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In their Talking It Over series, Dr. James Read, director of The Salvation Army Ethics Centre in Winnipeg, and Dr. Aimee Patterson, Christian ethics consultant at the centre, dialogue about moral and ethical issues. This is their last column and we thank them for stimulating thought and discussion.

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Dear Jim,

Back in August, the World Health Organization (WHO) put its ethical stamp of approval on administering certain “unregistered interventions” to people afflicted with the Ebola virus. I think many took the news uncritically, perhaps influenced by dystopian movies such as 28 Days Later and Contagion. In particular, I heard Christians respond positively to the announcement, perhaps out of a sense of social justice. After all, thousands of people, mostly in impoverished African nations, were dying of or infected with a contagious disease that had no treatment and could not be prevented. These were people who were also afflicted with extreme poverty and inequality. They deserved whatever assistance was available. Moreover, many were afraid this might blossom into a full pandemic as cases began to crop up in other nations.

It all had the appearance of a bold call to the cavalry. But it wasn't long before the questions nurtured by my bioethics education began to swell within me. Who should receive experimental treatments first—sick physicians or sick patients? Who gets to decide and by what measures? (It turned out that an infected doctor from Sierra Leone was denied an obtainable experimental therapy, while only a few days later another sick doctor, located in Liberia but from the United States, was treated and sent back home to recover.) If a treatment appears to work—or even if it doesn't—will the controls used in drug administration in so desperate an emergency stand up to scientific rigour? How can transparency and accountability be assured? (There was a cloud of suspicion hanging over Samaritan's Purse about how they transported an “experimental serum”—the same serum given to the now-recovered American doctor—out of the United States and into Liberia.) These are only a few questions, but you catch my drift: even in a situation of urgency, answers aren't always so clear cut.

What's your take?

Aimee

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Dear Aimee,

I think that many of us, when we hear of a disaster—especially one that's impacting people who already have few resources for self-reliance—want to do something. We can't just change the channel, and we can't just walk away. We want to do something, anything, to help.

And that's both an admirable reflex and a dangerous one. Lots of harmful and short-sighted consequences can follow. Just after the WHO ruling, there was a rush to send shiploads of nutritional supplements to affected regions with the claim that they might be the cure. I am cynical enough to think it was really just a way to make money by playing on the desperation of poor, sick people. There is absolutely no science to say the supplements cure Ebola. But those promoting the scheme could claim (and did) that there is no science to say ZMapp or other drugs considered by WHO work either.

I am very glad the American missionaries who were returned to Atlanta and who got ZMapp recovered. But did the experimental medication help? Or would they have recovered anyway? Having sidestepped the usual clinical trials for new drugs, it will be very hard to say for sure.

Scrapping the time-tested norms is understandable, however. When I read about the Ebola death rates at a clinic in Liberia run by Doctors Without Borders, I was horrified. At the time of the report, only 61 of 337 patients recovered. The rest died. Elsewhere, 90 percent of those infected die. What other virus has that kind of mortality rate?

At the same time, I learned (and this was eye-opening for me) that one reason the death rate is so high is that the clinics don't have isolation wards, the nurses and doctors have no protective gowns, and there is no efficient way of monitoring and controlling patients' electrolytes (the levels of potassium, chloride and sodium in the bloodstream). If these were available, fewer would get sick and fewer would die. Even without the WHO frantically bending its research-ethics rules.
Ebola is frightening. No question about that. But thinking we would have a cure-all if only we could flood African clinics with unvalidated drugs obscures the realities on the ground.

Or so I think. How about you?

Jim

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Dear Jim,

It's easy to be attracted to solutions that appear heroic. For instance, in our attempts to aid people who are trafficked, we can get caught up in the idea of rescue. But experts in anti-trafficking techniques tell us that, to some degree, trafficked persons have to rescue themselves. They can actually be put at greater risk when fools rush in. We can put our efforts to better use in less dramatic but more valuable ways. We can support anti-trafficking efforts such as those carried out in Salvation Army social services. We can educate ourselves and others. We can build relationships with people who are vulnerable. And, of course, we can pray. A lot of this is preventative work.

There's little difference in medicine. The very term “heroic measures” has taken on a negative connotation. In emergency and end-of-life situations, many treatments and techniques aimed at resuscitating a person or sustaining life are available. But over time we've discovered these measures can also add risk to an already dire situation, sometimes failing to revive and other times leaving a person with exceedingly little in the way of health or “quality of life.” That's one reason why many gravely ill patients have do-not-resuscitate orders. Statistics show that physicians are also less likely to request heroic measures in their own advance health care directives.

The best solutions are not often what we see in the movies—valiant protagonists taking big risks. Proactive measures, like the ones you mentioned, may not offer the emotional return of so-called heroism. But they do have the potential to provide long-term and wide-ranging achievements. As Archbishop Oscar Romero of El Salvador said, “We cannot do everything, and there is a sense of liberation in realizing that. This enables us to do something, and to do it very well…. We may never see the end results, but … we are the workers, not master builders; ministers, not messiahs.”

It doesn't make it any easier to know that people are still dying of Ebola, though, does it?

Aimee

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Dear Aimee,

The risk of all our sensible talk of scaling back our expectations, sticking with proven science, prioritizing prevention over heroic rescues, and so on, is that it will quiet our consciences too much. In realizing that I can't apply heroic measures, the danger is that I will apply no measures at all. And that would be tragic.

When Romero says we are ministers, not messiahs, I think he's preaching a message that takes concerted discipline for people like me to hear. It may require a transformation of our minds.

It used to be that when I read 1 Corinthians 3:16, I got quite chuffed: “Do you not know that you are a temple of God…?” (NASB). To think of myself as God's temple gave my ego a boost. It fitted well with my self-image as the possessor of unnoticed superpowers, able to leap tall buildings, rescue damsels, convert thousands. So, when I discovered that the “you” in the original Greek is plural, and that it means we together are the temple of God, I had to do a theological rethink.
It has taken some time, but for the most part I now think an even more marvelous miracle is at work: God isn't just saving individuals, God is creating a people. And I can be an integral part of it. Similarly, in the face of Ebola, we don't need “more realistic expectations;” we need a community of people pulling in the same direction. (By the way, while writing this, I have been reminded to make my donation through World Missions.)

I don't want to turn the Ebola crisis into a “lesson,” Aimee. The people who are giving their lives and those who are losing their lives deserve better. But, as we file the last of our columns, I need to say thank you to you, our editors and our readers for the realizations that what we do, too, is a co-operative effort, and not something I could do, or would enjoy doing, all alone.

Grace and peace in abundance!

Jim