Pandemic Ethics: Who gets the ventilator in the coronavirus pandemic? These are the ethical approaches to allocating medical care
By Julian Savulescu and Dominic Wilkinson
Cross-posted from ABC Online
Imagine there are two patients with respiratory failure.
Joan is 40, normally employed with two children and no other health conditions or disabilities. Mary is 80, with severe dementia, in a nursing home.
In the Western world, doctors are gearing up for an explosion of cases of COVID-19 and with a massive shortage of medical resources, including life-saving ventilators, they are likely to be presented with dilemmas of exactly this kind.
It is undeniable that people should have an equal chance when there are sufficient resources.
But when there are limited resources, doctors do take various factors into account.
Politics, Ethics, and Shutting Down in the Face of Covid-19
Written by Stephen Rainey
Recently, I wrote about some possible limits of democratic politics in the context of climate change science. The idea was that politics could owe debts to citizens that might prompt suspension of established, and in themselves desirable, norms under certain circumstances. Coronavirus presents more such circumstances, so it’s worth revisiting those earlier thoughts, and looking at how the responses stack up in light of them.
Viruses are not really organisms in the sense of living things with which we are broadly familiar. Whereas plants are practically self-sufficient, in generating their own energy, and most other life requires the consumption of plant or plant derived materials to thrive, viruses are utterly dependent upon colonising the mechanisms of cells in order to survive.
Covid-19 is a string of ribonucleic acid (RNA), with a fatty coating, and a spiky crown of proteins. Like any other virus, covid-19 requires the cells of other living things in order to generate the proteins it needs in order to multiply. This involves hijacking the mechanisms of the host cells. Covid-19 is what’s called a messenger RNA virus, meaning it fools a host cell into creating not the proteins required by the host organism, but those of the virus.
We all know now that among the host cells amenable to Covid-19’s survival are human cells. As a result of this, thousands have died, thousands more have fallen ill and will fall ill, and we have witnessed a pan-national suspension of socio-political rights and freedoms. It seems remarkable that the protein generating requirements of a string of RNA could so directly impact upon established socio-political norms. But more to the point, it is right that such impacts are evoked by this virus. A response to such emergencies that falls short will be ineffective, and unethical. 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.
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.
Heritable Human Genome Editing Can Cure or Prevent Diseases
By César Palacios-González
More than a year after the fallout from He Jiankui’s announcement to the world that he had edited human embryos in order to made them resistant to HIV, the debate on whether we should move ahead with heritable human genome editing has given no signs of slowing down. For example, just a couple of days ago the UK House of Lords was debating this issue, and the WHO’s advisory committee on genome editing is running a consultation on the governance framework that should rule over human genome editing. While there are many ethical questions surrounding human genome editing, there is a question that recently has gained prominence: is heritable human genome editing therapeutic? Continue reading
The Right Not to Know and the Obligation to Know
By Ben Davies
Most people accept that patients have a strong claim (perhaps with some exceptions) to be told information that is relevant to their health and medical care. Patients have a Right to Know. More controversial is the claim that this control goes the other way, too. Some people claim, and others deny, that patients also have a Right Not to Know.
A number of considerations (harm to the patient; autonomy; privacy) have been marshalled on either side of this debate over the past few decades (e.g. Laurie 2004; Robertson and Savulescu 2001; Herring and Foster 2012; Takala 2019). In this post, I focus on a distinct argument and its apparently unassailable logic. This is the view that a comprehensive Right Not to Know cannot be justified because in many cases a patient’s ignorance will likely lead harm to third parties (Council of Europe 1997; Rhodes 1998; Harris and Keywood 2001).
Responsibility, Healthcare, and Harshness
Written by Gabriel De Marco
Suppose that two patients are in need of a complicated, and expensive, heart surgery. Further suppose that they are identical in various relevant respects: e.g., state of the heart, age, likelihood of success of surgery, etc. However, they differ on one feature: for one of these patients, call her Blair, the need for the heart surgery is due to her lifestyle (suppose she was a smoker), whereas the other, Ingrid, has not had this lifestyle, nor any other that would lead to the need for the surgery.
Some people think that:
- We can be responsible and blameworthy for our actions and their consequences.
Some of those people also think that:
- We can, or should, take this into account when making decisions about how to distribute healthcare resources.
For the purposes of this blog post, let’s assume 1 and 2 are true. Commonly, it is thought that, in order to be blameworthy for something, one must be responsible for it. Further, it is commonly thought that, whatever the appropriate response is to blameworthiness for something or other (assuming that there is an appropriate response), it will be negative in some sense or other. Now further suppose that Blair is blameworthy for her illness. Given 1 and 2, this fact about Blair, combined with the fact that Ingrid is innocent with regard to her illness, suggests that, at least in some contexts, we should treat them differently (or at least it would be permissible to do so). Call a healthcare policy that adopts, and reflects, 1 and 2 a Responsibility-Sensitive Policy, or RSP for short.
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