The Case for Resource Sensitivity: Why It Is Ethical to Provide Cheaper, Less Effective Treatments in Global Health
Govind C. Persad and Ezekiel J. Emanuel
When Dr. Hortense screens her patients in Chicago for cervical dysplasia and cancer, she conducts a pelvic exam, takes a sample of cervical cells, and sends them for Pap cytology and human papilloma virus DNA co-testing. But when she conducts cervical cancer screening in Botswana, she uses a simpler, and less costly, diagnostic strategy. The difference in care between Chicago and Botswana presents an ethical dilemma in global health: is it ethically acceptable to provide some patients cheaper treatments that are less effective or more toxic than the treatments other patients receive? The authors argue that the answer is yes--when doing so is the most effective way of promoting health and realizing the ethical values of utility, equality, and priority to the worst off. Persad is an assistant professor at Johns Hopkins University. Emanuel is the vice provost for Global Initiatives at the University of Pennsylvania and a Hastings Center Fellow.
Other Voices: Richard Marlink writes that merely providing cheaper, less effective interventions is not a comprehensive approach to global health. Recounting his experience during the late-1990s AIDS crisis in Botswana, he argues that as time passes, dynamics evolve, and so should the response to a global health problem. Paul Ndebele, director of the Medical Research Council of Zimbabwe, proposes that instead of asking whether it is ethical to provide low-cost and less effective treatments, global health practitioners should ask what needs to be done to ensure that poor countries have access to more effective interventions.
Should people suffering from untreatable psychiatric conditions be eligible for physician-assisted death, even if they are not terminally ill? This is legal in rare circumstances in Belgium and the Netherlands. Steinbock argues that although there are reasons not to offer physician-assisted death to patients with severe, treatment-resistant depression, ultimately the concerns about these patients' unbearable and irremediable suffering and their right to make their own medical decisions are more compelling. However, better information is needed about the benefits and harms before a change in public policy is warranted. Steinbock is a professor emeritus of philosophy at the University at Albany/State University of New York and a Hastings Center Fellow.
Charlie Gard and the Limits of Parental Authority
Arthur Caplan and Kelly McBride Folkers
Charlie Gard, an infant in London who suffered from a rare and incurable condition, was the subject of legal and political battles over the last year. His parents fought and lost a court directive to allow him access to experimental therapy that they hoped might prolong his life, despite the opinion of his clinicians that the treatment would be futile and prolong his suffering. "The case was much in the news, but it has also been frequently misunderstood," write the authors, particularly with regard to the limits of parental authority. Caplan is the Drs. William F. and Virginia Connolly Mitty professor of bioethics at the NYU School of Medicine and a Hastings Center Fellow. Folkers is a research associate at the Division of Medical Ethics at NYU School of Medicine.
Also in this issue:
- Perspective: "When Public Health Becomes Politicized"
- At Law: "CRISPR Becomes Clearer"
- Policy and Politics: "Mitochondrial Replacement Techniques, Scientific Tourism, and the Global Politics of Science"
Contact Susan Gilbert, director of communications
The Hastings Center