McMaster ethicist: Who should be treated first for Ebola?

Is it ethical to give treatments that have never been tested on humans to patients infected with the Ebola virus? Should health care workers get the treatment first, or the sickest patients? McMaster health care ethicist Lisa Schwartz weighs in.
In this photo taken Saturday, Aug. 9, 2014, health worker wearing protective clothing and equipment, out of fear for the deadly Ebola virus, sit at a desk at the Kenema Government Hospital situated in the Eastern Province in Kenema, 300 kilometers, (186 miles) from the capital city of Freetown, Sierra Leone. Over the decades, Ebola cases have been confirmed in 10 African countries, including Congo where the disease was first reported in 1976. But until this year, Ebola had never come to West Africa. (Michael Duff/Associated Press)

Is it ethical to give treatments that have never been tested on humans to patients infected with the Ebola virus? Should health care workers get the treatment first, or the sickest patients?

Disease and ethics experts around the world are meeting today by telephone to debate these tough questions at the request of the World Health Organization. The convening comes after hundreds of people have already died from the current outbreak in West Africa.

Lisa Schwartz is the Arnold L. Johnson Chair in Health Care Ethics at the McMaster Centre for Ethics in Healthcare (Courtesy of McMaster University)

How would you weigh the risks of taking an experimental treatment, versus the very real risk that you could die from the virus?

“I think a lot of people would feel that they’d be willing to take the risk given that the disease is lethal in about 80 to 90 percent of the cases,” said Lisa Schwartz, who teaches health care ethics at McMaster University, on CBC Radio.

One such drug, ZMapp, has already been used to treat two American aid workers. Until now, there have been no human trials with that drug. The decision sparked some controversy over whether the drug should go to treat African patients first. 

But Schwartz said the patients receiving this treatment are assuming great risks.

“On the one hand, I think it’s really important that the most vulnerable people who are most affected get it as quickly as possible,” she said. “But in this case we have people who are from the country of origin of the drug itself who are, at least in one case, educated enough to know what the risks are and the harms.”

The question of who gets treated, and who gets treated first, is among the thorniest of questions here. Health care workers – who themselves assume great risk to care for infected patients – are often granted a certain dispensation. But not all health care workers can be treated, or there will be no one around to care for the next round of patients.

Schwartz contrasted the decision with common triage in the emergency room. A patient with a cut or broken arm will be seen after a patient with a heart attack.

But that’s not typically how it works when treatment is scarce.

“In contexts like this, where resource is scarce and it’s so lethal, it’ll be the people who are most likely to benefit, rather than the people who are sickest who receive care,” Schwartz said. 

Listen to the full audio interview in the player above.


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