The Ethics of Ebola

The Ethics of Ebola

It is a killer that eats people from the inside; a bloody, gruesome, murderer. A murderer unstoppable, who has claimed the lives of over 11,301 African people (“Latest”). It is a skilled assassin, with a 70-90% mortality rate, and its name is Ebola. With the testing of an Ebola treatment, the stopping of this criminal, comes an ethical dilemma, surrounding the randomized placebo-controlled trial (RCT). A RCT is a standard method of conducting scientific trials, where participants are randomly placed in either a control group or an experimental group. The control group is given a placebo, a sugar pill which has no effect on the patient, and no other treatment; the experimental group is given the trial drug. The criteria of the RCT is simple, but the ethics of it are far more complex.

Proponents of the RCT argue that it is the gold standard for testing experimental drugs; Peter J. Hotez of the National School of Tropical Medicine at Baylor asserts that “it’s the only proven path to determine safety and efficacy” (“Ethics of Fighting Ebola”).  The RCT is the main tried-and-true method by which most scientists feel confident in the reliability of their data.

Still, many argue that desperate times call for desperate measures, and unconventional solutions are needed to minimize fatalities from ineffective treatment or an experimental control (“Ethics of Fighting Ebola”). Those who are placed in the control group are guaranteed to not receive any other treatment, which denies them even the possibility of benefit and could possibly be unethical (Gutmann).

People against the RCT propose different methods for testing experimental Ebola treatment, to speed up the process and minimize deaths (Ethical Issues). Supporters of the RCT argue against alternative trial methods, saying that straying from the RCT could yield unreliable or invalid results (Gutmann). Conducting a trial that produces uninterpretable or misleading results could also be considered potentially unethical (Ethical Issues), because the participation of the patients would be futile. Two main routes of alternative trial are proposed: the retrospective control and the adaptive trial. In a retrospective control, there is no control group; instead, the experimental data is compared to accounts of past cases. It is proposed for Ebola because it eliminates the need to put people in a control group and provides all participants a chance at increased survival rates. Opponents argue that the retrospective control is inaccurate because it is impossible to account for unknown and unmeasured conditions, such as differing medical care, stage of illness at diagnosis, and environmental factors (Gutmann). The adaptive trial is a more flexible foundation for experimental testing: the trial is subject to spontaneous change at the discretion of the researcher. If a treatment seems to be effective, more people can be randomly assigned into that group, or if a treatment seems to be harmful, that group can be discontinued. It is effective in life-threatening situations such as that of Ebola at benefitting as many people as possible, quickly. However, this type of trial is extremely subject to the researcher’s bias, and therefore unobjective (Gutmann). The results may be difficult to interpret and coordinate between multiple separate trials (Ethical Issues).

In either case, the debate over the use of a randomized, placebo-controlled trial in experimental Ebola treatment continues to burn like wildfire. Ebola is a murderer not investigated by police, but by biologists, ethicists, and doctors; all three seem to butt heads when it comes to how to catch this criminal. But all this head-butting is tending the fire, and it is slowly but surely spreading its viral ashes across the African population.

Works Cited

Ethical Issues Related to Study Design for Trials of Therapeutics for Ebola Virus Disease. World Health Organization, October 2014. .pdf.

"The Ethics of Fighting Ebola." The New York Times. The New York Times, 01 Dec. 2014. Web. 06 Mar. 2016.

Gutmann, Amy, PhD. Ethics and Ebola: Public Health Planning and Response. Presidential Commission for the Study of Bioethical Issues, Feb. 2015. .pdf.

"Latest Available Situation Summary, March 09, 2016." Ebola Data and Statistics. World Health Organization, 09 Mar. 2016. Web. 10 Mar. 2016.