Opinion - Health
5:17 pm
Wed August 13, 2014

The Business of Ebola

IPFW Associate Professor and medical ethicist Abraham Schwab.
IPFW Associate Professor and medical ethicist Abraham Schwab.
Credit Courtesy / Abraham Schwab

As we all know, two individuals infected with Ebola now reside in Atlanta, Georgia. After they were identified as infected, they were flown to Atlanta in a special containment plane and then taken to a containment unit at Emory University.

Once at Emory they received an experimental serum, ZMapp, which, in animals, has been effective in eradicating the disease in individuals.

Those two patients appear to be doing well. But a third patient who received ZMapp -- a Spanish priest -- passed away August 11.

These three individuals received world-class treatment compared with the nearly 1,000 who have died and the 1,800 or so who have been infected. More was spent on treatment for the two Americans (upward of $2 million) than has likely been spent on all the cases in Africa combined.

This inequality has led medical ethicist Art Caplan to raise some serious questions about the justice of our use of healthcare resources. Why should these three individuals get special treatment? What makes them special when so many are dying elsewhere?

Whether or not these two Americans and this Spaniard should receive such lavish care, we know why they do: money. Samaritan’s Purse and SIM USA were able and willing to pay for the care of the two Americans. As a result, they were effectively quarantined, they received better care, and they received the experimental serum.

Physicians and other medical professionals still in Africa would like better care for their patients and future patients. They would like to have units to effectively quarantine all those infected, to provide the experimental serum to those recently exposed, and to help their patients get well. But without access to the necessary resources or funds, these hopes for their patients will remain unrequited.

While it might be nice, laudable, and praiseworthy for the companies who have access to the necessary equipment, resources, and treatments to offer these to the infected individuals in Africa, it’s not expected of them. While we regularly expect physicians and other medical professionals to risk themselves for patients, we don’t require the same things of health related businesses.

A Different Case / A Similar Story

In January of this year, the Justice Department joined several lawsuits against Health Management Associates (HMA) alleging fraud among other activities. In the New York Times coverage of the suits, they lead off with a single activity: a scorecard that HMA allegedly employed to pressure their Emergency Room Physicians. These scorecards ranked ER Physicians on their percent of admits for patients over 65 years old.

Here’s how it worked—ER physicians who were admitting 50 percent or more of their patients were coded green, physicians who were short of 50 percent but close were coded yellow, and physicians who were deemed too far away from 50 percent were coded red.

What obligation, what responsibility, or what moral rule has HMA failed to live up to by using these scorecards?

It’s hard to read HMAs actions as anything short of interfering in the doctor-patient relationship. Physicians should admit patients to the hospital based upon their medical condition, not based on whether they’ve admitted 40 percent or 20 percent or 80 percent of their previous 100 patients.

And yet, it’s also hard to see what, exactly, is wrong about the HMA’s alleged use of these scorecards. What obligation, what responsibility, or what moral rule has HMA failed to live up to by using these scorecards?

By encouraging physicians to admit patients, HMA aimed to increase their profitability. We expect nothing less of a business. To require them to do otherwise would be to require them to sacrifice their business interests for concerns of what makes good medicine.

Connecting the Dots

In the case of the Ebola outbreak, we, as a collective group, might decide to provide for the care of all Ebola victims, we might decide to pay for a ramped up production of serums to attenuate the disease, but to do so will cost a lot of money. The ZMapp serum will be expensive to produce, to handle, and to distribute. We would be out of line to expect a private business to shoulder such costs for our purposes.

HMAs efforts to improve its bottom line might strike us as unseemly and undesirable, but they are acting exactly as a for-profit business should. The scorecards might lead to less optimal patient outcomes, but the same could be said of the failure to provide serums, vaccines, and infrastructure. On what grounds do we require HMA to sacrifice their economic well-being but let these other businesses off the hook?

 

Abraham Schwab is an associate professor of philosophy and medical ethicist at IPFW.

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