Pandemic Ethics: Why Lock Down of the Elderly is Not Ageist and Why Levelling Down Equality is Wrong
By Julian Savulescu and James Cameron
Cross-posted with the Journal of Medical Ethics Blog
Countries all around the world struggle to develop policies on how to exit the COVID-19 lockdown to restore liberty and prevent economic collapse, while also protecting public health from a resurgence of the pandemic. Hopefully, an effective vaccine or treatment will emerge, but in the meantime the strategy involves continued containment and management of limited resources.
One strategy is a staged relaxation of lockdown. This post explores whether a selective continuation of lockdown on certain groups, in this case the aged, represents unjust discrimination. The arguments extend to any group (co-morbidities, immunosuppressed, etc.) who have significantly increased risk of death.
National Ethics Framework For Use in Acute Paediatric Settings During COVID-19 Pandemic
Oxford Uehiro Centre’s Director of Medical Ethics, Professor Dominic Wilkinson, has led a UK ethical framework for treatment decisions in acute paediatric settings during the Covid-19 Pandemic.
This ethical framework is a modification of guidance developed for treatment decisions relating to adults. The principles relating to decisions for children in the setting of the pandemic are the same as those for adults. The framework emphasises that decisions should be ethically consistent and apply to patients both with COVID-related and non-COVID related illness.The focus of the ethical framework provides guidance for a situation where there is extremely high demand and limited critical care capacity. However, it is important to note that at the time of writing (14 April 2020) there is enough paediatric critical care capacity across the UK. At the present time decisions about children in need of critical care should reflect the same fundamental ethical considerations as apply in normal times. Those decisions should be focused on the best interests of the child, and actively involve parents in decision-making.
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.
Guest Post: Pandemic Ethics-Earthquakes, Infections, and Consent
David Killoren
Dianoia Institute of Philosophy
Australian Catholic University, Melbourne
People often seem to be stubbornly resistant to change. Consider humanity’s collective failure to respond adequately to the climate emergency. Consider the lifelong smoker who won’t quit even after an emphysema diagnosis. Consider the meat-eater who watches Dominion, resolves to go vegan, and then falls off the wagon the next day. Even when we feel that we have excellent reasons to change our lives, we often drag our feet.
Yet when the coronavirus appeared in late 2019, our antipathy to change suddenly seemed to evaporate. Medical experts and politicians called for sweeping changes and huge numbers of people simply heeded the call. To be sure, there are dissenters. America’s deeply strange president is among them. But the degree of compliance with new restrictions and requirements that we’ve seen in recent weeks is extraordinary. Work, education, dating, dining, art, sport, even casual conversations with strangers—all of these facets of life have been dramatically altered, canceled, or paused for an indefinite period that may last two years or more, and there’s been little complaining from the people. If nothing else, the coronavirus crisis demonstrates this: When conditions are ripe, we are willing to upend our lives.
I’m not here to criticize or to defend the way we’re responding to the virus. But I want to raise some questions that I think aren’t receiving due attention. Continue reading
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.
Cross Post: Boris Johnson Will Be Receiving The Same Special Treatment Other Patients Do In NHS Intensive Care
Written by Dominic Wilkinson, University of Oxford
This article originally appeared in The Conversation
In a world where the adjective “unprecedented” has become commonplace, the news of British Prime Minister Boris Johnson being admitted to the intensive care unit of St Thomas’ Hospital with COVID-19 seemed to take it to a new level.
There is little information in the public domain about Johnson’s medical condition, but this is clearly a very serious step. He will only have been transferred to intensive care because it is perceived that his condition is potentially life threatening and there is a possibility that he would need urgent medical attention, including the possible use of mechanical ventilation.
What would happen if that became necessary? Would Johnson’s treatment be any different from anyone else with the same condition? Would he receive special treatment because of his political position, because of his importance for the country? Would he be prioritised for a ventilator? Continue reading
Why You Should Not (Be Allowed To) Have That Picnic in the Park, Even if it Does Not Make a Difference
Written by Alberto Giubilini
(a slightly longer version of this blogpost will appear in the journal Think. Link will be provided as soon as available)
It’s a sunny Sunda
y afternoon, early spring. The kind of afternoon that seems to be inviting you out for a stroll by the river. Maybe have a picnic on the green grass, in that spot over there, away from everyone. Why not?
The simple answer is: because there is a pandemic and the Government is enforcing a lockdown. You should stay home. End of the story.
And there isn’t a complex answer. The simple answer really is the end of the story.
But why? You probably understand the reasons for the lockdown. But that is a matter of policy, a general rule for the population. What difference does it make if I just go over there, where there is no one, keeping at distance from everyone? I am not going to harm anyone.
You are (probably) right: it (likely) does not make a difference, and you are (likely) not harming anyone. However, that is not the only relevant question to ask when we ask what we morally ought to do, or what a Government may permissibly require of us.
Let us consider the ethically relevant aspects of this situation. Continue reading
Pandemic ethics: Never again – will we make Covid-19 a warning shot or a dud?
by Anders Sandberg
The Covid-19 pandemic is not the end of the world. But it certainly is a wake-up call. When we look back on the current situation in a year’s time, will we collectively learn the right lessons or instead quickly forget like we did with the 1918 flu? Or even think it was just hype, like Y2K?
There are certainly plenty of people saying this is the new normal, and that things will never be the same. But historically we have adapted to trauma rather well. Maybe too well – we have a moral reason to ensure that we do not forget the harsh lessons we are learning now.
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