“He (Trump) deserves special treatment by virtue of his office. The question is whether it’s good treatment.”
– George Annas, head of Boston University’s center for law and health ethics
“The public is getting mixed messages about his condition and that’s a problem,” Annas said, adding that there’s a right to know anything that could affect Trump's ability to do his job.
Donald Trump has COVID-19. Just how ill is (was) the president? That question may seem somewhat invasive and less important to some, but, considering the ethics involved, the answer is critical to a nation suffering from a deadly pandemic. Truth and transparency is critical
Ethics and medical experts believe the public has the right to know more about Trump's condition – largely because he received special treatment to access an experimental COVID-19 drug. His treatment raises fairness issues that start with the flawed health care system many Americans endure,
Regeneron Pharmaceuticals Inc. revealed on October 6 how rare it was for anyone to get the drug it gave Trump outside of studies testing its safety and effectiveness. The drug, which supplies antibodies to help the immune system clear the coronavirus, is widely viewed as very promising
Trump also received the antiviral remdesivir and the steroid dexamethasone, and it’s impossible to know whether any of these drugs did him any good.
Marilynn Marchione, AP Chief Medical Writer, reported …
“Trump’s doctors asked for the Regeneron drug under 'compassionate use' rules, which allow a patient with a life-threatening disease to get an experimental medicine if they can’t enroll in a study testing it and there’s no good alternative.
“Trump was given the drug at the White House on Friday before he was taken to Walter Reed National Military Medical Center. Walter Reed is not a site where the drug is being tested, so he may have met that criterion on technical grounds. Had he enrolled in a study, he would have risked being randomly assigned to a comparison group getting usual care rather than getting the drug.”
(Marilynn Marchione. “Ethicists say Trump special treatment raises fairness issues.” ABC News. October 07, 2020.)
Marchione explained that compassionate use requests are decided on a case-by-case basis, and both the drug company and the U.S. Food and Drug Administration must agree. An FDA spokeswoman refused comment on the FDA’s decision or to say how many others have asked for the drug.
Access To Regeneron
Fewer than 10 of these requests have been granted, said Regeneron spokeswoman Alexandra Bowie. The drug is in limited supply, the priority is using it for the ongoing studies, and emergency access is granted “only in rare and exceptional circumstances,” she wrote in an email.
Regeneron also contacted Democratic presidential nominee Joe Biden’s campaign “to make them aware of the compassionate use mechanism, should they need to apply” if Biden becomes infected, Bowie wrote. “There was no promise of access to the medicine,” she added.
Alison Bateman-House, an ethicist at NYU Langone Health, said Regeneron’s overture to Biden raises concern. Bateman-House says …
“That crosses lines of appearing to promote a potentially unapproved product” in violation of FDA rules. Rather than directing people to enroll in studies, it suggests 'just call us up and we’ll cut the line for you' …
“(Trump’s medical team) has not met their moral responsibility to the American public (to be honest and forthcoming on his health) … You forgo much of your privacy when you become president.”
(Marilynn Marchione. “Ethicists say Trump special treatment raises fairness issues.” ABC News. October 07, 2020.)
As for Trump, “it’s not clear to me that this was an emergency situation,” said Dr. Steven Joffe, medical ethics chief at the University of Pennsylvania. Joffe says …
“I think there is something wrong with the privileged, the president, getting special treatment that’s not available to the rest of us. There’s so much injustice in our health care system, with so many people not even having access to the basics, that the favoritism shown Trump is 'a symptom of a much larger problem' … We’re certainly getting a very confusing picture. There are aspects of the story that don’t seem to fit together …
“The White House has an obligation to provide the American people with a clear picture of the health of the commander in chief during a health crisis, even if it withholds specific details such as his moment-to-moment vital signs.”
(Marilynn Marchione. “Ethicists say Trump special treatment raises fairness issues.” ABC News. October 07, 2020.)
Prior Ethical Problems
People not having access to the basics? Trump's moral responsibility? This is not the first incident that poses questions about Trump and the issue of medical ethics.
In 2015, Trump’s longtime physician, Dr. Harold N. Bornstein, told CNN that Trump that a letter suggesting that Mr Trump would be the "healthiest individual ever elected to the presidency" was not his professional assessment. Dr Bornstein said that Mr Trump "dictated the letter" to him. Trump’s willingness to lie to circumvent and subvert a critical vetting process, to baldly misrepresent himself by using people like Bornstein for his own gain, raises questions about his morality; his sense of honesty, transparency, decency, and accountability.
Then, in 2017 Dr. Bornstein told NBC News he was visited by one of Mr Trump's personal bodyguards, whom he identified as Keith Schiller, and two other men at his office on 3 February 2017. Bornstein said the president's aides took the original and only copy of Mr Trump's medical records, including lab reports.
While the White House has insisted the incident was not a raid, and was just "standard procedure," Dr Arthur Caplan, professor of bioethics at New York University, said it is a doctor's right to keep a copy of patient medical records. Caplan said …
"In the U.S., medical records are joint property. They do belong to the patient who can have a copy, but the doctor keeps one too because if an issue comes up about malpractice, they have to have the record. You can't just come in and take away everything."
(“Trump's health: Three big ethics questions.” BBC News. May 02, 2018.)
And, of course, Trump has stormed past accepted professional practices and triggered alarms about ethical decision making by caregivers, as he persists in his advocacy for treating seriously ill patients with COVID-19 infections with an unproven pair of prescription drugs – chloroquine and hydroxychloroquine.
In response, Dr. Anthony Fauci, one of the nation’s foremost infectious disease experts at the National Institutes of Health, has insisted such prescribing has no basis now, and, at best, should be subjected to rigorous clinical trial to determine their effectiveness.
Making COVID-19 matters worse, Trump and the GOP have slashed at the Affordable Care Act, Medicaid, Medicare, and other programs that seek to assist Americans with their health care. The administration also has pushed the federal Food and Drug Administration to hurry up what has been rigorous testing of prospective prescription medications, so potentially beneficial – and yes, harmful, too – meds can get to consumer markets.
(Patrick Malone. “Trump storms into medical-ethics minefield by flogging drugs’ untested use.”
JD Supra. March 24, 2020.)
Issues in medical ethics often involve life and death. Serious health issues are raised over rights of patient, informed consent, confidentiality, competence, advance directives, negligence, and many others.
Ethics deals with the right choices of conduct considering all the circumstances. It deals with the distinction between what is considered right or wrong at a given time in a given culture. Medical ethics is concerned with the obligations of the doctors and the hospital to the patient along with other health professionals and society.
Trump's Treatments
Right and wrong? If Trump's symptoms were mild, why were special treatments used and protocols ignored? Trump received this special care while flaunting public health advice about wearing a mask and other steps to curb the spread of the virus. He had an obligation to follow the safety rules and to set a good example – he is guilty of violating medical ethics on both counts.
If the opposite is true and Trump was gravely ill, why wasn't the American public informed of his true condition? Did he have a hand in the deceitful manipulation of information deemed of utmost importance to the public? Considering confirmation of the many lies and massive misinformation campaign of Trump and his administration, no one can be certain of the details of the Trump COVID-19 story.
As he left Walter Reed and returned to the South Portico balcony of the White House, Trump demonstratively removed his mask, indicating he has personally vanquished the virus while stating: “Don't be afraid of COVID.” (“President Donald J. Trump Defeats COVID” coins are going on sale for $100 at the White House Gift Shop.)
Meanwhile over 216,000 Americans have died from the virus, and key forecasts predict over 410,000 total U.S. deaths by January 1, 2021. Will those who really need “special treatment” be given the same opportunity for recovery as the president? Considering the history of actions from the executive branch, the nation is left with that unanswered question. It requires life-and-death ethical consideration. “Ethical” is not a word I have ever heard associated with President Donald Trump.
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