Dilemmas in Access to Medicines: A Humanitarian Perspective – Authors' Reply

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Sturm College of Law


Access to treatment, Global health


Our Viewpoint argues that expanding access to less effective or more toxic treatments is supported not only by utilitarian ethical reasoning but also by two other ethical frameworks: those that emphasise equality and those that emphasise giving priority to the patients who are worst off. Accordingly, we disagree with the suggestion by Smith and Aloudat that our Viewpoint interprets the issues at stake through a single ethical frame. In any case, however, the principles of beneficence and non-maleficence proposed in their letter would likewise support expanding access to less effective or more toxic treatments. Expanding access to such treatments is more beneficent than leaving some patients untreated. And refusing to provide these treatments because one fears causing harmful side-effects is akin to refusing to operate on a patient because one fears inflicting pain: it represents an overemphasis on non-maleficence so grave to be a dereliction of duty.