Last week, an ethics panel at the World Health Organization decided the potential benefits of using experimental Ebola treatments outweigh the risks in the current outbreak. However, the decision has generated opposition from the medical community, bioethicists, and others who believe the potential consequences of using untested medications could do more harm than good.
To address these concerns, the WHO panel outlined some key ethical and scientific criteria to guide the use of these untested treatments. I was interested to see that effective communication and collaboration is at the heart of many of these criteria. Some include:
- Informed consent and freedom of choice – This will involve communicating in a clear and direct manner about the possible benefits and consequences of experimental treatments and outlining the successes and failures to date, so that patients and their loved ones can make informed decisions about the course of care. According to Peter Smith, an epidemiologist at the London School of Hygiene & Tropical Medicine and WHO board member, “clear explanations of the purposes of trials to those in the affected communities will be vital.”
- Transparency about all aspects of care – To give patients and communities the information they need to make important decisions and to ensure that maximum information is obtained about the effects of the interventions, it is critical for medical professionals to be open and transparent about their experiences. Not only are there ethical issues involved with limiting this type of information, but it can also foster a distrust that could make the implementation of future treatments difficult.
- Involvement of the community – Community buy-in will be critical to the successful implementation of these medications. Medical professionals will need to reach out to a range of stakeholders in the affected communities as well as provide opportunities for these stakeholders to provide feedback and voice their concerns. Collaboration between medical professionals and community stakeholders will help promote a common understanding and process for implementation that meets the needs of all involved.
- Use of the best available information – WHO advises that the use of these experimental interventions should be based on the best possible assessment of risk and benefit from the available information. While this may seem fairly obvious, it does require the establishment of an official process and method for sharing information to ensure that the most up-to-date information is available to all medical professionals at all times.
As medical professionals, scientists, and government officials work to treat Ebola patients and contain the outbreak, the acceptance of experimental treatments will be challenging. Taking steps to effectively communicate and collaborate with patients is a crucial step to maintaining patients’ ownership over their health care, but has sometimes been forfeited in past emergency responses. While effective community engagement is complex, and while there are certainly many other considerations to take into account within experimental treatments, putting increased priority on transparent and collaborative processes is important to pursue. Regardless of where you fall on this issue, it remains clear that the successes and failures of the process for implementing experimental medications to address this Ebola outbreak will have a significant impact on how we are able to treat the infectious diseases of the future.