The ethical dilemma of saving the American Ebola patients

It was with much fanfare that two American aid workers were airlifted from across the world and brought to Emory University Medical Center where they began experimental treatment for Ebola. We hope for a full and speedy recovery for them and others like them who do God’s work.

But it appears to me that lost in this conversation are myriad others who need help but never get it. Right now, humanitarian work is being done all over the world, and in very dangerous places. These people  knowingly put their life on the line for others. Yet  tragically, some of them are injured or sickened in the service of others. But for them, the call from the CDC offering to medevac them out never came. There was a girl, who died of malaria while in Kenya. Or the young man who was serving in Egypt. Or a myriad other aid workers who die while serving their fellow human beings.

Also at issue, and it needs to be asked, at what cost are we saving lives? Who decides who gets what may have been, all told, a hundred thousand dollar medical evacuation? Susan Grant, the chief nurse for Emory Healthcare, in an article for the Washington Post rightly downplayed the infection risk posed by bringing these patients here. She went on to say:

The purpose of any hospital is to care for the ill and advance knowledge about human health … As human beings, we all hope that if we were in need of superior health care, our country and its top doctors would help us get better.

This statement brings to mind others that need saving. They don’t work in far away lands, they live here in the U.S, right across town, in fact. They don’t have fancy, exotic diseases.  Their conditions have names like diabetes, heart disease, hypertension, and lung cancer. Right now many of them are getting collection notices for their inability to pay from medical centers like Emory University. Others have been trying to get appointments at tertiary centers  like Emory. Only they’re told that their insurance is not accepted there, or their co-pays and deductibles will be more than they can afford.

How would Ms. Grant justify the incredible expense spent on this endeavor to those people? What would she say about the necessity of this experiment, a clinical trial with an n=2? Could she really tell those sweating in the Atlanta heat after their electricity got shut off that this was all really for their benefit?

I don’t know how to solve the ethical dilemma here. While I am hope for a cure on the one hand, I cringe at the highlight this places on those at the bottom end of America’s health care disparity gap. Perhaps someday in the distant future they can take solace in knowing that they didn’t suffer for naught. Because if they ever contract Ebola, there will be a cure waiting for them.

Deep Ramachandran is a pulmonary and critical care physician, and social media co-editor, CHEST. He blogs at CaduceusBlog and ACCP Thought Leaders, and can be reached on Twitter @Caduceusblogger

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  • Tim Mosher

    As one who was in Liberia rendering aid to the two missionaries, I will weigh in here. While the cost of the evacuation is a fair enough question, it must be realized the this was paid for with private, donated funds by Samaritan’s Purse -who has a pact with it’s employees to evacuate them out if possible. This has happened multiple times, it’s just never in the news. I imagine McDonald’s would evacuate it’s sick executives out of a third-world country if needed.

    Secondly, nobody is discussing how this whole incident has spurred the possibility of moving forward the development of the antibody that was used. Until this, there was nothing to indicate that the normal analysis-paralysis of drug development was different in spite of the uptick of Ebola. In fact, it is possible that had an African population been chosen to run trials on, it would have been considered racist (or whatever other term you might like to use). It is my hope that this has helped spur the speedy development of the serum so that many thousands have access to it sooner than otherwise would have happened. So in that case, the cost of this affair is more than worth it.

    And lastly, it seems to me that the opportunity for American researchers to examine these two cases in a safe, controlled environment, and do follow-up studies is a bit of a gift to them. It’s a much better option that the hellish, dangerous, and uncontrolled environment of a third-world Ebola clinic -trust me on that one.

    • T H

      Using logic and experience on people who want to stand and preach on soap boxes isn’t fair: just ask them. They’ll tell you so. (snicker)

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