A Bioethics Exercise

[mmmcdowe]

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Hey all, so I've been interested in bioethics and the question of what makes good doctors/medicine for a while now, and the recent Flu panic has got me thinking. I have devised the following scenario and I would be interested in other people's opinions. For those who are interviewing this year, perhaps you will get some good practice from this. I got a couple ethics q's on the trail.

A series of studies have recently been published on the leading brand of commercial facemasks, commonly used during pandemics and epidemics.

1) 25,000 lives in the USA alone are saved by the use of these masks each ear.
2) The masks have been clinically proven to not reduce an airborne virus's ability to be enter and infect a new host. The masks do, however, decrease the transmission from an infected to others around him/her.
3) Prevention is cited as the primary reason for consumers to buy these masks. The masks are also advertised for their ability to prevent one from becoming sick (the company's lawyers argue that, as the masks prevent transmission to new hosts if someone is wearing the mask, this is technically true as the advertisement does not cite that it is the WEARING of the mask by the uninfected that helps prevent one from catching the disease, and therefor it is also reasonable to assume that others wearing the mask is the cause of said prevention).
4) A study shows that those who believed the that the masks are preventative are much more likely to have purchased the masks before becoming sick are very likely to continue to use the masks once sick, in order to "prevent more sickness." However, those who are informed about the masks' inability to prevent infection are far less likely to purchase or use the masks before or after being infected. This is especially true among demographics which are most susceptible to fatalities from viral infections.

My question for you all is what should doctors do? Do we allow the perpetuation of an incorrect belief, or do we correct this belief at the cost of thousands of lives? Do we pursue the company?

Think carefully 🙂

 

[VneZonyDostupa]

If the masks are, in fact, preventing transmission from host to host, why wouldn't you want to encourage people to wear them during a pandemic?

Also, wonderful sig, haha.

 

[mmmcdowe]

Because of the fact that encouraging this use requires physicians to willingly allow patients to be ignorant of the functionality of such masks. They think that they are directly protecting themselves by wearing them, and this is not the case. The masks don't block a virus that is already airborne. Education is also a principle of medicine, not just healing. While it may be that physicians save lives, they are also withholding information "for their own good." This has proven to be a bad idea many times in the past, and is unethical in some ways. This isn't necessarily my view, but simply a response to your post.

 

[johncalvin]

I don't have a direct answer per se, but perhaps we can arrive at an answer by looking at vaccinations:

While getting vaccinated definitely prevents YOU from getting infected, many vaccines are subsidized by public agencies because it actually benefits everyone around you. It's the case of what economists call "positive externality."

Therefore, if these masks are heavily subsidized, I think most people would opt to wear them even after knowing that it may offer direct benefits to them.

Explain to a mother, for example, that wearing the masks will protect her children, or others who may come in contact with your family, etc. is usually enough for someone to wear an inexpensive or free mask.

 

[Trexate]

Thought provoking scenario. I imagine the conversation of mask efficacy doesn't come up much in a doctor - patient conversation. If it did, I would tell them the truth, including the study about how people are less likely to wear them. I would then encourage them to purchase some to have on hand in the event they do get ill, to prevent it from spreading.

However, I don't think parading around the fact that masks don't prevent you from getting sick is a good idea either.

"A woman has two children, and a homicidal maniac tells her she can only keep one. Which one does she let him kill?"

 

[mmmcdowe]

What this really is a question of, like so many debates of the today, is how much are doctors resposible for their patients relative to their responsibility to society (giving antibiotics for everything at the cost of evolving far more dangerous and resistant strains abroad, for example). A doctor is ethically, and I would bet legally, bound to tell the patient this so that the patient has the ability to make their own decisions about their health. At the same time, giving every patient this ability effectively kills thousands of others.

 

[Premed Worrier]

I understand the question and think it is a good one. I don't really know the answer, but I would have to say that it probably is not right for a doctor withhold the information of how it obstructs transmission. If you step back from this situation and ask 'Is it okay for a doctor to withhold information from patients in all similar scenarios?' (similar usually being a pretty loose term) You would probably say no since it is a physician's responsibility to inform the patient as well as possible in layman's terms (informed consent). Just my thoughts.