The Tribune, in its Oct. 20 editorial “What’s justified in fighting AIDS?” seems to argue that the ends justify the means. In the controversial AIDS experiment, women suffering from a life-ending condition may be given no treatment at all. This flies in the face of nearly every biomedical ethical imperative.
There are four essential principles that guide ethical decision-making in medicine: beneficence (to do benefit to the patients), non-malificence (to do no harm to the patient), justice (to develop reasonable and fair allocation of limited resources) and autonomy (to fully inform the patient of all risks associated with an intervention and make sure they are capable of understanding what they are told). This AIDS experiment, in my opinion, easily violates two of those principles and may violate the others.
There is, quite obviously, no benefit to the patient who receives the placebo treatment. Harm is done to that patient, in that she is to be kept from other potentially lifesaving treatments. Both beneficence and non-malificence are therefore violated.
We are not told if the patient is informed and has provided signed consent; has the patient been told that he or she is involved in the study and might receive a meaningless therapy? And this issue is ultimately one that deals with justice, in that its genesis is in the fact that the cost of therapy that a country such as the U.S. can afford is not so affordable on the Ivory Coast.
But patients should not be treated differently as a result, and it is here that the Tribune errs. Simply due to happenstance of geography and economy, the Tribune argues that these patients should be treated differently than had they lived here. It matters not that an individual country might have agreed. There is therefore no universal ethical rule to which the Tribune adheres. This is situ-ational biomedical ethics; this is how the Nazis justified their horrors. This is wrong; the comparison to Tuskegee is apt.
