The ethics of experimental medications

With the recent outbreak of Ebola in West Africa, the search for a cure has become all the more urgent. Or rather, the search for a federally-approved vaccine has become all the more urgent. It is not as if treatments for Ebola do not exist. Mapp Biopharmaceutical Inc. has developed ZMapp, which has been used on very few patients, including two Americans. However, it has only been used experimentally as it has not yet been approved by the FDA. Five out of the seven patients treated with ZMapp have responded positively to the medication, according to a CBS news article. (The other two died but whether their deaths were due to the treatment or Ebola is unknown). After treatment, the patients who survived tested negative for Ebola. One of the main questions today is, who should have the power to make a decision in an ethically-fraught situation such as this, in which the circumstances are dire and there exists a possible cure that is not federally approved?

In the United States, officials mandate that everyone entering an established school system, public or private, receive specific vaccines: chicken pox, tetanus, and hepatitis, to name a few. Because school is required for all under 16 years of age, children and adolescents are essentially being forced to receive these vaccines. Vaccinations are common to Americans and are not concerning to us. It is a routine step with which everyone complies.

However, in underdeveloped countries, vaccines and general medicine are not very well understood. In some parts of West Africa, where the Ebola virus is most active, people have burned down treatment centers, patients have escaped, and looters have stolen bloody sheets and mattresses, spreading the virus further, according to an article by the Associated Press. This is because many residents of Ebola-threatened areas—particularly poorer ones—have limited information about modern medicine, and thus view treatment with skepticism. As a result, they disregard the warnings of health officials. Here, energy must also be spent on educating the population on health care rather than having all of it focused on suppressing the disease.

Despite the disparity in backgrounds, everyone today faces the same ethical concern with the discovery of a potential cure for Ebola, ZMapp.

The Center for Disease Control asserts that in the past, the most effective method for handling and eradicating Ebola outbreaks has been to ensure that people use safe burial practices to prevent viral spread through bodily fluids, and that patients cooperate in being treated, which includes adhering to quarantine restrictions. Since ZMapp is not yet available in large quantities, the ethical choice of whether or not to risk using it has not been a widespread issue, but the question regarding experimental treatments remains interesting. Hypothetically, if an experimental medication offers a cure, should it be used against patient resistance, especially in areas where misunderstanding exists?

While it seems wrong to force patients to take drugs against their will, especially if these drugs are not federally approved in a given country, it also seems unethical to withhold a possible treatment and risk spreading the virus to others. When more people are succumbing to an epidemic each day and a drug has shown promise in helping them, that drug should be prioritized both for an examination by the FDA and for use in cases of the disease. If patients are provided with comprehensive and honest information on the drug, including the drug’s benefits, its side effects, and the potential consequences of not taking it, they can ultimately make their own choice on whether or not to take it. However, once they comprehend the situation, they may be more likely to choose to take the drug, which is more likely to save their lives and prevent spread of the disease. Of course, along a different trajectory, the drug should be entered into clinical trials immediately so progress can be made on getting it approved or tweaking it if needed.

In the end, the power of decision still ultimately lays in the hands of the patients, and even more so with the non-federally approved drug. While it can be encouraged, it cannot be forced. The same goes for the federal approval process. We cannot force them to speed up the process in order to have a cure as it could have unknown fatal side effects. So it seems we have arrived at some sort of stalemate. The best that can be done is to continue to respect the patients’ wishes, acknowledging that not everyone has the same degree of experience with modern medicine and that not everyone has the resources available to have immediate access to various immune boosting vaccines, and to continue the search and approval of a cure.

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