The WHO medical ethics panel convened Monday to discuss the ethics of using experimental treatments for Ebola in West African nations affected by the disease. I am relieved to note that this morning they released their unanimous recommendation: “it is ethical to offer unproven interventions with as yet unknown efficacy and adverse effects, as potential treatment or prevention.” There are, of course, the common caveats about ethical criteria guiding the interventions, but ultimately the recommendation has saved me from a tortured “WHO’s on first”-style commentary.1 I’m sure we all appreciate that.
But just because the WHO recommendation follows what I’ve been arguing for the last 10-odd days doesn’t mean that the argument is actually over. In fact, as far as I can tell, it’s just getting worse, where worse should be interpreted to mean “even more people coming out of the woodwork to argue about ethics when they don’t have any familiarity with ethics.” Granted, Twitter is full of sample bias, but still. It is for this reason that I think it’s still important to post this statement on the ethics of providing unproven interventions that my husband (a real life bioethicist) and I worked on last week. We were side-tracked by needing to actually verify the science behind ZMapp, as well as the additional hands-throwing-up of hearing that ZMapp was provided for a Spanish priest after various US public officials stated there was none left to give.2 I hope that having this information out there–on why yes, it is ethical to provide unproven interventions in pandemic situations–is useful for answering the questions people who don’t have much background in ethics may have, as well as getting into the cultural zeitgeist for discussions not only about future pandemic situations but also discussions about disparate treatment of people from the Developed vs Developing World.3 [Cross-posted at The Broken Spoke.]
Paternalism, Procedure, Precedent
The Ethics of Using Unproven Therapies in an Ebola Outbreak
A “secret serum.” A vaccine. A cure. A miracle. With the announcement of the use of ZMapp to treat two Americans sick with the Ebola virus with apparently no ill effect, the hum and buzz on social media, commentary websites, and even the 24/7 news cycle, has become one of “should the serum be given to Africa? Will it?” The question has dominated for more than a week, and become something that the World Health Organization feels it needs to address by convening a panel of medical ethics experts to offer an analysis of what should be done.
And the general question about untested cures/vaccines in the event of a disease pandemic is an important one; there are already guidelines for what kind of treatments can and will be made available during a flu pandemic, and it seems quite sensible that a guideline be developed for all potential pandemic pathogens. However, it isn’t a question that is relevant in the current context, because we are already past that.
While people may be stating “should the serum be made available?” that’s not the question being asked.
- For other commentary on the committee composition, see Udo Schuklenk’s short, sweet, and to the point commentary; you can also read his reaction to their statement here. [↩]
- After it was confirmed that the Spanish priest received ZMapp, ↩]
- Again, to clarify: This was finished on Saturday afternoon. Obviously, in that time frame, we have learned that a third Westerner was given ZMapp, it was released to two West African doctors, and WHO’s medical ethicspanel convened and–pleasantly–reached the same conclusion we did. This is merely a more detailed argument for the release of unproven interventions. [↩]