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Discussing the ethics of hydroxychloroquine prescriptions for COVID-19 prevention

The President says he's been taking hydroxychloroquine for more than a week now.

MINNEAPOLIS — President Donald Trump said on Monday that he's been taking hydroxychloroquine to protect himself against the coronavirus. It is a drug typically used to treat malaria and lupus.

The Federal Drug Administration issued warnings that the drug should only be used in clinical trials or for patients at a hospital under the Emergency Use Authorization.

"Yeah, a White House doctor, didn't recommend—I asked him what do you think—and he said well, if you'd like it and I said yeah, I'd like it, I'd like to take it," President Trump said, when a reporter asked him if a White House doctor recommended that he take hydroxychloroquine on Monday.

In a statement, the President's physician, Dr. Sean Conley said after discussions, they've concluded the potential benefit from treatment outweighed the relative risks. All this, despite the FDA warnings.

University of Minnesota bioethics professor Joel Wu said this is problematic.

"It's ethically problematic if the President is being treated for COVID specifically by hydroxychloroquine because our understanding based on the current evidence is not safe or effective in treating or preventing COVID," Wu said. 

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Wu referred to Principlism which involves four principles when discussing ethics or a moral dilemma.

1. Beneficence, which is the obligation to do good

2. Non-maleficence, the duty to not harm

3. Respect for Autonomy

4. Justice. 

In this case, Wu said beneficence, non-maleficence and respect for autonomy are all in tension with each other.

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"Doctors, as the experts in medicine, do have an ethical obligation not to do things where the risks for harm or the burdens of intervention outweigh any of the opportunity for benefit," he said. 

He said this applies, no matter who the patient is.

"It doesn't matter whether you're the President or not," he added. "Everyone should be treated equally in this regard."

Because the FDA currently says hydroxychloroquine is yet to be proven helpful in treating or preventing COVID-19, and because so far, it also warns that it could cause abnormal heart rhythm problems, Wu argued that the benefits do not outweigh the risks, at least not for now.

"Since the evidence is not there and what we know of the drug is that it is neither safe nor effective to treat or prevent COVID, it is ethically problematic to use it," he said.

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Plus he mentioned the ethical dilemma of taking the drug away from those who need it for diseases proven to be responsive to hydroxychloroquine, like Malaria and Lupus.

"To the extent that it is effective in treating other diseases, you're taking the drug away from the people who need it when it's an effective drug to treat somebody where it wouldn't work," he said. 

The University of Minnesota said it is currently working on a clinical trial for whether hydroxychloroquine is effective in preventing COVID-19. They said they expect to have a good grasp of their early data in about a month or so.

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The state of Minnesota has set up a hotline for general questions about coronavirus at 651-201-3920 or 1-800-657-3903, available 7 a.m. to 7 p.m.