As some of you may know, the Ebola outbreak has quickly become the largest in recorded history. So far there has been a suspected death total of 1420, and is expected to rise even though the effort of the WHO and infected countries are trying everything they can to prevent further infections.
As of yet, there is no definitive treatment for Ebola, however there have been reports of a drug called ZMap which has the potential of being a cure. ZMap has undergone no clinical trials and it has only been used to treat 6 patients, 1 of which has died and the other 5 are alive and recovering. Many people would like to use this experimental drug for the treatment of Ebola, even without any proof that it works, as of yet it has not been tested in humans for safety and effectiveness. Nothing can be for certain until a randomised control trial is done.
At the moment, more of this drug is being manufactured to be available as experimental treatment. Now I understand the seriousness of this outbreak and the need for effective treatment, but is it really a good idea to hand out experimental drugs which may or may not assist in the healing process and could potentially do more harm than good?
The ugly examples of experimentation
Many a time, first world countries have experimented with drugs, treatments and vaccines on third world, developing countries. Some examples of this:
- 1990s- meningitis testing in Nigeria
- 1990s- HIV/AIDS testing in Zimbabwe
- 1970-1980- Forced sexual reassignment in South Africa
- 1970s- Forced contraception in Zimbabwe
- 1900s-1910- Sterilisation experiments in Namibia
These bring up huge human right issues, such as unethical experimentation and lack of informed consent, a disregard of autonomy, beneficence, non-maleficence and justice. This also brings up the issue of power relationship and exploitation of vulnerable people.
Who are vulnerable people?
The term vulnerable can be defined as “the possibility of being attacked or harmed, either physically or emotionally.” According to StatsSa the vulnerable people of our country consist of children, the elderly, women and the youth. Others who are also classified as vulnerable are those who are freedom constrained (prisoners, mentally handicapped, soldiers and students), those who are poor, uneducated, powerless, homeless, different in culture and lacking in health care. These individuals make up the majority of Africa’s population.
Why are the vulnerable exploited?
The researcher has the power advantage in this situation, and going against ethical guidelines allows for the opportunity to reach an end to the research quicker, cheaper and easier.
How can it be avoided?
The declaration of Helsinki has established clear guidelines for medical research which require a trust relationship between the researcher and the subjects. This relationship involves the respect for the dignity of the subjects by enforcing accountability in research as well ensuring transparency, justice, fairness and a commitment to the protection of human rights.
Why experimenting is a good thing
The primary purpose of research is to generate new knowledge. Researching and experimenting grows knowledge of professionals in both a personal and global capacity.
There is a great benefit of experimental treatment as often it is beneficial to the subject, it offers an opportunity to patients who might not have any other options. Patient have the right to choosing an experimental treatment, when they are informed that the risks and benefits are unknown and the possible side effects.
Why not to provide experimental treatment
When an outcome of a treatment cannot be guaranteed, the risks are unknown and no studies have been done, the treatment is unsafe.
Where to go from here
It is important to maintain ethical standards and balance the risk and benefits when deciding about an experimental treatment. In the case of the Ebola outbreak, the WHO has decided to go through with the treatment because the possible benefits outweigh the possible risks, especially in these dire circumstances.
To ensure their autonomy it would also be important to ensure the subjects/patients are educated on the drug, the risks, benefits and the fact that the outcome is yet unknown. As well as allowing them to make their own informed decision regarding treatment.
To ensure beneficence, every individual involved in the process should act in the best interests of the patient, and maintaining a trust relationship between the researcher and the patient.
And ensuring justice by being accountable, transparent, fair to all and committed to the protection of human rights.
By maintaining these standards, experimental therapy is possible, especially when it has the possibility of benefiting so many people.