Ethics and infectious disease

Bioethics

Volumn 19, Issue 3, 2005, Pages 272-289

  Selgelid, Michael J ^a,b  

^a Centre for Values   (Australia)

^b UNIVERSITY OF SYDNEY   (Australia)

Author keywords

[No Author keywords available]

Indexed keywords

ACQUIRED IMMUNE DEFICIENCY SYNDROME; CLONING; EPIDEMIC; EUTHANASIA; GENETICS; HEALTH SURVEY; HISTORY; HUMAN; INFECTION; INFECTION CONTROL; JUSTICE; MEDICAL ETHICS; MEDICAL RESEARCH; MEDICAL TECHNOLOGY; MULTIDRUG RESISTANCE; PATIENT CARE; PUBLIC HEALTH; REVIEW; SEVERE ACUTE RESPIRATORY SYNDROME; STEM CELL; TUBERCULOSIS;

ANALYTICAL APPROACH; BIOETHICS AND PROFESSIONAL ETHICS; HEALTH CARE AND PUBLIC HEALTH;

ACQUIRED IMMUNODEFICIENCY SYNDROME; BIOETHICAL ISSUES; BIOETHICS; COMMUNICABLE DISEASE CONTROL; COMMUNICABLE DISEASES; DEVELOPING COUNTRIES; DISEASE OUTBREAKS; ETHICS, RESEARCH; FORECASTING; HEALTH PRIORITIES; HEALTH SERVICES ACCESSIBILITY; HISTORY, 20TH CENTURY; HISTORY, MEDIEVAL; HUMAN RIGHTS; HUMANS; POLITICS; SOCIAL JUSTICE; TUBERCULOSIS;

EID: 21044455535     PISSN: 02699702     EISSN: None     Source Type: Journal    
DOI: 10.1111/j.1467-8519.2005.00441.x     Document Type: Review

References (64)

1. A version of this paper was presented at the VI World Congress of Bioethics, Brasilia, Brazil, October 2002.
2. K. Lee, and A. Mills. Strengthening Governance for Global Health Research. British Medical Journal 2000; 321: 775-776, at http://www.bmj.com/ cgi/content/full/321/7264/775.
3. Although I shall not in this article discuss this point at great length, others who have worked in this area, such as Margaret Battin and Solomon Benatar, have agreed that it is quite correct. A similar point is made by (especially Chapter 8 of) P. Farmer. 2003. Pathologies of Power: Health, Human Rights, and the New War on the Poor. Los Angeles. University of California Press.
4. I shall use the expressions 'bioethics ', 'biomedical ethics', and 'medical ethics', interchangeably.
5. P. Ziegler. 1969. The Black Death. London. Penguin.
6. A.W. Crosby. 1989. America's Forgotten Epidemic: The Influenza of 1918. Cambridge, UK. Cambridge University Press: 203.
7. G. Kolata. 1999. Flu. London. Pan Books: xii.
8. B. Gewen. 'The Great Influenza' and 'Microbial Threats to Health': Virus Alert. The New York Times March 14, 2004, available at: http://www.nytimes.com/ 2004/03/14/books/review/14GEWENT.html.
9. J. Miller, S. Engelberg & W. Broad. 2001. Germs: The Ultimate Weapon. London. Simon and Schuster: 58.
10. M.B.A. Oldstone. 1998. Viruses, Plagues, and History. New York. Oxford University Press: 3.
11. For more on smallpox, see M.J. Selgelid. Smallpox Revisited? American Journal of Bioethics 2003; 3, 1, available at http://www.bioethics.net/journal/ j_articles.php?aid=91, accessed 1 March 2005;
12. and M.J. Selgelid. Bioterrorism and Smallpox Planning: Information and Voluntary Vaccination. Journal of Medical Ethics 2004; 30, 6: 558-560; available at http://jme.bmjjournals.com/cgi/ reprint/30/6/558, accessed 1 March 2005.
13. World Health Organization. 1999. Report on Infectious Diseases, Chapter 16, Removing Obstacles to Healthy Development, available at http:// www.who.int/infectious-disease-report/pages/textonly.html, p. 2.
14. C. Gilbert. AIDS Draws New Attention. Milwaukee Journal Sentinel, 15 April, 2002.
15. See http://www.redribbon.co.za/.
16. L. Garrett. 2000. Betrayal of Trust: The Collapse of Global Public Health. New York. Hyperion: 474.
17. Ibid., p. 473.
18. UNAIDS: AIDS Epidemic Update, 2004. Available at www.unaids.org.
19. L.B. Reichman and J.H. Tanne. 2002. Timebomb: The Global Epidemic of Multi-Drug-Resistant Tuberculosis. New York. McGrawHill: x-xi.
20. See also P. Farmer. 1999. Infections and Inequalities: The Modern Plagues. Berkeley, CA. University of California Press.
21. World Health Organization. Tuberculosis, Fact Sheet No. 104, revised April 2000, available at http://www.who.int/inf-fs/en/fact104.html, p. 1.
22. L.K. Altman. Death Rate from SARS is Revised Upward. International Herald Tribune May 8, 2003.
23. I b i d.
24. I. Kickbusch. A Wake-Up Call for Global Health. International Herald Tribune April 29, 2003.
25. Available at http://www.odci.gov/cia/publications/nie/report/nie99-17d. html. One conclusion of the report is that we should perhaps worry most about new infectious diseases - more dangerous than AIDS - likely to emerge in the future.
26. I highlight variation in severity to suggest that there is likely no simple, obvious answer to this question. I should here point out the practical importance, in addition to theoretical difficulty, of this kind of question. It is now widely acknowledged, for example, that quarantine policy is outdated and in need of revision. Biodefense planning and the emergence of SARS provide the most recent illustrations of the immediate importance of this issue.
27. This topic, of course, has not been altogether ignored. For discussion in the context of AIDS see U. Schuklenk. 1998. AIDS: Individual and 'Public' Interests, in A Companion to Bioethics, P. Singer & H. Kuhse. eds. Oxford, UK. Blackwell: 343-354.
28. For recent discussion of quarantine policy in light of the smallpox bioterrorist threat, see G.J. Annas. Bioterrorism, Public Health, and Civil Liberties. The New England Journal of Medicine 2002; 346: 1337-1342.
29. World Health Organization, op. cit. note 12.
30. N.L. Stepan. 2001. Picturing Tropical Nature. Ithaca, NY. Cornell University Press;
31. L. Garrett. 1994. The Coming Plague: Newly Emerging Diseases in a World Out of Balance. New York. Penguin.
32. Gilbert, op. cit. note 13.
33. D.B. Resnik. Developing Drugs for the Developing World: An Economic, Legal, Moral, and Political Dilemma. Developing World Bioethics 2001; 1: 11.
34. Others, to the contrary, might claim that this situation is 'unfortunate' but not necessarily 'unfair' or 'unjust'.
35. Fighting Back. The Economist May 11-17, 2002, 27.
36. R. Dorrington, D. Bourne, D. Bradshaw, R. Laubscher & I.M. Timaeus. The Impact of HIV/AIDS on Adult Mortality in South Africa. Burden of Disease Research Unit, Medical Research Council of South Africa, available at: http:// www.mrc.ac.za/bod/index.htm.
37. At the time of this writing the South African Government appears to finally be changing its stance on HIV/AIDS.
38. This seemed to occur with regard to the above-mentioned MRC Report, for example.
39. Note that points (4)-(6), at least, appear to conflict with the South African constitution by failing to respect what are recognized as human rights here. The same thing may be said about the failure to provide antiretrovirals to HIV-positive South Africans more generally speaking.
40. See D. Webb. 1997. HIV and AIDS in Africa. London. Pluto Press;
41. A. Whiteside & C. Sunter. 2000. AIDS: The Challenge for South Africa. Cape Town. Human & Rousseau;
42. & H. Marais. 2000. To the Edge: AIDS Review 2000. Pretoria, South Africa. University of Pretoria, Centre for the Study of AIDS.
43. Increased risk of HIV infection results, for example, in the presence of other untreated STDs or when immune systems are weakened from poor nutrition or infection with worms.
44. S.R. Benatar. Global Disparities in Health and Human Rights: A Critical Commentary. American Journal of Public Health 1998; 88: 295-300.
45. Garrett, op. cit. note 15, p. 59.
46. Search conducted on October 30, 2002 at www.google.com.
47. Many of these referred to a more recent work of Ronald Bayer. There have of course been books and anthology sections on ethical issues associated with AIDS in particular. And Internet searches of 'Ethics and AIDS', as was pointed out by Peter Singer in discussion, will yield more results - i.e. 408 results on 1 March 2005. The fact remains, however, that discussion of infectious diseases in general (which would likely inform discussion of particular diseases such as AIDS) is lacking. In my opinion even AIDS - with the exception of doctor-patient relationship issues (especially the 'duty to treat') and AIDS-related international research ethics (especially the debate over 'standards of care') - has not received adequate attention in mainstream bioethics literature, given the magnitude of the problem. On 1 March 2005, in any case, a Google search of 'ethics and tuberculosis' yielded only 42 results (though tuberculosis kills two or three million persons per year) and 'ethics and malaria' yielded zero (though malaria kills one million per year). On the same date, 'ethics and stem cells' yielded 440 results - despite the newness of stem cell research (in comparison with AIDS).
48. The development of elaborate life-sustaining technologies made the question of euthanasia, for example, more urgent. I should note that - in addition to technological advance - the birth of bioethics was also importantly related to the civil rights movement of the 1960s. See H. Kuhse and P. Singer. 1998. What is Bioethics? A Historical Introduction, in A Companion to Bioethics, P. Singer and H. Kuhse eds. Oxford, UK. Blackwell: 3-11.
49. See Garrett, op. cit. note 27, pp. 30-52, esp. pp. 30-31.
50. Ibid., pp. 30-31.
51. Ibid., p. 31. Not only did it fail, but this program was somewhat counterproductive. DDT-resistant mosquitoes returned in higher numbers than before; and misuse of medication promoted drug-resistant strains of malaria. By '1975 the worldwide incidence of malaria was about 2.5 times what it had been in 1961... A new global iatrogenic form of malaria was emerging - "iatrogenic" meaning created as a result of medical treatment. In its well-meaning zeal to treat the world's malaria scourge, humanity had created a new epidemic' (p. 52).
52. Ibid., p. 36.
53. Ibid., p. 33.
54. Gewen, op. cit. note 8.
55. See H. Joffe. 1999. Risk and the Other. Cambridge, U.K. Cambridge University Press;
56. & N.L. Stepan, op. cit. note. 27, for discussions of how AIDS and tropical diseases, respectively, are regularly understood and portrayed as problems of others.
57. Udo Schuklenk suggested this point in conversation.
58. This was (independently) suggested by Mary Tjiattas. Peter Singer concurred in conversation.
59. I do not mean to imply that other issues in bioethics do not require appreciation of social, political, historical, and economic phenomena. My point is one of degree: assessment of the health care situation in the developing world often requires substantially more contact with these other disciplines. Others who have worked in this area will agree.
60. For further illustration of what I here have in mind see M.J. Selgelid. Ethics, Economics, and AIDS in Africa. Developing World Bioethics 2004; 4, 1: 96-105.
61. See D. Moellendorf. 2002. Cosmopolitan Justice. Boulder, Colorado. Westview Press.
62. This objection was (independently) raised by Julian Savulescu in discussion.
63. In discussion.
64. James William Ley, philosophy Ph.D. student at the University of Sydney, encouraged explicit inclusion of this point.