Friday, 12 August 2022

Monkeypox and medical ethics

You are not been alone if you’ve noticed that the public health establishment’s reaction to the monkeypox outbreak has been rather different from its reaction to COVID-19. In the latest episode of Last Orders, Tom Slater drew a parallel with the summer of 2020 when the public health establishment’s attitude towards large gatherings was firmly negative if it involved a loved one’s funeral or a child attending school, but strongly positive if it involved protesting for a fashionable cause.

An article in the current issue of the British Medical Journal criticises the medical response to monkeypox. Written by a New York physician, it highlights several shortcomings which require action: patients are waiting too long to get swabs and vaccines, and suspected cases are told to self-isolate “without being provided a place to isolate, a non-stigmatizing medical reason or note to provide to their employers, or financial protections for work missed.”

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These problems are relatively easy to solve with some money and effort. I have nothing to add to his recommendations, but my eye was drawn to the conclusion of the article in which he appeals to medical ethics:

And lastly, we must recognize that the least stigmatizing and least homophobic approach to this infectious disease is to provide individuals with information on how it spreads and what steps can mitigate their risk of disease. Our patients have the autonomy to figure out what’s best for them. As a healthcare community, it’s our job to help individuals make informed decisions about what they want to do with their bodies, and provide empathetic care regardless of what that decision is. As doctors, we must show the basic compassion that is missing in all of our policies for monkeypox.

This seems to me to be a reasonable and liberal approach. Indeed, since the author is talking about infectious disease, one might almost describe it as ultra-libertarian. No mandatory vaccines this time around.

Monkeypox is not COVID-19. It is much less deadly and far less transmissible. It is not going to bring any health service to its knees. 

And yet it is quite a nasty infectious disease which carries negative externalities, costs money and puts a burden on the healthcare system. If giving people the facts and letting them make their own decisions is the best approach with this contagious disease - and I agree that it is - it would be inconsistent and unethical to demand government coercion against individuals making “informed decisions about what they want to do with their bodies” when those decisions have little or no effect on other people and when the diseases involved are non-communicable.

I am not familiar with the author of the BMJ article. For all I know he could be a prominent campaigner against the nanny state in New York. If so, he has his work cut out. New York’s former mayor, Michael Bloomberg, tried to ban large servings of sugary drinks. Its last mayor, Bill de Blasio, successfully banned the sale of flavoured vapes. It is illegal to smoke in Central Park, a tract of land that is nearly twice the size of Monaco. 

I, for one, applaud the author’s call for a humane and liberal approach to risky lifestyle decisions and am heartened to see his views appear in a journal that has not always cherished such principles. I look forward to the public health establishment basing policy recommendations on free choice and individual autonomy in the future. 

Our patients have the autonomy to figure out what’s best for them. 

Thank you, brother.

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