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8 The Moral Case for Eradication Claudia I. Emerson …it’s clear that though eradication rests firmly on both chemistry and entomology, it depends even more heavily on human beings. —C. A. Needham and R. Canning (2003:22) Abstract This chapter considers the question of whether there is a moral imperative to pursue disease eradication once we have the means to achieve it. It examines three arguments that support the case for eradication from an ethical perspective: (a) the duty to rescue, (b) the duty to future generations, and (c) the notion of disease eradication as a global public good. It concludes that where disease eradication is possible, ethical motivation offers compelling reasons to act that cannot be dismissed without incurring moral liability. Ethical considerations should thus be weighed in the balance of reasons that inform decisions about whether or not to pursue disease eradication. Introduction The eradication of smallpox, hailed as one of the greatest achievements in the history of medicine, continues to inspire efforts to eradicate other diseases that cause immense human suffering and death. It is a testament to the evocative power of eradication that campaigns to eradicate diseases (e.g., polio) persevere despite the many challenges that must be overcome. The challenges are complex: scientific, technical, economic, political and sociocultural. Within the sociocultural strand, we can locate the ethical considerations that relate to disease eradication efforts. Some of these considerations reflect ethical issues that arise in the context of mass immunization programs, such as risk and benefit, adequacy of informed consent, the tension between individual and collective interests, transparency, and questions of resource allocation (Verweiji and Dawson 2004; Dawson 2009; Ulmer and Liu 2002; Paul 2005; Paul and Dawson 2005). Analyses of these issues have been presented by others and those arguments will not be repeated here. Instead, this chapter will reflect on the broader question of 104 C. I. Emerson whether there is an ethical imperative to pursue disease eradication once we have the means to achieve it. If there is an obligation to pursue disease eradication, on what grounds can it be justified? The aim of this chapter is to present ethical arguments that support the case for eradication.1 It is not claimed that ethical arguments alone make a case for eradication—ethical grounds are necessary, but insufficient. The goal is to examine ethical considerations that are compelling enough to warrant inclusion in the decision-making process. Elsewhere the ethical case for completing polio eradication has been considered (Emerson and Singer 2010), which alongside sustained analyses of the economic and scientific feasibility (Thompson and Duintjer Tebbens 2007; Barrett 2004) make the case for eradicating polio. Those arguments shall be considered in greater depth and extended to the investment case for disease eradication more generally. In many ways, polio is a paradigm case from which insights can be drawn: it is an eradicable disease that has proved elusive to eradication. It is against the backdrop of prospective eradication with its inherent technical, economic, and sociopolitical challenges that the analysis is situated.2 Obligations to rescue and to future generations, as well as the notion of disease eradication as a global public good are examined from an ethical perspective. The conclusion is that where disease eradication is possible, ethical motivation offers compelling reasons to act that cannot be dismissed without incurring moral liability. The implication is that ethical considerations should be weighed in the balance of reasons that inform decisions about whether or not to pursue disease eradication. Why Are Ethical Arguments Needed? Disease has been called the true serial killer of human history, having affected more human lives than war, famine, and natural disaster (Dobson 2007). Few would readily contest that eradicating disease to save countless lives from disability and death is the right thing to do if achievable, and if doing so would not have detrimental effects on other goods on balance. Why, then, would ethical arguments in support of disease eradication be required? Articulating the ethical arguments that support eradication serves several purposes. 1 Disease eradication is not referred to here as a general strategy, but rather those instances where eradication is an appropriate strategy for a specific disease, where all of the criteria for the disease to be deemed eradicable have been met. Moreover, the question is concerned with choosing eradication over control efforts, not with choosing between different potential targets of eradication. This latter question is complex and merits its own analysis...

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