Video Series: (Un)fair Access to Covid-19 Treatment in Mexico?
Widespread corruption and racism in Mexico created extra hurdles for the development of Mexico’s recently published federal guidelines for deciding who gets to access scarce medical resources (e.g. ventilators in the case of Covid-19). Dr César Palacios-González (Oxford), who helped develop these guidelines, talks about these challenges.
Video Series: Which Non-Covid-19 Patients Should Get Treatment First?
In the UK we’re past the peak of the coronavirus pandemic but new ethical issues are arising: the healthcare system is now under enormous pressure – it’s working less efficiently than before (because of precautions to protect healthcare personnel), and there’s an enormous backlog of patients whose treatments have been put on hold. Which non-Covid-19 patients should get treated first and who will have to wait? Dominic Wilkinson, Professor of Medical ethics and Consultant in Newborn Intensive Care, sheds some light on this important question, and proposes a practical solution. (To watch with subtitles, press the ‘YouTube’ button in the video.)
We’re All Vitalists Now
By Charles Foster
It has been a terrible few months for moral philosophers – and for utilitarians in particular. Their relevance to public discourse has never been greater, but never have their analyses been so humiliatingly sidelined by policy makers across the world. The world’s governments are all, it seems, ruled by a rather crude vitalism. Livelihoods and freedoms give way easily to a statistically small risk of individual death.
That might or might not be the morally right result. I’m not considering here the appropriateness of any government measures, and simply note that whatever one says about the UK Government’s response, it has been supremely successful in generating fear. Presumably that was its intention. The fear in the eyes above the masks is mainly an atavistic terror of personal extinction – a fear unmitigated by rational risk assessment. There is also a genuine fear for others (and the crisis has shown humans at their most splendidly altruistic and communitarian as well). But we really don’t have much ballast.
The fear is likely to endure long after the virus itself has receded. Even if we eventually pluck up the courage to hug our friends or go to the theatre, the fear has shown us what we’re really like, and the unflattering picture will be hard to forget.
I wonder what this new view of ourselves will mean for some of the big debates in ethics and law? The obvious examples are euthanasia and assisted suicide. Continue reading
Maximising Ventilators: Some Ethical Complications
Written by Joshua Parker and Ben Davies
One of the impending tragedies of the COVID-19 pandemic is a grave mismatch between the supply of ventilators and the numbers needing them. This situation, as seen in Italy, is predicted to be mirrored here in the UK. Coronavirus can cause acute respiratory distress syndrome for which the management is mechanical ventilation on the ICU. This represents these patients’ only chance at survival. Part of the response to the incoming tsunami of patients requiring ventilation is to produce more ventilators. This is a reasonable way to try to lessen the mismatch between supply and demand. However, producing more ventilators cannot be the solution in isolation. As a complex piece of medical equipment, ventilators need trained staff to operate them and provide the additional care ventilated patients require. There has been a significant push to attempt to ensure enough ventilator trained staff as possible. Both staff and ventilator shortages present significant issues; yet it is shortages of ventilators that account for the bulk of ethical discussion so far. It is therefore worth exploring some of the ethical problems that might arise should there be plenty of ventilators, but not enough staff.
The Perfect Protocol? Ethics Guidelines in a Pandemic
Written by Joshua Parker and Ben Davies
One question occupying politicians and healthcare workers in the middle of this global pandemic is whether there will be enough ventilators when COVID-19 reaches its peak. As cases in the UK continue to increase, so too will demand for ventilators; Italy has reported overwhelming demand for the equipment and the need to ration access, and the UK will likely face similar dilemmas. Indeed, one UK consultant has predicted a scenario of having 8 patients for every one ventilator. Aside from anything else, this would be truly awful for the healthcare professionals having to make such decisions and live with the consequences.
Ethics is an inescapable part of medical practice, and healthcare professionals face numerous ethical decisions throughout their careers. But ethics is challenging, often involving great uncertainty and ambiguity. Medics often lack the time to sort through the morass that is ethics. Many therefore prefer heuristics, toolboxes and a handful of principles to simplify, speed up and streamline their ethics.
What is Your Gender? A Friendly Guide to the Public Debate
What is your gender? A friendly guide to the public debate
Brian D. Earp
Note: This is a lightly edited transcript of an informal lecture, based on coursework submitted as part of my Ph.D. It was recorded on Whidbey Island, Washington, and published online on January 15th, 2020. A link to the video is here: https://youtu.be/LZERzw9BGrs.
Video description: I’m a philosopher and cognitive scientist who studies gender, sex, identity, sexuality and related topics and I am offering this video as a friendly guide to the (often very heated) public debate that is going on around these issues. This is my best attempt, not to score political points for any particular side, but to give an introductory map of the territory so you can think for yourself, investigate further, and reach your own conclusions about such controversial questions as “What does mean to be a man or a woman?” This video is not meant to be authoritative; it is not the final word; experts on these topics will find much to quibble with (and perhaps some things to disagree with outright). But for those who would like to take some first steps in getting a sense of the landscape without feeling intimidated, I hope this will be of some use. Continue reading
Coronavirus: Dark Clouds, But Some Silver Linings?
By Charles Foster
Cross posted from The Conversation
To be clear, and in the hope of heading off some trolls, two observations. First: of course I don’t welcome the epidemic. It will cause death, worry, inconvenience and great physical and economic suffering. Lives and livelihoods will be destroyed. The burden will fall disproportionately on the old, the weak and the poor.
And second: these suggestions are rather trite. They should be obvious to reasonably reflective people of average moral sensibility.
That said, here goes:
1. It will make us realise that national boundaries are artificial
The virus doesn’t carry a passport or recognise frontiers. The only way of stopping its spread would be to shut borders wholly, and not even the most rabid nationalists advocate that. It would mean declaring that nations were prisons, with no one coming in or out – or at least not coming back once they’d left. In a world where we too casually assume that frontiers are significant, it doesn’t do any harm to be reminded of the basic fact that humans occupy an indivisible world.
Cooperation between nations is essential to combating the epidemic. That cooperation is likely to undermine nationalist rhetoric.
2. It will make us realise that people are not islands
The atomistic billiard-ball model of the person – a model that dominates political and ethical thinking in the west – is biologically ludicrous and sociologically unsustainable. Our individual boundaries are porous. We bleed into one another and infect one another with both ills and joys. Infectious disease is a salutary reminder of our interconnectedness. It might help us to recover a sense of society.
3. It may encourage a proper sort of localism
Internationalism may be boosted. I hope so. But if we’re all locked up with one another in local quarantine, we might get to know the neighbours and the family members we’ve always ignored. We might distribute ourselves less widely, and so be more present to the people around us.
We might even find out that our local woods are more beautiful than foreign beaches, and that local farmers grow better and cheaper food than that which is shipped (with the associated harm to the climate) across the globe.
4. It may encourage altruism
Exigencies tend to bring out the best and the worst in us. An epidemic may engender and foster altruistic heroes.
5. It may remind us of some neglected constituencies
Mortality and serious illness are far higher among the old, the very young, and those suffering from other diseases. We tend to think about – and legislate for – the healthy and robust. The epidemic should remind us that they are not the only stakeholders.
6. It may make future epidemics less likely
The lessons learned from the coronavirus epidemic will pay dividends in the future. We will be more realistic about the dangers of viruses crossing the barriers between species. The whole notion of public health (a Cinderella speciality in medicine in most jurisdictions) has been rehabilitated. It is plain that private healthcare can’t be the whole answer. Much has been learned about the containment and mitigation of infectious disease. There are strenuous competitive and cooperative efforts afoot to develop a vaccine, and vaccines against future viral challenges are likely to be developed faster as a result.
7. It might make us more realistic about medicine
Medicine is not omnipotent. Recognising this might make us more aware of our vulnerabilities. The consequences of that are difficult to predict, but living in the world as it really is, rather than in an illusory world, is probably a good thing. And recognising our own vulnerability might make us more humble and less presumptuous.
8. Wildlife may benefit
China has announced a permanent ban on trade in and consumption of wildlife. That in itself is hugely significant from a conservation, an animal welfare, and a human health perspective. Hopefully other nations will follow suit.
Pandemic Ethics: Infectious Pathogen Control Measures and Moral Philosophy
By Jonathan Pugh and Tom Douglas
Listen to Jonathan Pugh and Tom Douglas on Philosophical Disquisitions discussing Covid 19 and the Ethics of Infectious Disease Control, a podcast interview that was inspired by this blog.
Following the outbreak of the SARS-CoV-2 coronavirus, a number of jurisdictions have implemented restrictive measures to prevent the spread of this highly contagious pathogen. In January, Chinese authorities effectively quarantined the entire city of Wuhan, the epicentre of the outbreak, which has a population of around 11 million people. There has since been much discussion of various measures that might be implemented now or in the future to counter the spread, including various forms of social distancing, further mass quarantines and lockdowns, closed borders, mandatory testing and screening and even potentially forced treatment.
There are important questions about the lawfulness of infectious pathogen control (IPC) measures. Here, though, we focus on the moral justification of IPC. How can moral philosophy help us to think through when and whether different IPC measures ought to be employed?
To do so, we will briefly summarise our analysis of the different ways non-consensual medical interventions can be justified in infectious diseases control and criminal justice settings, which we originally published open access here.
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