Download Ebola Virus Ethics Forum

Ebola Virus Ethics Forum
Ebola Virus—a highly contagious RNA virus that has around
a 50-90% fatality rate. Symptoms typically start a week after
infection.
Tranmission
Human-to-human transmission of the virus is only possible
with direct contanct with bodily fluids. Needles, syringes,
containmated surfaces, fecal matter, and embaling fluids
used on infected individuals all pose a risk of infection. The
semen of infected males can transmit the virus for up to 3
months after the initial infection.
Why does the virus spread?
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Lack of personal protective equipment
Reusing needles
Inherent sanitation issues like
disposing of fecal matter
Traditional embalming and burial
rituals
Lax protocol for “universal
precautions” in hospitals
Limited access to running water
Eating bush meat—the fruit bat is
considered a natural host
Treatment
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Oral rehydration therapy, pain management, fever
reducers, and nausea medication
ZMapp—human monoclonal antibodies against
the Ebola virus made in using a tobacco mosaic
virus
TKM-Ebola—RNA interference drug that binds and
inhibits proteins important to Ebola replication.
Researchers are working on a vaccine, but have
been unsuccessful so far
2014 Outbreak
The first case was reported in March of 2014. Guinea, Seirra Leone, and Liberia are the
most heavily affected countries and there have been some cases in Senegal and Nigeria. These
are some of the poorest countries in the world. So far, out of around a 3,000 infected
individuals there have been about 1,500 deaths.
Ethical Considerations
The use of “unregistered interventions”
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ZMapp and TKM-Ebola are treatment options that have not undergone human clinical
trials and have not received FDA approval. However, ZMapp does seem to have saved
the lives of several infected individuals, including two Americans.
o Is it justifiable to use these drugs on people during an epidemic?
o By using experimental drugs are we turning people into experiments during
desperate times?
o If a vaccine or robust drug treatment becomes available, who receives treatment
first?
o Is this a case of the Western experimentation narrative like the Tuskegee Syphilis
Trials?
“In the particular circumstances of this outbreak, and provided certain conditions are met, the panel
reached consensus that it is ethical to offer unproven interventions with as yet unknown efficacy and
adverse effects, as potential treatment or prevention.”
–The World Health Organization (WHO) August 11, 2014
Distribution of limited treatment options
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The majority of infected West Africans did not receive the experimental drugs, however,
two Americans and a Spanish priest received ZMapp.
o Do you think it is justifiable to give treatments to individuals because of their
citizenship or status?
o Why did predominantly Caucasian people receive treatment instead of the
native population?
The other group that received ZMapp were Liberian health workers.
o During an epidemic, who should be given treatment priority, doctors or
patients?
Foreign Aid
o Is this a global problem or a West African problem?
o Should wealthier countries be giving monetary contributions?
o What do you think about President Obama sending troops to Africa to help with
the crisis?
Research Dollars
o Do you think more treatments are not available because pharmaceutical
companies are not willing to make drugs for people who cannot afford them?
Larger Social Issues
o Does the Ebola outbreak reflect the need for better social understanding in
Africa if people do not trust their healthcare workers? For example, in parts of
West Africa people hide from health workers, do not trust their physicians, and
have been exposed to coercive quarantine measures.
o Would the circumstances of the epidemic have been the same if it had occurred
in richer countries?
o Would the global public health response have been different if Ebola emerged in
the Western world?
Healthcare worker issues
o Should healthcare workers be forced to work in an environment that is
potentially dangerous to their own health?
o How do you compensate for these risks? Hazard pay? Should it be your moral
duty or professional obligation?
o Some healthcare workers are not being paid. Would that stop you from working?
Sources:
http://abcnews.go.com/Health/wireStory/us-troops-heading-africa-ebola-fight-25624075
http://theconversation.com/epidemic-ethics-four-lessons-from-the-current-ebola-outbreak30534
http://www.cdc.gov/vhf/ebola/outbreaks/
http://en.wikipedia.org/wiki/Ebola_virus_disease
http://www.who.int/mediacentre/factsheets/fs103/en/
http://www.who.int/mediacentre/news/statements/2014/ebola-ethical-review-summary/en/
http://www.bioethicsinstitute.org/announcements/untested-interventions-and-the-ebolaoutbreak