Nancy Kass, ScD
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Author Contributions:Conception and design: N. Kass.
Drafting of the article: N. Kass.
Critical revision of the article for important intellectual content: N. Kass.
Final approval of the article: N. Kass.
Kass N. Ebola, Ethics, and Public Health: What Next?. Ann Intern Med. 2014;161:744-745. doi: 10.7326/M14-1864
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Published: Ann Intern Med. 2014;161(10):744-745.
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Institute for Biomedical Ethics, University of Basel, Switzerland.
August 25, 2014
All health care workers should be treated equal for access to experimental drugs for Ebola
Paper by Nancy Kass teasing ethical questions around use of experimental drugs against Ebola for two American health care workers and whether such experimental treatments should be made available to all infected patients is a timely discussion on ethical debate generated by the current Ebola outbreak (1). She justified administration of highly experimental drug to two American health workers with two main arguments. First, health care workers such as these two Americans have shown tremendous courage and responsibility towards their patients in spite of major odds and significant risk to their own health while being at the forefront of fight against Ebola. Her second argument states that being health care providers, these two had knowledge and they fully understood the risks associated with accepting highly experimental drug and hence were able to give ‘informed consent’. One might argue that their ability to provide informed consent was at least partially compromised by their illness and awareness of impending death in absence of treatment, but for the sake of argument, lets accept that they were indeed capable of providing informed consent.I argue that the same two arguments should then also be applied to other local health care workers who are on the forefront of treating patients with Ebola in Western Africa. WHO report states that more than 240 health workers got infected and more than120 health care workers; mainly local doctors and nurses have died due to Ebola while carrying out their duties during this outbreak (2). Being locals, they were a resource, knowing the communities, understanding the grass root reality, speaking the local language and hence crucial to provide care to the patients. Many African countries already face major shortage of trained health care professionals (3). Death of these health care workers has further weakened the health care delivery system. If American health care professionals received the experimental drug for ‘supererogatory’ reasons, the local health care workers also qualify for the same unless supererogatory reasons require traveling to a foreign country to provide health care in dangerous situation. As far as argument about understanding risks associated with experimental drugs that have never been used in humans before, the health care professionals across borders and nationalities can be presumed to understand these unless we believe that this ability is dependent on nationality somehow.Thus, the local health force infected with Ebola should be considered for experimental therapy not only for the reasons of supererogatory actions and informed consent but to protect already weakened health work force in countries affected by Ebola outbreak. References(1) Kass N. Ebola, Ethics and Public Health: What next? Ann Intern Med. doi:10.7326/M14-1864.(2) World Health Organization. Unprecedented number of medical staff infected with Ebola. 25 Aug 2014. Accessed at http://www.who.int/mediacentre/news/ebola/25-august-2014/en/ on 25th August 2014.(3) Hongoro C, McPake B. How to bridge the gap in human resources for health. The Lancet 2004; 364 (9443): 1451-1456.
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