The Limits of Patient Autonomy
The paper did not mention observed side effects of the drug, if any. American patients are told the following about potential side effects:
- Nausea, vomiting, abdominal pain, headache, or temporary hair loss may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.
- Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.
- Tell your doctor immediately if any of these unlikely but serious side effects occur: vision changes, yellowing eyes/skin, severe stomach/abdominal pain, dark urine.
- Tell your doctor immediately if any of these rare but very serious side effects occur: unusual tiredness, easy bruising/bleeding, signs of infection (e.g., fever, persistent sore throat), change in the amount of urine, severe/persistent headache, seizures, confusion, very stiff neck.
- A very serious allergic reaction to this drug is rare.
- However, seek immediate medical attention if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.
Circumstances, then, alter both medical conduct and ethics.
Of course, 16 percent of the refugees given the drug benefited from it, in that their worms were eliminated and infestations are deleterious for health. Moreover, there would have been possible public health benefits to the administration as well, because people who do not have worms cannot spread them to others.
It is difficult to work oneself into a lather of indignation about the whole business; but from the point of view of medical ethics, the paper is certainly not without theoretical interest.