Unlike typical hospitals and healthcare settings, vertical aid programs focus on a specific disease or intervention technique. Well and Good outlines a case in which a physician, Dr. Asadour, is set up in a town in South Sudan to run an anti-cholera vertical aid program with the instruction to only admit and treat cholera patients. All patients whose symptoms did not resemble cholera, under the guidelines of a vertical aid program, were turned away and sent to a crowded, limited-resources local hospital (Thomas, Waluchow, Gedge 267). Dr. Asadour was confronted with a variety of moral dilemmas surrounding the ethicality of vertical aid programs. If a patient is admitted and upon closer review it is determined that he or she does not have cholera, is it ethical to turn the patient away if they were already admitted? If the program center has the resources to treat serious conditions, such as meningitis, that don’t fall under the specific purpose of the vertical aid program, should they? Are vertical aid programs in it of themselves unethical?

It is well established that there are not unlimited resources when it comes to healthcare and treatment of patients, but how does one decide how and on who to allocate the resources? In deciding how to allocate money and medical resources, “policymakers will examine various diseases in terms of their communicability, frequency, cost, associated pain and suffering, and impact on length of life and quality of life, among other factors” (Beauchamp, Childress 280). It is this type of examination that leads to the start of vertical aid programs; healthcare professionals come up with a disease or intervention technique that appears to provide the best cost-benefit analysis in a particular area based on the above factors. While in theory this might be a smart way to approach healthcare and allocate limited resources, is it ethical? In the case of a meningitis patient, both bacterial and viral meningitis can be fatal if not treated immediately with antibiotics. This disease, which consists of inflammation of the meninges of the brain and spinal cord, is potentially fatal yet easily treatable by medical professionals, so should physicians involved with vertical aid programs that are not geared towards meningitis treat this patient (“Meningitis”)? According to the program’s guidelines, physicians should be turning these patients away, but do the principles of nonmaleficence and beneficence say otherwise? Physicians have a duty to help their patients and prevent them from harm, so personally I believe turning away patients that they have the resources to treat is unethical. While resources may be limited, I imagine that the antibiotics needed for meningitis and treatment of cholera patients require different resources.

What if upon admission the patient is discovered not to have cholera? I believe that the principles of beneficence and nonmaleficence speak even stronger to this situation; if they have already been admitted to the clinic, I do not think it is ethical for the physicians to then turn them away. This situation is reminiscent of the argument between withholding and withdrawing treatment we discussed earlier this semester in regards to life-saving treatments. It is one thing to not admit the patient initially (withholding treatment); however if you admit the patient, examine them, determine their condition and have the appropriate resources to treat them, how can a physician turn that patient away in good conscience? I believe the latter scenario is similar to withdrawing life-saving treatment from a patient against their wishes; if the physicians have the resources to save a life that wants to be saved, why wouldn’t they?

Ultimately I believe the duty of physicians to uphold beneficence and nonmaleficence should override the policy of vertical aid programs to only treat those with a specific disease using a specific technical intervention. While that particular disease may be a larger issue in that specific area, it will not be the only illness that plagues the people in that area. Even if resources are limited, if the physicians have the resources necessary to admit and treat patients with other diseases, I believe they have a responsibility to do so.

References:

Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. New York: Oxford UP, 2001. Print

“Meningitis.” Mayo Clinic. Mayo Foundation for Medical Education and Research, 2017. Web. 14 Apr. 2017.

Thomas, John E., Wilfrid J. Waluchow, and Elisabeth Gedge. Well And Good: A Case Study Approach to Health Care Ethics. N.p.: Broadview, 2014. Print

“Morality requires not only that we treat persons autonomously and refrain from harming them, but also that we contribute to their welfare” (Beauchamp and Childress, 202). The principles of Beneficence states it is our duty to help others. Specifically, positive beneficence demands that we “provide positive benefits to others” ( 202). Consider the following case: Dr. Arman Asadour is a physician who works with a non-governmental organization or NGO. He is sent to South Sudan to help refugees who’ve arrived from a war. The people are in horrible conditions physically, mentally, and health wise. Cholera breaks outs in the town. The NGO that Dr. Asadour is a part of, set up a station that treats Cholera patients only. Those who have conditions other than Cholera have to be sent to the local hospital. The local hospital is already overcrowded.  It is Dr. Asadour’s duty to help those with Cholera but is it his duty to help non-Cholera individuals as opposed to letting them to go to the hospital knowing the rule? (Thomas, Waluchow, and Gedge, 267).

One aspect to consider is how much help the local hospital can provide for individuals with other conditions. The local hospital is already overcrowded and the cost of transportation and medication are other factors that cause more problem. These refugees have no money so they cannot help cover transportation or their own medicine. Sending them to the local hospital is essentially letting them go to a space with scarce resources to die. Positive beneficence argues that we produce positive benefits to others. Transferring individuals to the local hospital does not provide benefits. Instead, there are negative outcomes because there is no guarantee that these individuals will get treated due to limited resources. There is no guarantee that these individuals will even get looked at the same day seeing as the hospital is overcrowded.

Dr. Asadour should help treat non-cholera persons because he holds the same obligation to them. These individuals do not have Cholera but they are sick and they need treatment.They can possibly die from their condition just like the people with Cholera. There is no guarantee that the local hospital can save them.  A solution that will allow Dr. Asadour to help the others is for Dr. Asadour and the NGO to set up another work station for individuals with other conditions.  This station will allow Dr. Asadour to persons in both categories. Beauchamp and Childress provided some rules for obligatory beneficence that are applicable to why Dr. Asadour should non-cholera. Some of the rules include: “prevent harm from occurring to others” and  “remove conditions that will cause harm to others” (204). By deciding to treat them, Dr. Asadour is preventing harm from occurring to others meaning that the non-cholera individuals will not be able to spread their conditions to those at the hospitals nor will they get sick from others at the hospital. The other rule is the removal of conditions that will cause harm to others. Setting up another work station will separate the cholera and the non-cholera individuals. This separation removes the condition of exposure to the other.

Dr. Asadour should treat non-cholera persons because as a doctor, it is his duty to help others. By helping these individuals he is fulfilling the rules of beneficence. He is contributing to the welfare of these individuals and providing positive benefits.

Works Cited:

Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. 7th ed. New York: Oxford UP, 2009. Print.

Thomas, J. E., Waluchow, W. J., & Gedge, E. (2014). Well and good: a case study approach to health care ethics (4th ed.). Peterborough, Ontario: Broadview Press.

Resources are limited in healthcare. Although the goal is to treat and save as many people as possible, in some cases it may not be economically feasible to do so. Resource scarcity leads to budgets on how much money can be allocated to certain programs, such as preventative care or research. Although the concept of allocation is accepted within health economics, problems can arise when people are competing for the same amount of resources and only some will be able to receive them. This leads into my question: is allocation ethical?

First, to help put allocation into context, let us create a scenario. Suppose two people are both in need of a heart transplant. One patient is a middle-aged man who damaged his arteries by consuming foods high in saturated fats and being inactive in his youth, while the other patient is a young old boy who was born with a rare condition at birth, causing his heart to fail. Also, let’s assume that the surgery has a high chance of a favorable outcome, meaning it will most likely be successful and the organ will not be rejected by the body’s immune system.  The decision that we now need to make is who will receive the surgery.

There are several issues with using allocation in this case. For one, who is to make the decision on who gets the surgery? Is there a policy in place, or an ethics review board that addresses cases of this matter? If there is no stable ground as to who should make the decision of allocation, then a nonpartisan decision may be difficult to achieve. Secondly, how is someone to measure effectively who gets the heart transplant over the other? In the Beauchamp and Childress reading, they present a case for cost-utility analysis (CUA). The objective of CUA is to come to a decision the creates the biggest possible health gains given the resources provided (Beauchamp 282). However, this way of coming to a conclusion is unethical in some cases, because it discriminates against those who are older and favors the youth, since they are predicted to live longer. Due to their youth, they have more to gain in life years from a life-saving treatment than someone who is older (Beauchamp 282).  Also, who is to say that the life years gained will be of an acceptable quality? Even if the young boy receives the heart transplant and his life years are extended, that is not to say his Quality of Life (QOL), will improve, and in some cases, may get worse.

On the other hand, there is a benefit to using the concept of allocation in healthcare. By making decisions that are based on who will receive the greatest benefit, the decision is free of pathos, which helps to eliminate potential bias in the decision. Another benefit of allocation is that is allows the hospital to save money, which may be put towards helping other patients. Also, since allocation can help health care professionals to make decisions, it can be used where it would be unethical to make a decision otherwise.

In conclusion, while I believe that there are several benefits to using allocation, I do not believe the benefits of using such a system overcome the potential harms. Groups such as the elderly will be discriminated against due to their low anticipated health gains from such a surgery. Also, using a standardized measure of health assumes that everyone’s ideal QOL would be similar. Everyone does not have the same mindset when it comes to their quality of health, and health care professionals should take note of that. If allocation is to be used in the future, it should be in situations where physicians and patients are aware of the possible benefits and risks involved, and are willing to accept the decision that is made by the appropriate health care professionals.

Sources:

Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. New York:  Oxford UP, 2009, 2013. Print.

Healthcare Rationing. Digital image. Cartoonstock.com. N.p., n.d. Web. 14 Apr. 2017.

Case 8.2 Ethics and Humanitarian Aid: Vertical Aid Programs

Background:

Dr. Asadour is a physician working for a non-governmental organization (NGO) whose mandate is to “participate in a global vertical aid anti-cholera program”. (Thomas 267). He travels to a town in South Sudan containing thousands of refugees from the internecine war. These refugees have a variety of health issues and Cholera has also broken out. The purpose of the NGO was to treat patients with Cholera only and other patients must be sent to the local hospital, which presents a problem as the local hospital is already beyond capacity. The dilemma is whether or not Dr. Asadour will admit patients who are in need that don’t have Cholera.

Analysis/Argument:

“Cholera is an often fatal bacteria disease of the small intestine, typically contracted from infected water supplies and causing severe vomiting and diarrhea” (CDC). The illness is not as clear cut to tell compared to other illnesses. Especially given the conditions of the patients in South Sudan, many of them exhibit symptoms that are similar to cholera. Therefore, admittance into the NGO is something that is already of a hassle and Dr. Asadour faces the moral dilemma of rationing resources. Should he stick by the litigation and only admit those with Cholera?

I would want Dr. Asadour to treat the illnesses within the community based on urgency and the severity of the symptoms rather than rationing to those with Cholera. One of the main reasons would be due to a time frame. With numerous patients who needs admittance, taking the time out to reject those that don’t display the symptoms of cholera could result in wasted time in saving lives. However, Dr. Asadour and his staff should not completely reject the idea of only admitting patient with Cholera. They should keep it in the back of the heads that Cholera is highly contagious and facilitative matters should be handled in order to prevent any type of contamination. Admitting patients with severe symptoms would also result in less patients being sent to the local hospital, which is already beyond capacity. If a patient is in a very severe state of health, then they should be admitted immediately to Dr. Asadour’s care. This has a higher potential to save the patient’s life.

The idea of vertical aid programs is also something that should be considered when taking this case into account. Dr. Asadour’s mission was funded primarily from wealthy philanthropists who are in hope of eradicating the disease Cholera. However, having that one disease aim seems to bring upon some issues. These western donors and NGOs often “overlook the voices and priorities of local communities” (Thomas 268). As we see with this case, there are many different illnesses in South Sudan with many levels of severity and urgency. Therefore, if the moral obligation was to just save as many lives as possible, then rationing to those individuals only with Cholera negates the moral purpose. According to an article published by Dr. Levine in the Center for Global Development, vertical aid programs “risk diverting attention from, or even undermining, broader “horizontal” health systems established to prevent and treat all forms of ill-health”. In global health, targeting a specific illness or area of health is very difficult and ineffective because health is in a sense, on a spectrum. Especially in an area like Southern Sudan, with ongoing wars, corruption, and rivalries of power, a broader approach to health seems to be a much more favorable one than a one track vertical aid program.

What do you guys think about what Dr. Asadour should have done in this specific instance? Furthermore, do you guys think that vertical aid programs should continue? I’d love to hear from you all!

 
Works Cited

“Cholera – Vibrio Cholerae Infection.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 09 Nov. 2016. Web. 11 Apr. 2017.

Levine, Ruth. “Should All Vertical Programs Just Lie Down?” Center For Global Development. CGD, 05 Oct. 2007. Web. 11 Apr. 2017.

Thomas, John E., Wilfrid J. Waluchow, and Elisabeth Gedge. “Case 8.2: “Ethics and Humanitarian Aid: Vertical Aid Programs.” Well and Good: a Case Study Approach to Health Care Ethics. 4th ed. Canada: Broadview, 2014. 131-138. Print.

Determining how scare medical resources are distributed amongst a healthcare system is a vital question that must be addressed in order to ensure a hospital is operating at its full efficient.  As the state of Oregon has shown, ranking the value of medical procedures subject to great scrutiny, as many will disagree on the specific of the methodologies used for the ranking.  Rather than asses procedures on “importance,” healthcare systems should analyze their capacity to withstand demand shocks and develop a system of patient triage that maximized positive health outcomes.

Patients who require organ transplants are likely aware of scarcity in healthcare, as there are a limited number of hospitals equipped to perform such surgeries.  Also, there is a perpetual shortages of available organs, demonstrating how some components of medical care are already vastly outstripped by demand.  Consequently, when the demand for a common medication or vaccine increases beyond predicted levels, the US healthcare system can increase the production of a desired compound and take emergency action to provide increased access to care.¹  While scarcity will increase, scaling up production of common medications and vaccines demonstrates is an example of how a healthcare system can successfully deal with instances of shortage and avoid excessive rationing. 

However, the availability of most medical care falls somewhere between these two examples.  Additionally, more nuanced factors like age and ability to pay for treatment influence how the medical care is allocated.  Setting aside these other factors, a purely utilitarian ethical model would promote treating patients who:

          1. Require immediate care

          2. Present a high chance of recovery. 

That is, if two patients require immediate care, the patient more likely to have a positive health outcome (or have a lower associated cost relative to improvement) is prioritized.  For sake of argument and simplicity, I’ll assume that these two conditions are independent of each other; though in reality, there is likely a direct relationship between how long a patient can wait to be treated and the chance of having a good medical outcome. 

Though this may appear to be contradictory to the principle of justice, a healthcare system should focus on operating in a utilitarian manner to promote justice through efficiency and positive health outcomes.  By prioritizing patients who are more likely to recover, aggregate-level utility (positive health outcome vs. negative health outcome) is maximized by the utilitarian triage system.  Under this framework, patient justice is not secondary to the quantifiable medical outcomes, but rather an extension of the healthcare system operating at its greatest possible efficiency.  Justice at the aggregate-level is not about selecting people who are “deserving” of medical care in a social sense, but rather ensuring that a hospital can cause as many good health outcomes as possible.²  In any healthcare system that does not operate efficiently, there will be patients who are untreated or under treated as a result of operation inefficiency.  Consequently, hospitals can promote healthcare justice by reducing the number of patients who fall victim to an inefficient healthcare system.

1) Lorenzoni, G. 2006. Theory of Demand Shocks. National Bureau of Economic Research.

2) Gatter, RA; Moskop, JC. 1995. From Futility to Triage. Journal of Medicine and Philosophy. 20: 194.

Moral Dilemma:

In the case of “Ethics and Humanitarian Aid: Vertical Aid Programs”, Dr. Asadour works in a non-governmental organization (NGO) to help in a “global vertical aid anti-cholera program” (Thomas 267). Dr. Asadour and his team travel to South Sudan with a Memorandum of Understanding to treat cholera exclusively. Patients, with and without cholera, line up at the admissions tent. His moral dilemma arises when deciding who to admit into the hospital.

Analysis:

First, we need to understand the nature of the disease. Symptoms of cholera include watery diarrhea, vomiting, and dehydration. People can die within hours without treatment, so Dr. Asadour will need to act quickly. Also, according to the CDC, cholera “is not likely to spread directly from one person to another”. So long as his team is methodical in their actions with disposing wastes, Dr. Asadour should not worry about cross-contamination. (Center for Disease Control and Prevention)

Dr. Asadour’s moral dilemma involves the ethics of rationing. According to Beauchamp, rationing is “a form of allowance, share, or portion” and is linked to limited resources (Beauchamp 284). This means Dr. Asadour will need to exclude some people from these resources in order for other patients to receive full care. He must set priorities or guidelines as to who is and isn’t admitted to hospitals. Specifically, Dr. Asasdour must set criteria “to determine a qualifying pool of potential recipients” and decide the “final selection of recipients” (Beauchamp 288).

Dr. Asadour needs to assess the symptoms of the incoming patients to see if their symptoms match those of cholera. Although the work station has the supplies to treat other illnesses, the team has a legal obligation to treat patients with cholera only. They could send the extra supplies to the local hospital, but it not ethical to violate the original mandate. “If word gets out that the NGO will treat non-cholera conditions”, the work station will become overcrowded, lose supplies, and must shut down while those inflicted with cholera will remain untreated (Thomas 267).

As for treating patients with cholera, there are many types of rationing to consider. Rationing by age is the most straightforward policy because it includes numerical categories. There are still unethical issues to this method. For example, Dr. Asadour may deem it unethical to admit a seventeen-year-old boy with mild symptoms and refuse admission to middle-age woman with severe symptoms. The “first come, first serve” and the lottery methods are also unjustified in this case because symptom severity varies from person to person.

Dr. Asadour should consider a type of rationing that is involves a direct assessment of each individual patient and their symptoms related to cholera. He can assess each patient individually and personally. Dr. Asadour can use medical insight to determine the needs of each patient. Specifically, he interview the patients and collect information on the severity of their symptoms to determine who is admitted. There are some downfalls to this method. It will be time-consuming and qualitative, meaning Dr. Asadour will have difficulty comparing and ranking patients without numerical values.

Conclusion:

The best solution for Dr. Asadour is to stick to the original mandate of only treating patients with cholera because it is unethical and illegal to abandon the mandate. The NGO made the effort to send the team to South Sudan to treat cholera only, and it will be hazardous if the team abandons their original obligation to treat other diseases. They will risk losing supplies and the work station in its entirety.

Next, Dr. Asadour should assess each patient and determine the severity of their symptoms. Dr. Asadour will then make the decision of who to treat and ration the resources from person to person. Overall, there is no clear and fully ethical policy of rationing resources in vertical aid programs. However, all humanitarian aid workers must understand the joys and the consequences that can come with these programs. Due to scarce resources, workers will have to turn away some to treat others.

Citations

Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. 7th ed. New York, NY: Oxford UP, 2001. Print.

Center for Disease Control and Prevention. “Cholera – Vibrio Cholerae Infection.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 03 Oct. 2014. Web. 12 Apr. 2017.

Thomas, John E., Wilfrid J. Waluchow, and Elisabeth Gedge. “Case 8.2: “Ethics and Humanitarian Aid: Vertical Aid Programs.” Well and Good: a Case Study Approach to Health Care Ethics. 4th ed. Canada: Broadview, 2014. 131-138. Print.

To respond to the posts about the HeLa case, I was researching Henrietta Lacks and discovered that coincidentally, a film, The Immortal Life of Henrietta Lacks, will be released on April 22, 2017. It is based Rebecca Skloot’s nonfiction book, The Immortal Life of Henrietta Lacks, a great read. The trailer is below.

“In 1951, cancerous cells from Henrietta Lacks lead to breakthroughs that change the face of medicine forever. Aided by writer Rebecca Skloot, Deborah Lacks embarks on a quest to learn about the mother she never knew.”

“Science took her cells. Her family reclaimed her story. Oprah Winfrey and Rose Byrne star in this adaptation of the critically-acclaimed book. HBO Films presents The Immortal Life of Henrietta Lacks Saturday, April 22 at 8pm on HBO. ”

I look forward to seeing this and wonder how the film is going to respond to the ethics regarding the Lacks case.

The story of Henrietta Lacks is intertwined with many bioethical complexities. In 1951 Henrietta Lacks, African-American mother of five, was suffering from cervical cancer. She lived in Baltimore and therefore was treated at John’s Hospital, where treatment for African-Americans was less than sub-par. After her death, Lack’s cells were taken into the lab to study the mechanisms behind cervical cancer. At this moment in the story it is evident that something has gone wrong here. No consent for this was ever agreed to by Henrietta or her family. The scientists were never given permission to harvest Henrietta’s cells or exhibit scientific experiments on them. To their surprise, the scientists found that the cells were extraordinary. They reproduced rapidly and resiliently making them the first human cells successfully grown in a lab. These cells went on to be mass produced and distributed around the scientific community. These cells were used in research that saved lives and is widely recognized as a significant contribution to science yet her family has received no compensation. Henrietta Lack’s family can’t afford to see any doctors despite their relative’s significance to the field.
The dichotomy here is between justice and the greater good. Overall, Henrietta Lack’s cells were apart of research that was used to eradicate polio; they did a great amount of good for the population. The question is whether that outweighs the unfairness with which her family was treated. Is it even ok that the scientists took the cells to begin with? Does that fact that the scientists made a remarkable scientific discovery that saved lives, outweigh the injustice experienced by Henrietta Lack’s family? In modern day medicine, all of this would need to be justified with a sign consent form and I believe that is necessary. I believe that consent and jurisdiction needed to be given by the family in order for the scientists to remove the cells and undergo tests on them. The fact that the family was completely ignored through the whole process goes against the theory of justice.
In John Rawl’s book, The Theory of Justice, he discusses the two fundamental principles of justice. The first states that all individuals have the same basic liberties. The second states that social and economic positions should be open to all. In this situation the first principle is not respected. The same basic liberties of other patients were not respected in this case. The same basic liberties of other families were not respected in this case. In this situation it also seems like race player a role. In Baltimore at this time, Blacks and Whites didn’t receive the same levels of respect especially in terms of healthcare. The scientists may have taken further advantage of Henrietta Lacks because she was a Black woman. Overall it is clear that injustice was done on Henrietta Lacks and her family.
In my opinion despite the greater good that came out of the discovery of her cells, it was not right for the scientists to exploit them without any permission.

Works Cited:

Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. New York, NY: Oxford UP, 2001. Print.

Rawls, J. (2013).A theory of justice. New Delhi: Universal Law Publishing Co Ltd.

Gedge, E., Waluchow, J. W., & Thomas, J. (n.d.). Who Owns the Research? The Case of the HeLa Cells. InWell and Good: A Case Study Approach to Health Care Ethics(4th ed.). Broadview Press.

Henrietta Lacks has gone to space, won several Nobel prizes, and fueled the multibillion-dollar cell culture industry but she doesn’t know any of this. She hasn’t received accolades or been compensated with a single cent either. How? Because she died of cervical cancer in 1951 at John Hopkins Hospital. Shortly after her death, a biopsy of her tumor was taken for research in a cervical cancer lab but instead of dying like cells had before, her cells reproduced another generation every 24 hours. The cells were shared with other researchers before being mass produced and used to test the first vaccine for polio that ended up extinguishing the disease for good. Permission for doctors to use anyone’s cells or body tissue at that time was normally not obtained so the fact that Henrietta or her family didn’t give direct consent is not surprising.

The part that is unsettling is that even after the 1970’s, when informed consent came into practice, nothing was done to compensate her family. However, I do think it’s important to note that George Gey, the original scientist who worked with the HeLa line, attempted to protect the privacy of the deceased and made the cells available to all interested in biological research at no cost. Biotechnology laboratories and academic research institutions are the ones who continually divided her cells and profited millions while the Lacks family couldn’t afford proper healthcare, not the scientists attempting to cure cervical cancer. Although I don’t believe it’s just to use a person’s remains without their consent, at the time, common practices were followed. The real injustice is that over 50 years later, rich white profit-seeking men are continually exploiting a poor African American woman who lost her battle with cancer.

A somewhat similar but more modern case was presented in 1990 with the case of Moore vs. Regents of California. John Moore had visited the University of California Medical Center in 1976 seeking leukemia from Dr. David Golde. Dr. Golde took cell samples and created a cell-line without the knowledge or consent of Mr. Moore. Moore, a well-educated white man, sued for a portion of profits gained from his own body upon finding out that Dr. Golde was attempting to sell the line to Genetics Institute, a biotechnology corporation in the commercial application field. The Court did not agree with Mr. Moore as they concluded that bio-medical research would be undermined if individual patients had the power of profit from medical advancement as a result of their own physical make-up. It said nothing about the implications of profit on the researchers side. This decision made a blanket statement that says medical researchers have the ultimate right to body tissues of patients for private gain.

The issue boils down to Henrietta’s autonomy versus the principle of benevolence in reference to the lives that were saved with research involving cell research. The obvious benefit is the obliteration of polio and the lives and resources saved in doing so. However, does this benefit to society justify violating a patient’s autonomy? I do think the benefits to advancement in the medical research field are significant but I don’t believe that justifies exploiting a patient for profit. Dr. Gey’s collection method isn’t ethically sound in our eyes but when the cells were taken, common practice was followed. Does that make him excused from the controversy on grounds that his intentions were pure? Or should he still be held accountable for all the implications that followed? Lastly, how does Moore vs. Regents of California affect future patient rights? I look forward to hearing what you all think about the controversy!

Resources:

Moore v. Regents of the University of California. (n.d.). Retrieved from http://www.casebriefs.com/blog/law/property/property-law-keyed-to-cribbet/non-traditional-objects-and-classifications-of-property/moore-v-regents-of-the-university-of-california-2/

Skloot, Rebecca, The Immortal Life of Henrietta Lacks (New York: Random House, 2010)

Case 8.2: “Ethics and Humanitarian Aid: Vertical Aid Programs”

Introduction

Humanitarian aid highlights tensions in the utilitarian perspective between long- and short-term consequences of actions and policies, and many humanitarian aid workers find themselves acutely torn between deontological and utilitarian ethical perspectives. In this case, Dr. Asadour is a physician attached to a non-governmental organization whose mandate is to participate in a global vertical aid anti-cholera program. Cholera has broken out in a town in South Sudan and the NGO has set up a temporary work station with a Memorandum of Understanding to treat cholera only. Patients with other conditions must be sent to the local hospital, though it is already beyond capacity (Thomas, Waluchow, and Gedge 267).

The Question

As patients line up at the admissions tent, Dr. Asadour must decide whether or not to admit them. Some patients have symptoms that might or might not be cholera, but this cannot be determined unless they are admitted; once admitted, if they do not have cholera, they could nevertheless be treated easily without transfer to the local hospital. The NGO has emergency medical supplies that could save lives of those with non-cholera conditions, such as meningitis. Is it ethical to violate the mandate and treat?

Application:

Challenges Emerging From Resource Scarcity and the Need to Allocate Them

I came across “Ethics in Humanitarian Aid Work: Learning from the Narratives of Humanitarian Health Workers,” a qualitative study drawing on Grounded Theory analysis of 20 interviews with health care professionals who have provided humanitarian assistance; I found the predicaments that it presents to be applicable to this case.

The study reveals that respondents persistently were confronted by situations in which the resources available were insufficient or inadequate—insufficient to sustain life, or inadequate in relation to people’s needs. The choices that scarce resources presented were a recurring source of ethical struggle. Describing her work at an urban hospital in the Caribbean, R19 (RN) said:

“Whenever you see so many sick [people] and you realize that there are some that have to be turned away then you do say okay well we need to triage and we need to decide you know who we’re going to treat” (Schwarz et. al.).

She raised questions about the rightness of vertical aid, yet explained that over time she came to believe that refusing care to some was justified to ensure care for others. In many instances, professionals chose to offer resources to the people perceived to have the best chance of survival (Schwarz et. al.).

Challenges of resource allocation were most acute when patients’ lives were at stake. But care resources for chronic conditions were also scarce. Here, too, respondents faced situations in which they had to choose who would receive care. The deciding itself was often morally difficult, as were the consequences of the decisions. R10 (physical therapist), for instance, brought funds from friends at home to support the health needs of the people in Central America with whom she worked. In one way, she said, money gave her options for problem solving—she might purchase the services of a local person to create a chair that allowed a child with a disability to sit upright, for instance. But in another way, “It created more problems because people had given me all this money in the faith I would do the right thing with it and I didn’t know exactly what the right thing was” (Schwarz et. al.).

Challenges Emerging From Aid Agency Policies and Agendas

Treating people’s chronic conditions is outside the remit of some agencies. In vertical programs, treatment is only provided to individuals who have specified health conditions that match pre-established priorities. Even where adhering to the agency policy was judged on balance to be the ethically correct act, it could still be difficult to do (Schwarz, et. al.).

What about Beneficence?

As we have discussed in class, beneficence demands that we actively promote the well-being of others and prevent or remove harm to them (Vaughn 10). Accordingly, there is little doubt that the health care professionals have such a duty to advance patients’ welfare, promote their well-being, and prevent or remove harm to them. To what extent does the principle of beneficence justify violation of the mandate?

In the Media

TEDxHamburg – Linda Polmann – “What’s Wrong With Humanitarian Aid? A Journalist’s Journey”

This is a general discussion provided by TEDx on the ethical dilemmas associated with humanitarian aid. What, then, is the solution?

Conclusion

Sometimes, refusing care to some is justified to ensure care for others.

In some instances the policy, or following it, is felt to be too significant a violation of other ethical obligations.

The desire to help a particular patient—a woman with diabetes, for example—outweighs an agency directive against providing treatment deemed unsustainable in the context, a situation that tests perceived duties of beneficence against policies on scarce resource allocation.

Works Cited

Schwarz, Lisa, et. al. “Ethics in Humanitarian Aid Work: Learning From the Narratives of Humanitarian Health Workers.” AJOB Empirical Bioethics, 2010, 1(3): 45-54. Web. 9 April 2017.

Thomas, John E., Wilfrid J. Waluchow, and Elisabeth Gedge. “Case 8.2: “Ethics and Humanitarian Aid: Vertical Aid Programs.” Well and good: a case study approach to health care ethics. Peterborough, Ontario: Broadview Press, 2014. Print.

Vaughn, Lewis. Bioethics: Principles, Issues, and Cases. New York: Oxford University Press, 2010. Print.