23 October, 2009
Often in life we are faced with problems that we cannot solve ourselves. In many cases we can go to specialists who will be more able to analyse the problem and give us a solution. When your car breaks down and you take it to the garage to be repaired you trust that the service people know what they are doing, although you may get a second opinion. The same with getting a mortgage or any other major decision. When it comes to our health the decisions we make can be literally life or death and so we would like to arm ourselves with as much information as possible. Yet some decisions on, say, whether to try a treatment or not may require more information than we can absorb in a timely manner. Risk analysis can be difficult when weighing up, say, a 99% chance of chronic pain for the rest of your life versus a treatment that has a 2% chance of giving you cancer. In most countries with a modern health service, patient consent is a something that has to be explicitly gained. Some consent forms can be daunting though, and perhaps put patients off of getting treatment simply be being so dense with information. In many cases it is difficult to say whether one choice or the other would be best, and if a trained doctor can’t tell you, then what chance do non-specialists have? Of course as autonomous individuals it seems right that we should make our own medical decisions, but this can be dangerous.
Vaccinations are without a doubt one of the greatest life savers humanity has ever produced. Some are better than others though. Flu vaccines are variable in their effectiveness since each season’s shot is based on a subset of the viruses that are out in the wild. The flu shot will protect most people (after a couple of weeks) against that subset, but not against others that may be more widespread than predicted. In addition many of the most vulnerable people cannot create the antibodies that the flu shot should allow them to generate. Herd immunity is the best protection for the elderly, that is, if everyone was to get the flu shot there would be less flu going around and less of a chance for any individual to catch it. Most countries deem the expense of giving everyone the flu shot every year to be too high compared to the benefits of reduced mortality. This may be the sensible choice, but it is arguable.
Other diseases are much more troublesome. The measles vaccine is far more effective and only in rare cases will someone not get immunity from taking the vaccine. But such people exist, they take the vaccine, fail to develop immunity and don’t get measles simply because there isn’t that much of the disease around since everyone else took the shot. But what about when people opt out? By not getting the vaccine and allowing yourself (more likely your child) to get the disease you are increasing the chance of those non-immune people getting the disease as well. Even though they did all that could be done to prevent it, by quirk of fate, poor genetics, they get no help from the vaccine, and no help from herd immunity. Should vaccines therefore be mandatory? Should this medical decision be taken out of our hands?
Broad powers are granted to medical staff in the cases of outbreaks of especially dangerous diseases. Indeed we would probably not want someone to make their own medical decisions if they had been infected with Ebola and wanted to leave the isolation unit. It is not all or nothing, and an accommodation must be reached between, for example, the Human Right of Vaccination (as described by Mary Robinson) and the Human Right of freedom to do to our own bodies what we wish.
The ethics of testing drugs is also fraught with difficult, arguable choices. There are a large number of new treatments available now that have never been tested on pregnant women. This is entirely understandable, since who would risk unknown harm to their unborn child? Yet the result of this is that many conditions have treatments that cannot be given to people when they are pregnant simply because we don’t know the effect, and indeed probably never will. For some diseases, such as AIDS, it is often difficult to get people to try new drugs since the existing treatments are a ‘gold standard’ and work very well. Sure the new drug may be even better, but is it ethical to ask people to risk their lives with something that may be no better, or even worse than placebo, when there is an available, and worthwhile treatment? In all cases, whether searching for new treatments and cures, or even administering the existing ones, ethics plays a large part in the medical world.