Ethical Case Study Regarding Randomised Medical Trials in a Developing Country Essay

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Global Healthcare Ethics and the Randomised HIV Trial

Healthcare professional face a range of ethical issues in the pursuance of their vocation. In the context of HIV research and the conducting of research among vulnerable population, such as poor expectant mothers in developing countries, the compete of global health ethics should provide a foundation for the assessment of ethical practices, both in planning, undertaking, and reviewing the work (WHO, 2014; Stapleton et al., 2013). Global health ethics is an interdisciplinary field, which covers not only health research, but also issues such as the provision of healthcare, and development of health policy, with the aim of understanding the moral values which should be implemented at a global level, undertaken utilising a predominantly geographic approach to macro level health issues (Stapleton et al., 2013). In this context, global health ethics is primarily concerned with issues such as pandemics, the effects of natural disasters, poverty, and other health-related factors that affect large populations (Stapleton et al., 2013). The content approach may also be adopted towards global health ethics, with the health issues themselves are also considered, which combines both the macro level, and the micro level, and issues associated with medical ethics in terms of treatment (Stapleton et al., 2013; Pinto and Upshur, 2009).

It may be argued that the research study in Africa, Thailand, and the Dominican Republic, which took place in 1997 with sixteen randomised trials in developing countries, researching a drug to prevent HIV being transmitted from mothers to their unborn infants would come under the remit of global health ethics. HIV is certainly a global issue, with millions of people infected. The research tackled an issue which may help to improve health outcomes for thousands of people, by preventing the transmission of HIV in utero, therefore presenting disease, which is always better than treatment.

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However, the study was controversial as it included 17,000 pregnant women, and of the sixteen randomised trials, fifteen trials involved a placebo was used as a control.

The ethical dilemma presented in this case is the potential harm that could be created for the unborn children. The global health issue requires assessment of treatment, as a positive outcome may save thousands, if not millions, of children being born with HIV. This would have a significant impact on the lives of the individuals, as well as societies which suffer from high levels of HIV incidences. For research to be valid, it is necessary to compare a treatment against a control, which is usually a no treatment group, although this may also include existing established treatment as a comparison. Therefore, it may be argued there is need for the research which was conducted. However, the research design is controversial, with the utilisation of a placebo. General ethical approaches towards medical interventions usually seek to minimise the potential for harm. In this research, in fifteen of the trials, the control group received only placebos. The placebo should have no medical impact, and therefore mothers receiving this drug were receiving no treatment. This is controversial and three counts, firstly, the mothers themselves may be suffering as a result of taking a placebo, as alternative treatments may have been available. Secondly, the main subject of the treatment; the unborn children, are a particularly vulnerable population, and may have been placed at greater risk as a result of the research. Thirdly, the mothers participating in the study came from underdeveloped nations, where there are low levels of healthcare and low levels of education, so may not have completely understood the potential risks to themselves, as well as to their unborn children. Global health ethics is particularly concerned.....

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