Ethics of Scarcity or the Scarcity of Ethics

Ethics of Scarcity or Scarcity of Ethics is an engaging journey into the arena of child health research in the poor nations of the Global South. In contrast to most books on the topic, it covers the ground from micro-ethics to macro-ethics, from conservative realism to radical realism, and from immediate causes to systemic, root causes. Written in a readable and revealing style by a retired Professor of Medical Statistics, it was catalyzed by a study of bodily measures like chest circumference to identify babies of low birth weight in settings where a weighing scale is not available. Done by two pediatricians and the author at the Muhimbili National Hospital in Dar es Salaam, Tanzania, it was, at the outset, deemed a scientifically valid and ethically laudable undertaking.

The book begins with a sanguine interaction between the two doctors and the author that led to the design, conduct, analysis and publication of the study. Yet, later revelations raised questions about its ethics and rationale. These doubts stimulated the author to undertake a comprehensive survey of the literature on low-birth-weight studies. Not only was general the scientific quality of the reviewed studies found to be substandard but also their adherence to the tenets of the Nuremberg Code of research on human subjects was deemed seriously wanting. 

The rationale driving these studies embodied the ethically and factually dubious notion of scarcity of resources. The misuse and abuse of resources that often lie at the root of the health maladies in the poor nations were not examined. It was not asked why poor nations have large military budgets but not a key item like a weighing scale in rural clinics. Instead, a proxy measure to replace direct weighing was sought. 

The book shows that health research in the poor nations often superficially addresses or ignores fundamental features of the societal context. In places where respect for human dignity is violated with impunity, the researchers focus on formalized informed consent. Consent from the authorities is taken as a valid substitute for individual consent. The double standards employed by Western researchers who conduct studies in the poor nations are exposed with the help of several examples.

The book underscores the need to avoid elitist approaches to ethics and probe the root causes of health maladies, raise systemic issues, ask critical questions and genuinely respect human dignity when undertaking health studies. 

Noting that the global health and medical professions have at present largely ignored the wanton, deliberate destruction of clinics and hospitals in Palestine, and the torture and murder of nurses, ambulance drivers, doctors and even hospitalized patients, the book asserts that its ethical standing has been seriously compromised. Ethics cannot be fragmented. In this neoliberal era, it is not resources that are scarce but ethics that are scarce. 

The primary ethical principle promoted by this book is:

The first step in the evolution of ethics is a sense of solidarity with other human beings

—Albert Schweitzer

And the central spirit it encapsulates is:

Be Realistic, Demand the Impossible!

Ernesto Che Guevara