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An Ethical Analysis of Merck River Blindness Case

Case Facts

Merck is among the largest global pharmaceutical companies. The company is established in Whitehouse Station, New Jersey. The enterprise is renowned for its mass production of scientifically approved medications. The company employs a labour force of over 62,300 people (Basáñez et al. 2006). The Merck pharmaceutical company is also known for the production of drugs aimed at reducing and curing of a tropical disease found in the Central Africa and Central Asia (Beauchamp, Bowie & Arnold 2004). The tropical disease is commonly known as river blindness, while scholars call it onchocerciasis (Basáñez et al. 2006). People suffering from the river blindness disease usually show symptoms such as itchiness and blindness.

The Merck company produces goods that have also received governmental support to market and advertise their products all over the globe. Due to this, the company realised the pick of its profit and was able to increase an annual income up to two billion dollars in 1994 (Beauchamp, Bowie & Arnold 2004). The enterprise received support from the government due to the fact that the production of the pharmaceutical drugs had a scientific approval. The company later decided to use over one hundred million dollars in the production of the orphan drug. The scientists tested the medication on both animals and human beings, who were used as subjects in the test. The experiment was conducted to enable the scientists to identify if the medication could cause adverse effects for the health of the specimens. The first animals that were subjected to the drugs were mice and rats rather than cats and dogs (Beauchamp, Bowie & Arnold 2004). The mouse tested for the drug efficiency showed both negative and positive effects from the treatment.


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The orphan medication was very expensive and rare to find in the health institutions. In 1990, the medication of the river blindness disease was not available for the patients inflicted by the disease. Not only was it out of reach for common people, but even the government could not go to the expense of purchasing the medication for the population. Moreover, the river blindness disease also adversely affected the impoverished in the society. Finally, Merck decided to market and sell the drugs at a price that the consumers could afford. Consequently, the medication was offered at no expense to the consumers (Basáñez et al. 2006). The river blindness disease is also experienced in the third world countries. The countries are economically poor; therefore, they cannot support patients affected by the disease. The economic issues have created a dilemma for the population and also made them desperate to find the solution for their health problems.

In 1980, many researchers identified that the Mectizan, a drug claimed to reduce the effects of river blindness, had failed. However, the researcher Dr. William Campbell saw the possibility of the drug to have positive results on the treatment of the disease. The scientist used over $500,000 in his research to find a solution to the menace. The Mactizan drug was designed to kill the microfilaria found in the blood. The dilemma faced by Dr. Campbell was if the same drugs would have positive results when used by human beings.

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Ethical Issues

During the research, Dr. Campbell had to seek support from the board of directors of the Merck company. However, his research was accepted by the directors in an effort to mitigate the disease. The main ethical issues faced by Dr. Campbell was that he had to subject human beings to the drug in his tests, which was done in order to identify if the drug had better outcomes. Dr. Campbell conducted a research which seemed to have no commercial potential to Merck. However, the use of Mactizan faced both financial problems and ethical concerns. The medication was then tested on desperate people who volunteered for the tests. The people who volunteered also had no information about the possible side effects of the drug which included the possible outcomes. The patients who received the drug were also left to be analysed by physicians and nurses. The physicians monitored and motivated the patients. In return, the physicians and nurses were also exposed to acquiring the same disease that they were treating.

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Ethical Dilemma

The main ethical dilemma faced by Dr. Campbell in the treatment of the river blindness disease is:

To proceed with the treatment of river blindness


Not to proceed with the treatment of river blindness

Dr. Campbell, as the researcher, is the one responsible for making the decision. He is also responsible for the effectiveness and efficient treatment of river blindness in Merck. Merck is also faced with the possible undesirable results for the ethical dilemma options. To identify if the treatment of the river blindness is efficient, the volunteers will either have to survive or die from the Mactizan medication. Merck also faces financial problems which may lead to the board of directors stopping supporting the initiative till the end. The alternative, not to proceed with the medication, will lead to more people losing their lives. Dr. Campbell is also going to lose his relevance as a researcher. Merck is also possibly going to lose its prominence in the fighting the disease. The government is also expected to take responsibility for treating the patients. This can undermine the government’s reputation since it has no power to mitigate the disease.

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Ethical Analysis

Utilitarian Approach

The utilitarian theory analyses the outcomes of each dilemma option for all the participants directly or indirectly affected by it (Smart & Williams 1973). According to the utilitarian approach, a decision can only be considered right when it is for the greater good of the majority (Mill 2010). This means that the utilitarian approach believes in the prevalence of pleasure over pain for every person affected. Moreover, the approach is interested in the predictable consequences. The actions are usually measured and analysed in order to choose the option which creates the bigger good for the dominant population (Ferrell & Gresham 1985).

The affected participants in the treatment of river blindness include Dr. Campbell, Merck/ the board, the government, employees (physicians and nurses) and the patients.

The Consequences of Proceeding with the Treatment of River Blindness

Firstly, Dr. Campbell is expected to receive criticism if the medication does not show any positive improvements for people’s health. This move is also expected to increase employment of physicians and nurses who will take care of the patients. Secondly, the Merck is likely to become bankrupt since the medication cost is wholly covered by the pharmaceutical company. Thirdly, the government is expected to grow economically, and it will also gain relevance when the population gets treatment. Moreover, the nurses and physicians are expected to contract the same disease that they are supposed to medicate. The firth consequence is that the patients will improve their health.

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The Consequences of Not Proceeding with the Treatment of River Blindness

Firstly, Dr. Campbell will lose relevance as a researcher. The board is also expected to stop supporting the initiative when financial obligations are out of reach. Nurses and physicians are also likely to become jobless if the program is not available. The government is also expected to lack political relevance since they are not able to help mitigate the disease. The patient’s mortality rate is also expected to increase.

Kantian Approach

The Kantian approach implies that rational beings should honour other rational beings when making decisions without considering consequences (Secker 1999). The analysis approach is examined by the maxims which rational beings can follow without challenges (Köhnke 1991). For Dr. Campbell the maxim is:

To always respect the patient’s interests


To never respect the patient’s interests

The maxim respects all people in equal measure. In order to analyse the maxim theory, the CI is conducted to realise the ethics which is provided by each alternative.

To always respect the patient’s interests

  1. Universal =YES

The outcome is that all patients’ interests will be respected. Dr. Campbell is not going to profit from the exercise.

  1. Respect for Rational Beings =YES

The intention of Dr. Campbell and the board is to respect patients’ well-being at the expense of their status. The act is not profit-oriented.

  1. Respect for Autonomy =YES

The intent of the decision-maker is to respect the patients’ right to health. This is a selfless act.

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To never respect the patient’s interests

  1. Universal =NO

The outcome is that patient’s interests will be ignored. Merck will use a lot of capital to manage the disease: this may make the company stop supporting the medication due to bankruptcy. This is selfish.

  1. Respect for Rational Beings =NO

The intent of Merck is to promote their relevance to the society. This is selfish.

  1. Respect for Autonomy =NO

The intent of the decision-maker is to ignore possible adverse effects on patients. This is not ethical.

Rights Approach

This approach ensures that the decision made guarantees that the right to life is not denied (Ferrell & Gresham 1985). This is demonstrated by the fact that the ethical right ensures that the patients seeking medication will definitely have to receive the treatment. This means that the patient’s health medication offered by the Merck institute is justified by the ethical rights. The latter also have two sides which include the positive and negative rights. In the research of Dr. Campbell, the positive rights were mainly denied. The positive right that the patients with river blindness were deprived of was the right to have adequate information on the side effects of the Mactizan drugs. The ethical dilemma at Merck is related to the fact that Dr. Campbell should ensure that the patients receive the efficient medication. The board should also make sure that the patients receive the medication without incurring any cost. The rights analysis ensures that the patients receive medication; this enables Dr. Campbell to choose between the ethical dilemma options available. Merck also demonstrates that the right hierarchy is maintained by overlooking the cost expenditure of the program. This demonstrates that life is more important than any other aspect of business.

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Distributive Justice Approach

Distributive justice theory contends that benefits and burdens should be distributed equally among all society members. The veil of ignorance ensures that every individual respects other people and equally values their own welfare and the welfare of others (Heller 1987). This is demonstrated by the decision-maker recognising the worse off patients. In the river blindness case, Dr. Campbell identifies that patients with river blindness have to be subjected to the Mactizan medication. Consequently, he faces the ethical dilemma of deciding on the medication and also ensuring that all patients receive equitable treatment regardless of their social status and racial origin. 

Potential Worse Off Parties

Merck is the worse off as they invest lots of money to medicate the patients without any commercial gain. As a utility maximiser, Dr. Campbell must ensure that the chosen option will serve the patients from the impoverished region best. This outcome involves proceeding with treatment which will improve patients’ health, otherwise their health will deteriorate.

Justice analysis requires Dr. Campbell to select an option which serves the interest of the impoverished in society as well as people with any other social and racial background (Pollock 1998).


The final recommendation for Dr. Campbell would be to ensure that treatment of river blindness is available. Dr. Campbell should also realise that he is responsible for the decisions that he makes personally. To ensure that the medication serves its purpose, both Dr. Campbell and Merck should guarantee that:

  1. Experiments are adequately conducted on animals before being tested on people. This will help analyse the drug before testing it on people.
  2. The first human test is conducted on a limited number of specimens. This should ensure that hazardous reactions do not affect the majority of population.
  3. All people affected are treated by physicians.



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