Funmurphys: the Blog

Why I Don't Understand "Medical Ethics"

I guess I don't undertand medical ethics. You'd think providing healthcare in the manner that causes the least deaths would be the most ethical way, right? Wrong, according to Dr. Sally Blower discussing the best strategy to treat AIDS in South Africa:

Using data from the KwaZulu-Natal province for their parameters, researchers from UCLA and the University of California, San Francisco, devised a mathematical model to predict the impact of drug allocation strategies that the South African government is implementing to treat 500,000 people by 2008. These data included birth rates, natural death rates and death rates stemming from AIDS.

They looked at three drug allocation strategies: one that would allocate antiretroviral drugs only to the city of Durban and two making them available in both urban and rural areas.

Of those, the Durban-only strategy would be the most effective in preventing new infections, reducing them by up to 46 percent -- amounting to preventing an additional 15,000 infections by 2008 -- compared with the two strategies that would include both urban and rural areas. The strategy also would avert the greatest number of deaths from AIDS and generate the least amount of drug resistance.

But major problems would emerge with that approach, said Sally Blower, professor at the Semel Institute for Neuroscience and Human Behavior at UCLA and senior author of the study. Most important, this approach is against basic ethical principles guiding treatment equity and would lead to more urban/rural healthcare disparities than already exist.

"If there was rational planning, you could determine drug allocation strategies by balancing ethical objectives with epidemiological objectives," said Blower, a member of the UCLA AIDS Institute. "But it's obviously unlikely that this type of rational planning would or could occur. So it's much more likely that the actual drug allocation strategy will be determined by a mix of politics and feasibility."

She added: "Unfortunately, you can't have the maximum impact on the epidemic and be ethical."

Forgive me, but isn't there a difference between providing treatment for a deadly disease ravaging a continent, and handing out candy to first graders? I suppose you have to ask yourself, do we allocate scarce goods where they do the most good, or do we allocate scarce goods where we feel good about ourselves? What we have here is just creeping socialism. What we don't have is an appreciation of the fairness of treatment to not just those who have the disease, but to those who don't yet have the disease - they are completely ignored in conventional medical ethics, yet they are more numerous than those who have it.

I suppose it goes hand in hand with the whole no money for organ donors even if it increases organ donation because while the doctors, nurses, orderlies, janitor, and the hospital itself are being paid to perform the operation, it would just be wrong to pay the donor.

Posted by Kevin Murphy at September 13, 2006 11:31 AM | Science