Medical Ethics

Apparently there is some controversy arising over the use of an untested treatment for Ebola on some people who stand a really good chance of dieing from Ebola. blurbWhat is ethically wrong with trying untested cures on someone who is likely to die in any case?It seems to me that desperate measures should be allowed in desperate situations. When the afflicted are denied some potential cure, are the caregivers and big pharma not protecting their own interests over the interests of the doomed?

Thread moved here from the Proposed New Topics forum.

An 'expert' on the radio this morning said that there are no more than 20 or so doses available and that if they did work it would take years to get properly into production.I don't see a problem so long as consent is given and the treatments are used only where there is no hope otherwise. If the latter makes the treatment useless, then there's a bit more of an issue.There's also a suggestion that the drugs should be saved for the volunteers trying to help the fight - the medics and ancilliaries.

I think part of the problem is that there is a ongoing outbreak.
So there is no time now to really get all the ethic committees and normal menutia through proper channels.The drug has not been tested in humans.And as the article stated if it does show efficacy then the problem of deciding who gets treatment will come up.
If the drug proves toxic in humans then you have the problem of people dying from untested drugs under the duress of disease and a potential for consent issues in vunerable populations.But yes I agree with you get it out there and try as 70 percent of the people with it will probably die.

With early treatment, the mortality rate of Ebola is something above 50%. The fact that death is not certain is one issue. The second is that consent given in such cases is not always rational or perfectly informed. What interests are you talking about? For those few patients in the US, there would be no problem regarding a caregiver or a drug supplier getting paid. The problem is that no one can be sure that giving someone an experimental drug will do that person no harm. That problem exists with for any situation where there is no guarantee that the patient is going to die without treatment.In these cases, if the patient takes an experimental drug and dies, big pharma actually benefits, because they gain information that will be used to either improve the treatment or to discard a bad candidate.

If you had Ebola, wouldn't you take the treatment?

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While the American Ebola patients gave their consent, and while most people would want to do something rather than nothing, the decision about gaining access is more in the hands of the drug manufacturer than the would-be subject. The dying may feel more cavalier about entering a drug experimentthe rewards (life) could justify the risks (since death approaches anyway)but a company may still withhold a drug from a willing volunteer for fear that it will fail and reduce investor interest or increase attention from malpractice attorneys.

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SourceI understand that bankrupt companies don't make drugs for anybody but it looks as though the harm they are most interested in preventing is harm to themselves. The treatment will apparently cost many thousands of $ and largely because of the costs related to ensuring that the manufacturer has taken every conceivable measure to ensure the safety of the drug.5 yrs later we get a drug that is legally defensible but costs $1800/dose. In the meantime many people die. This seems more unethical to me than trying something that you are not sure about.

If the doc said 'So you are going to die in 10 days. We think this will help but we don't know what else it will do'. I would have to say yes.This is really the question. Is it unethical to try radical treatments on people who have nothing to lose?

Is that actually the situation for people who have Ebola. I suggest that it is not the case.What if the doctor told you that you have < 40 percent chance of recovery without the drug, and that the drug has been shown to improve the survival rate in rats, but also has some adverse effect on the valves of the hearts of all rats? Would you take the drug under those circumstances?

Sometimes people think they have nothing to lose - i.e. they have given up hope. Medical professionals are still responsible for what they do. They can't do anything without consent but they have to be careful what they do with consent too.

I think that it would come down to the particulars regarding what kind of damage and what rate of effectiveness. As the patient, I think that my calculations would be substantially different from the calculations of the insurance adjusters and risk management team at the hospital.Are the interests of the patient really the focus of the system that we use to produce drugs? I think that the lobbyists have managed to hide the real agenda of making piles of cash behind the guise of public safety and the patient's best interests.I see that this qualifies as ethical capitalism but does it qualify as ethical medicine?

Exactly my point. I've spent some time over the last few years looking at litigation cases involving pharmaceutical drugs. Every treatment option for a major health concern has side effects that in the worst case are life threatening. Some of the drugs involved only promise a few extra months of life under compromised health conditions and are extremely expensive. I am not aware that insurance adjusters are making any of the decisions regarding Ebola treatment. However, I don't see why the opinions of the risk management team are unimportant. The hospital might also consider whether you are the best possible candidate to receive a given treatment when only a few doses are available. You won't make that calculation even though the calculation is highly appropriate.Is there a particular example you can cite of someone being denied Ebola treatment for what you consider an inappropriate reason? You haven't made a case that this is happening to Ebola patients.

I have taken training courses in bioethics as it relates to biomedical research and human subjects, so perhaps I could shed some light on the issue.From an ethical standpoint, there really isn't a ethical controversy.1. There is no standard treatment that offers hope (the "compassionate use" exemption under FDA rules).2. The patient or the patient's proxy give informed consent.3. Access is not based on ethnic, cultural, or economic biases.The last one seems to be the ethical question at hand, given that it was Americans that were given access to the drug. The first two problems are easy-peasy given the limited, but successful animal trials that the drug went through. Yes, and that is covered under the "compassionate use" exemption for drugs not currently in clinical trials.Page Not Found | FDA

I would strongly suspect that any costs for experimental treatments are paid for by the drug company, just as they are in any FDA approved clinical drug trial.

I haven't read this, but when I ran across it I remembered this thread so I thought I'd share it with you: On the science and ethics of Ebola treatments