Ethics of scarcity

February 10, 2007 at 1:40 am (Sarah's Posts)


My university is undergoing a fairly large survey (2,400 kids) in the city of Pune to determine polio vaccine coverage during the most recent national immunization day (NID). The city is broken up into wards, and each ward is covered by an immunization officer. We’re finding pretty high overall coverage rates (I don’t have the exact numbers yet, but it is somewhere around 95%), although the survey is a little self-selecting because we’re using houses as the starting points which misses out on all the migrant workers. For polio, they are the ones that are of most concern and are responsible for most disease spread. But, at the least it has been a very informative and interesting exercise that brought us to an ethical dilemma.

The chief immunization officer for the city wanted to hear about our survey and started asking questions. Now, from his point of view, he would love to have information on exactly which children haven’t been vaccinated because then he could make sure to cover them in the next NID. So, is it ethical for us to give him that information?

My first response was a Big No Way. People underwent the survey with the understanding that we are university students who are trying to determine coverage rates, not that we would send immunization officers to their houses. I think that you’d be sent packing by any ethical review board in the states based on not getting consent to give out personal information.

On the other hand, my professor felt strongly that we should give him the information. In her mind, it is unethical to waste the money of an already stretched public health system by keeping the information to ourselves, leaving children who could potentially spread the disease. To that end, I didn’t come into contact with anyone who thought that immunization was wrong or didn’t want it. People mostly just missed the NID and thought that they would get covered in the mop-up sessions where volunteers go door-to-door with the vaccine. Still, even if nobody would protest in this case, I think that it could be dangerous to set the ethical precedent that individuals don’t have a right to their personal information.

In my mind, there is a balance in this situation where we could give out the information about any wards that weren’t well covered, but that still leaves a huge number of people that need to be combed through in order to ensure high coverage. Does scarcity affect the right of the individual to their privacy when it comes at the expense of the public good?


1 Comment

  1. msoule said,

    I think that this ought to be a consideration in further studies conducted by the university or other organizations that are monitoring these things. It would be easy to build in a little part of the survey that asked whether it would be ok to pass the immunological status information along to the public health authorities. There’s no possibility of invasion in that case.

    That’s the future, though. In terms of what ought to be done in the present with this information, I think that it ought to be shared. The broader question of whether poverty disallows you privacy, I think that you are correct to say that it’s a dangerous precedent. Poor people are getting stepped over enough without the bureaucracy poking its nose at them whenever it pleases and in whatever way it pleases. So certainly, the best effort should be made to respect them. Which is why, in the future, there should be a clause that ensures that respect. However, in terms of what ought to be done NOW, I think this information is more valuable than the comparatively small invasion of privacy.

    We also should remember that, as Americans, we are arguably more obsessed with our privacy than other people. I don’t want to make anthropological statements that I can’t really back up, but that’s my feeling about it. Not everybody has HIPAA. Not to deny that we should respect the personal space of poor people just as much as we should everyone. Just a thought.

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