath. The field of medicine was created to save people; to prioritize anything above saving people would seem counter intuitive.

That being said, there is one place I believe QALY is acceptable to use, the military. In military there are situations where time and resources play a larger factor in the decision making of who get treated and when they get treated. At times three categories were created: those who would live, those who needed help to live, and those who would die. These three categories outline what QALY stands for—they have grouped injured people based on the procedure needed and the outcome/quality of life is received medical attention. This utilitarian standpoint when treating combat related injured helps save the most amount of lives without wasting resources.

Alex

Citations:

Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. New York: Oxford UP, 2016. Print. pp 237 – 241.

Hillary Clinton tweeted that the 5,000% spike was “outrageous”, and Amounted to “price Gouging.” Nothing about the Drug Itself Had Changed except This: a New Company — Turing Pharmaceuticals — Had Bought the Rights to Distribute It. The Daily Beast Dubbed Turing’s CEO “the Most Hated Man in America.” “What happened to AIDS drug that spiked 5,000%.” CNNMoney. Cable News Network, n.d. Web. 25 Mar. 2017.

“20 Years After HIV Announcement, Magic Johnson Emphasizes: “I Am Not Cured”.” PBS. Public Broadcasting Service, n.d. Web. 25 Mar. 2017.

In the case of the Nuu chah nulth Nation and Arthritis Research (case 9.1), the primary dilemma revolves around the use of blood samples for other, unspecified research. Dr. Richard Ward came to the Nuu chah nulth Council to receive permission to take blood samples in hopes to “ discover a genetic predisposition to [rheumatoid arthritis] and … help in the search for a cure or at least direct people testing positive to physiotherapy” (W & G 289). His results for discovering a link to arthritis were lacking; however, he was able to publish a groundbreaking paper on the genetic distinctiveness of the Nuu chah nulth Nation. During Dr. Richard’s rise to fame, he neglected his original agreement with the Nuu chah nulth Nation and has let the blood sample circulate through the research community.

The issue at hand is the vagueness of the consent that the Nuu chah nulth Nation signed. Due to this vagueness, the Nation was exploited for their genetic information, receiving neither the promised information nor help regarding Arthritis in their community. Although Dr. Richard Ward forgot to contact the tribe after a year, he technically fell within the constraints of his proposed research –“to conduct a Health Canada sponsored study” (W & G 289). A small loop hole, due to the vagueness in the description of his study, allowed him to branch away from solely doing Arthritis Research. This action should not condone but it prevented; however, I argue that the blame falls on both sides. The consent should have been more specific, and at the time there should not be blind trust in the researcher. This act of blind trust is still prevalent in research today. This became painfully obvious after looking at my own research.

Doing research myself, I never put much thought into the mandatory consent form given out at the beginning of each experiment. For the most part, it is routine and a box on my checklist to ensure the lab does not get sued. I never realized it was also to protect the rights of the subject and the data collected from them. The most frightening part is the fact that most participants in my research do not read the consent but rather agree to my verbal synopsis of it. There is a blind trust towards scientists. People assume the best from them and offer little hesitation when agreeing to someone in a “white lab coat”, especially when the incentive is high.

My final thought after reading this paper is the iconic line from the Hippocratic Oath: “to abstain from doing harm”. I agree that Dr. Richard Ward preformed unsanctioned experiments due to vagueness; however, would the reaction from the Nuu chah nulth Nation be different if the research helped them instead of hindering them? I find it interesting that the reaction of the tribe would have probably been different if Dr. Richard Ward found something prevalent to the Nation’s health, but also unrelated to Arthritis. If no harm were done to the Nuu chah nulth Nation, would there be such large backlash towards the additional experiments?

Citations

Thomas, John E., Wilfrid J. Waluchow, and Elisabeth Gedge. “Case 9.1 The Nuu chah nulth Nation and Arthritis Research” Well and Good: A Case Study Approach to Health Care Ethics. 4th ed. Peterborough, Ontario: Broadview, 2014. 289-192. Print.

Waterson, Bill. “Calivn and Hobbes”, http://1.bp.blogspot.com/-Cmn9aQ8ZpPE/U3fKHC9-3uI/AAAAAAAAGlU/v0jCsff3dEQ/s1600/Research.jpg.

Should Informed Consent be based on rational beliefs? A Critique:

Julian Savulsecu and Richard W Momeyer argue, “being autonomous requires … a person [to] hold rational beliefs” (Savulsecu & Momeyer 282). They make an important distinction between rational beliefs and rational choice. Rational beliefs is the knowledge of the situation regarding its accurately and validity. Rational choice is how a person acts upon the beliefs that they have. When specifically applying this to the medical world, Savulsecu and Momeyer believe that it is not enough to simply provide information to the patients; rather, the physicians should help their patients with more rational thinking and deliberations.

Overall, I do not agree with Savulsecu’s and Momeyer’s argument of rational beliefs. Autonomy does not, and should not, correlate with a persons belief – knowledge – or the rationality of choice behind it. Autonomy is very basic. It is the right or condition of self-government I would argue that a person’s autonomy should be based off the action a person takes. Being autonomous is an action – similar to the action of jumping. If you meet a set of criteria that distinguishes an action form others, then I believe that you have preformed that action. If both feet come off the ground and I elevate my body, then I have jumped. In the case of autonomy, a person would preform a self-governing action. Performing this action does not require extensive knowledge on a situation, only the person’s opinion at that moment of time, and the action itself. When the action is complete, the person has preformed acted autonomously and therefore responsible for the outcomes of their actions.

Rationality and true/false beliefs do not hold much weight when deciding whether a person is/was autonomous. Acting rationally upon true beliefs may lead to a better consequence, however the quality of the consequence should not dictate whether or not it was an autonomous decision. Take the Jehovah Witness case for an example. The doctor actions to transfuse or not, regardless of the information he knew, would be his decision and his decision alone. When a willing, conscious effort is made to preform a task, that action is autonomous; and therefore, in that moment, the performer of such action has autonomy.

I agree with the end result and the change they want. I do believe that doctors should be made to give a more conscious effort to teach and educate their patients. Not only does this help the doctor feel more at ease when making decisions mid-surgery, but also creates a more trusting relationship between the doctor and patient. None the less, I would like to stress being autonomous has more to do with the action than the belief or choice behind the action.

Alex Liu

Citations:

Savulescu, J., and R. W. Momeyer. “Should informed consent be based on rational beliefs?” Journal of Medical Ethics 23.5 (1997): 282-88. Web.