ebola and public health ethics (ebolaethics?)

via reuters, KFF recently posted a short article about the ethics of giving experimental treatment to the ‘hero doctor’ Sheik Umar Khan — and, really, to any of the trained health professionals who continue to show up to work even though they were at very real risk in Sierra Leone, in Liberia, in Nigeria and, now, contemporaneously but apparently unrelatedly, DRC.

there’s a complex of issues at stake, here, around rationing a scarce (and experimental) resource when need is greater than supply. i only going to wade in on the one issue i feel comfortable putting a point on; questions of ethics related to the nationality of who has been treated and where they were treated, or the ethics of using an experimental drug once other options were exhausted are important issues — but beyond the scope of this post.

this post is specifically about priority-setting for who gets treated: those who work in health care and those who do not. whether human resources for health (HRH) — Dr. Khan, medical volunteers from abroad, Sierra Leonean nurses, etc —  should be given priority in the face of a health crisis raises the Kantian issue of whether people should be used as means for ends (with Kant saying “no.”). if HRH are prioritized because of their ability to save more lives by having their own life saved, it is because they are being viewed as a means to an end — namely, the end of potentially saving more lives. this does not, inherently, treat all individuals of being of equal moral worth.

the case above at least keeps things within the “sphere” of health, rather than raising questions about favoring saving the young versus the old, or the powerful (say, the president or prime minister) over other citizens in the face of disaster. these too are difficult questions.

the debate will continue about whether and how Dr. Khan and others should have been treated with the experimental ZMapp, of which there is expected to be a long-term (rather than a quickly resolved) scarcity relative to need. demand significantly and dauntingly and heartbreakingly outweighs supply. but the question of whether Dr. Khan — or other HRH still fighting the fight — should be given priority to receive the treatment needs to be answered along several lines: should HRH be given preference? if so, should that preference be given based on whether, once cured, they will continue to treat patients? what happens once there are no more treatments to continue treating with — does the prioritization scheme shift?

this is a separate — but important — set of questions from the more politically charged question of the nationalities of recipients of the limited supply of ZMapp. i suspect these questions of power and race and exploitation, of where drugs were developed and where they were tested and who paid for them in what ways, will dominate the discourse. but other questions of ethics, desert, scarcity, and priority-setting require consideration for dealing with the present crisis and planning for future outbreaks, as well as strengthening health systems and equipping them to make decisions more generally.

further reading on these topics include: Norm Daniels, Frances Kamm, and Dan Brock. i hope these scholars will discuss and debate these issues in the near future.


some posts… no shit

some posts maybe you are never ready to write. nevertheless, the news of marc roberts‘s death over the weekend seems to warrant both an immediate response and the response that is just right. he seemed to usually be able to manage these simultaneously but, given the sense of time that follows a completion of a life well-lived and well-said, i’ll err on the side of the former.

i won’t claim to have known marc as well as many but i knew him well enough to respect him, which means, perhaps, seeing past rough first impressions. he pronounced himself a reformed economist at some point early enough to influence me: politics and the realities of implementation and the curves of ethics-in-real-life became the subject of his writing and his teaching and we are better for it.

marc had a standard line — a bit of a trap — that he would lead you  into (funnier to watch others go than to realize you had followed in). you might make a comment; maybe even one you thought useful. then he would start. he grew up in jersey. [fill in a few lines about the roughness of growing up in a steel town in jersey.] they had a saying back then, he’d say, that would apply to the point you’d just raised.

no shit.

familiar and biting each time (after the first, which was less pleasant). what always made it ok was the sense that he was, and wanted you to be, in pursuit of the right questions. he raised questions of distribution when everyone else was looking at average treatment effects. he was a reformed economist when the economist profession was booming. he wanted to know about implementation when everyone was looking at theoretical equations. and wanted to know about practical theory when everyone was looking at the sexy result of the moment.

we were through “pinning butterflies,” i was told indirectly by marc. categorizing of treatments or results wasn’t what we needed — we needed to explain things and try to make sense of them.

and then to do better.

some posts you are never ready to write. but some some are scratched in before you even sit down to it and some give you a sense that you shouldn’t wait. with marc, the gist sank in early, so one doesn’t have to do much work to imagine he’s still around. which is quite a good thing.

we need his voice. it’ll be missed but, as with all good teachers, it, with its gruff accent, is hardly gone.

thank you, marc. (http://www.bostonglobe.com/metro/obituaries/2014/07/29/marc-roberts-chestnut-hill-harvard-school-public-health-professor-had-global-reach-economics-teacher-and-consultant/v41p3cyjbSEjNH2YONAE6J/story.html)



adapted writing guide, a few thoughts on writing and pedagogy

i just spent some time summarizing and adapting someone else’s adaptation of someone else’s guide to writing (specifically for ethics and philosophy but many of the points apply more generally). i have attached it in case it is of use!

i am now assisting with this particular ethics course for the first time. it was therefore no longer surprising  but still unsettling that on almost every midterm i graded last week, i wrote “a thesis sentence would be helpful.” i‘ll note that this is a masters-level course. i thought about reintroducing the (as noted by a friend, colossal “In-and-Out 4-by-4 Animal Style”) sandwich as teaching tool but opted against it.

i find it upsetting that in a school of public health – covering topics for which communication skills are ostensibly quite important – there so little direct emphasis on improving writing and public speaking.

first, for better or for worse, at least in my department, TAs do the vast majority of the grading. we generally don’t have the time (nor, ahem, the commensurate pay) to comment on writing style and grammar as well as content.

second, the writing resources at school are limited to one man. he does a great deal of good work but we can hardly assign all students to go to him before a paper is due, as in undergrad the professor could mandate that a paper went to the writing center before it was turned submitted  (where you were forced to read your paper out loud, which was both terrifying and extremely helpful).

third, the above point is all the more upsetting given the school’s cultivation of an international student body. that there are no writing resource that ESL (or, likely EnL) students can access when working on a specific paper is fairly upsetting.

fourth, i am of the firm opinion that one really learns how to write or present by having to comment on or grade good and bad writing or presentations. however, most times when i try to insert a mandatory “read your paper out loud to another student” or “grade a fellow student’s paper” into a curriculum, it is shot down for one reason or another. yes, it’s a pain. yes, students might go easy on each other. nevertheless, i still think is a good idea and a necessary component of taking good writing seriously. rating other students’ presentations seems to go over slightly better – but only slightly.

Writing for ethics_HEL2013