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Pandemic Ethics: Extreme Altruism in a Pandemic

Pandemic Ethics: Extreme Altruism in a Pandemic

Written by Julian Savulescu and Dominic Wilkinson

Cross-posted with the Journal of Medical Ethics blog

Altruism is one person sacrificing or risking his or her own interests for another’s interests. Humans, like other animals, have a tendency towards altruism. This is usually directed to members of their own group. An example is donating a kidney to a family member. This is quite risky – it involves immediate risk of death from anaesthesia or post-operative complications, and long term risk of kidney failure.

But sometimes people are altruistic towards strangers.

Altruism often involves fairly small personal sacrifices. (For example, most people donate to charity, but in countries like the UK, it is typically only a tiny proportion of their income) Where someone can cause great benefit to another person at little or no personal cost, there is an ethical obligation for them to do so. This is the Duty of Easy Rescue. A whole movement has arisen called Effective Altruism which aims to ensure that altruistic acts do as much good as possible.

Altruism can also be extreme. Some people give up their entire livelihood to work overseas for aid agencies or charities. During a pandemic, health workers may take on significant personal risk to provide front-line medical care. In times of war, people may choose to literally give their life for others of their nation.

We can define extreme altruism as an act taken for the benefit of another that involves making large life-altering or life-threatening sacrifices or personal risks.

Society’s approach to extreme altruism is inconsistent. At times of obvious societal need, it encourages it (for example, clapping on the doorstep for ‘key workers’ is in order to offer our appreciation for their altruistic assumption of great risk) or even requires it by conscription of military personnel. At times of perceived lesser need, it is discouraged or even banned. For example, in normal times people are only allowed to take part in research, even if they do so with full knowledge and for no payment, if the risk of the research is minimal, and not if the risks are similar to everyday life. In some jurisdictions, altruistic kidney donations to strangers are banned.

It is not clear why extreme altruism should be limited to national emergency. If someone is competent, knows all the relevant facts, and is thinking clearly and choosing autonomously, they should be able to sacrifice their interests or even life for others. If someone is permitted to participate in highly risky personal activities for purely personal benefit (e.g. climbing Mount Everest, base jumping, or boxing) they ought to be permitted to at least take equivalent risks for the benefit of someone else (e.g. participating in research). Just as a rational, clear thinking person who is competent should be able to sacrifice their own life through suicide for any reason, they should be able to do this for the benefit of others.

We have argued at various points for extreme altruism in medicine. In one sense, there is a constant national emergency: we are all aging and slowly dying. There is a war against aging and death: we are fighting it with medicine. And people should be able sacrifice their interests or lives in this war. 

Extreme altruism extended to COVID-19

Read More »Pandemic Ethics: Extreme Altruism in a Pandemic

Pandemic Ethics: Key Workers Have a Stronger Claim to Compensation and Hazard Pay for Working During The COVID-19 Pandemic Than The Armed Forces Do When on Deployment

By Doug McConnell and Dominic Wilkinson

Post originally appeared on the Journal of Medical Ethics Blog

 

While the general public enjoy the relative safety of social distancing, key workers are at a higher risk of both contracting COVID-19 and transmitting it to their families. This is especially the case for ‘frontline’ workers who are frequently exposed to the virus and may not have access to adequate personal protective equipment (PPE). Tragically, many key workers have died of COVID-19 around the world already, including over 100 in the UK.

Although it is relatively rare for key workers to die from COVID-19, the risk of death is obviously much greater than one would usually expect in these roles and key workers clearly have good reason to be anxious. For ‘frontline’ workers, the distress is compounded by working in harrowing conditions where so many are dying alone. Furthermore, frontline workers have to take on the burdens of ensuring they do not transmit infections to their families, by moving in with patients, living in hotels, or maintaining rigorous social distancing in their own homes.

These atypical costs, risks, and burdens suggest that key workers are owed compensation in addition to their usual pay and a few instances of nationally coordinated applause. Read More »Pandemic Ethics: Key Workers Have a Stronger Claim to Compensation and Hazard Pay for Working During The COVID-19 Pandemic Than The Armed Forces Do When on Deployment

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.

Read More »Pandemic Ethics: Why Lock Down of the Elderly is Not Ageist and Why Levelling Down Equality is Wrong

Guest Post: Pandemic Ethics. Social Justice Demands Mass Surveillance: Social Distancing, Contact Tracing and COVID-19

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Written by: Bryce Goodman

The spread of COVID-19 presents a number of ethical dilemmas. Should ventilators only be used to treat those who are most likely to recover from infection? How should violators of quarantine be punished? What is the right balance between protecting individual privacy and reducing the virus’ spread?

Most of the mitigation strategies pursued today (including in the US and UK) rely primarily on lock-downs or “social distancing” and not enough on contact tracing — the use of location data to identify who an infected individual may have come into contact with and infected. This balance prioritizes individual privacy above public health. But contact tracing will not only protect our overall welfare. It can also help address the disproportionately negative impact social distancing is having on our least well off.
Contact tracing “can achieve epidemic control if used by enough people,” says a recent paper published in Science. “By targeting recommendations to only those at risk, epidemics could be contained without need for mass quarantines (‘lock-downs’) that are harmful to society.” Once someone has tested positive for a virus, we can use that person’s location history to deduce whom they may have “contacted” and infected. For example, we might find that 20 people were in close proximity and 15 have now tested positive for the virus. Contact tracing would allow us to identify and test the other 5 before they spread the virus further.
The success of contact tracing will largely depend on the accuracy and ubiquity of a widespread testing program. Evidence thus far suggests that countries with extensive testing and contact tracing are able to avoid or relax social distancing restrictions in favor of more targeted quarantines.

Read More »Guest Post: Pandemic Ethics. Social Justice Demands Mass Surveillance: Social Distancing, Contact Tracing and COVID-19

National Ethics Framework For Use in Acute Paediatric Settings During COVID-19 Pandemic

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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. Professor Wilkinson produced the framework along with RCPCH Clinical Lead, Dr Mike Linney, Chair of RCPCH Ethics and Law Committee. This ethical framework is a modification of guidance… Read More »National Ethics Framework For Use in Acute Paediatric Settings During COVID-19 Pandemic

Video Series: Is the Coronavirus Pandemic Worse for Women?

Dr Agomoni Ganguli Mitra talks about how pandemics increase existing inequalities in societies, and how this may result in even more victims than those from the disease itself. She urges governments and others to take social justice considerations much more into account when preparing for, and tackling, pandemics. This is an interview with Katrien Devolder as part of the Thinking Out Loud video series.
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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.

Read More »Maximising Ventilators: Some Ethical Complications

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.Read More »Guest Post: Pandemic Ethics-Earthquakes, Infections, and Consent

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.

Read More »The Perfect Protocol? Ethics Guidelines in a Pandemic