Experimental medical interventions in a public health emergency: an ethical review

Abstract

The ethical challenges of researching in disadvantaged communities include those of informed consent, standards of care and issues pertaining to justice, including distributive justice. Research, specifically regarding epidemic infections, in underdeveloped countries is more difficult to carry out when the aforementioned challenges exist. In order to address an emergency epidemic public health challenge, all available treatment and other measures need to be implemented with urgency. If there is no known intervention for the disease causing the epidemic, the question is raised as to whether or not it is ethical to use an experimental investigational drug, which has not completed a clinical trial, in an attempt to address the crisis. In this research paper I define the circumstances of a public health emergency epidemic in order to determine when it is appropriate to consider the use of experimental interventions. The 2014 Ebola crisis in West Africa and the on-going risk of Ebola recurrence is a case in point that demonstrates the formidable challenges the crisis of an epidemic present. I critically assess the existing regulatory guidelines for compassionate drug access and clinical trials in order to determine whether these regulations are appropriate within a public health emergency situation. I critically assess the major ethical and legal arguments that do and do not justify the use of experimental interventions. I lastly critically assess the major challenges regarding the use of experimental interventions within the context of autonomy and justice. I conclude that the arguments in favour of experimental interventions outweigh the arguments against them.