Right before our eyes, the most egregious aspect of COVID-19 has had its ugly head raised since the first news of the impending pandemic. Much of our attention during this pandemic has been focused on its deadly nature; economic impact; disruption in education; and the political battle over wearing face masks. But none of us have paid attention the blatant disregard for medical ethics.
Let me frame this column by saying a little bit about medical ethics. Put simply, this is a branch of medicine that examines (and upholds) the concepts/principles of autonomy, non-maleficence, beneficence, and justice. Respect for autonomy – the patient has the right to refuse or choose their treatment. Beneficence – a medical provider should always act in the best interest of the patient. Non-maleficence – to not be the cause of harm. In other words, whatever is done to a patient, it should provide the potential for more good than harm. Justice – concerns the distribution of scarce health resources, and the decision of who gets what treatment.
These are the basic rights of every living being, and these are the rights that medical ethicists uphold. But what does this have to do with COVID-19?
Most connect the field of bioethics to either the atrocities of the Nazi concentration camps or the inhumane, unthinkable horrors of the U.S. Public Health Service Syphilis Study at Tuskegee. Yet, ethical violations in health care and medicine have caused neglect, suffering, and even death throughout every phase of this pandemic.
At the outset, initial recommendations from the Centers for Disease and Control Prevention (CDC) informed us that should we suspect we’ve been infected with the COVID-19 virus, not to go to the hospital or doctor’s office. Instead, we were told to call your doctor, and let them make the arrangements for testing and/or treatment. But, what about the millions of people in this country who don’t have a primary care doctor? Research from Northwestern University Feinberg School of Medicine found that 25 percent of Americans don’t have a primary care physician. For vulnerable groups like Blacks, Latinos, the uninsured, the poor, and those with less education were more likely to lack primary care. Those living in the South were even less likely to have primary care. This violates the ethical principle of Beneficence. In who’s best interest were the CDC’s recommendations? There was no apparent consideration of acting in the best interest of all.
We saw it again with the clinical trials research process. With countless research and published studies documenting the inequities and the lack of inclusion of participants in the research that reflects the general population, for whom the drug or treatment is intended to be made available. Anything less is not only an ethical violation, but equally as important, it is faulty science. Knowing what we do about how ethnicity and social determinants of health affects how drugs are metabolized in the human body tells us that to subject a segment of the population to treatments that didn’t include people who looked like them in the clinical trials is dangerous.
Any medical care that is provided must first and foremost not actually cause harm. It can’t just stop there. It must also offer the potential that the good it is intended to provide, is greater than any harm it can cause. Anything else is non-maleficence. You would think that after over a century of clinical trials we would have learned this lesson before being in a pandemic.
While we’re on the subject of research and clinical trials, what about the lack of consideration for the storage needs of the vaccine? Let me explain… the Pfizer vaccine has to be kept stored at -94 degrees Fahrenheit. the Moderna vaccine has to be stored at -4 degrees Fahrenheit. Twenty percent of the world population doesn’t even have a refrigerator in their homes, how likely is it that the city, region, or town, there is the type of refrigeration to store these vaccines? I thought there was supposed to be a “global collaboration” on the development of the vaccines? Ok, let’s localize it; what about the rural and under resourced parts of inner cities all across this nation? Where is the sense of distributive Justice? Who lives? Who dies? Who makes the decision?
Lastly, a word about autonomy. At no point throughout this pandemic have many in marginalized communities, particularly Blacks and Latinos denied access to care, testing, clinical trials, and imminently the ability to have equitable access to a vaccine. This is all further tempered by the impending vaccine mandate. Yes, I said vaccine mandate. It is inevitable that the ability to travel on airlines, enter sports arenas, malls, theaters, museums; even to be eligible for certain government benefits or programs is all on the table as possibilities. Regardless of the rationale for a mandate, we must keep in mind of the impact on autonomy.
Rarely do we consider the ramifications of medical ethics when it comes to medicine and healthcare. The law says what you must do. Ethics says what you ought to do. The COVID-19 has revealed sobering truths for us all that can never be forgotten. These are all the kind of ethical issues and dilemmas that only matter, sadly, if you are not affected by them.
Glenn Ellis, MPH is a Visiting Scholar at The National Bioethics Center at Tuskegee University and a Harvard Medical School Research Bioethics Fellow. He is author of Which Doctor? and Information is the Best Medicine. For more good health information visit: www.glennellis.com