Third World ethical challenges for the First World

By  Bridget Campion, Catholic Register Special
  • November 30, 2011

When I began work as a health care ethicist more than 20 years ago, the discipline was focussed on two main issues: respecting the rights of individual patients, particularly through the practice of informed consent, and working through issues posed by the growth in medical technology. Artificial organs, gene-altering therapies, conceiving children in Petri dishes sounded like the stuff of science fiction. But they were real and ethicists grappled with questions of limits, of preserving human dignity, of trying to understand what death meant when a body could be kept warm and breathing almost indefinitely. This was medical ethics in the first, or developed, world.

Doctors Abdallah Daar and Peter A. Singer, in their book The Grandest Challenge: Taking Life-Saving Science from Lab to Village, take us to a very different world — one where each year one-million people die of malaria, 9.4-million people are diagnosed with tuberculosis and 1.5-million children die of diarrhea brought on by infection and parasites. They take us to the developing world, the poorer regions of the globe where the effects of poverty cause people to be far sicker and have shorter lifespans than their counterparts in the developed world. It is where 90 per cent of the world’s population live and, until recently, was ignored by health care researchers. Thanks to people like Daar and Singer, this is changing.

The Grandest Challenge describes the very personal experiences that led the authors to question the deep disparities that exist in health care as it is practised globally, and traces their efforts to lessen the gap. For them, the solution lies (at least in part) in applying the discoveries of biotechnology to health concerns in the poorest areas of the world, involving scientists and researchers from affected countries in these projects and pursuing partnerships with private companies.

As Singer and Daar point out, simple childhood inoculations illustrate the disparities. As they are administered now, vaccines usually require multiple visits to a doctor, are given by injection (necessitating sterilization procedures and skilled persons to give the shot), require refrigeration and must be transported to clinics. As well, the vaccines we are accustomed to receiving, and which are given to children in the developing world, do not target the diseases that ravage poorer countries: malaria, tuberculosis and HIV. Vaccines, like most of medicine, have been developed with the needs and capacity of the Western world in mind.

Approached by the Bill and Melinda Gates Foundation, Singer and Daar gathered experts from around the world to identify the grand challenges that must be met and devise research projects that would build upon the findings of Western biotechnology to solve those challenges. For instance, one researcher suggested working on vaccines that could be administered in one-time oral doses that needed no refrigeration. Other scientists proposed using the finding of genetics to modify mosquitoes and the parasites they carried in order to halt the spread of malaria. Another scientist wanted to pursue genetically modified foods in order to enhance their nutritional content.

As they continued to work with groups world-wide, Daar and Singer saw the importance of building infrastructures within developing countries that were sensitive to the culture of communities and would encourage local growth in the business of health care — including partnerships with multinational corporations. Singer and Daar now head the Canadian Grand Challenge Program at the McLaughlin-Rotman Centre for Global Health in Toronto.

People who question the ethics of an industrialized model of health care in the developed world and who find biotechnology more of a threat than a promise may question some of the solutions proposed in The Grandest Challenge.

As Catholics, we are not against technology per se but must be careful that it does not undermine human dignity nor take priority over human beings. As well, we do not believe that ends, no matter how noble, justify illicit means, such as the use of embryonic stem cells for genetic modification of malaria-carrying mosquitoes. (Ultimately, researchers turned to adult stem cells in that particular project). 

But what Singer and Daar show us in this vivid and well-written book is a picture of our neighbour — of our sisters and brothers who have been left at the side of the road, ignored by those passing by.

My belief is that, with an increasingly global perspective on health care, health care ethics must now turn its focus to the larger questions of social justice. In this respect, The Grandest Challenge is an accessible, informative and valuable resource.

(Campion is a bioethicist in Cobourg, Ont.)

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