Ethical considerations of COVID-19: Your questions answered
As major figures worldwide declare the COVID-19 pandemic to be “unprecedented times that warrant unprecedented intervention,” life as we know it has shifted drastically in response to new policies, emergency procedures, and pressures from resource allocation.
Here we are faced with the question: Where should we draw our limits to protect our rights and the rights of those most vulnerable? A recent webinar by Lisa Schwartz, the Arnold L. Johnson Chair in Health Care Ethics at McMaster University, gives insight into the bioethical considerations that underpin the difficult decisions currently being made to balance collective needs and safety.
“We live in mutual interdependence,” explains Schwartz. The policies being constructed need to reciprocate people’s sacrifices for the needs of the community. How can society ask frontline workers to continuously put themselves in danger if society cannot provide them with personal protective equipment, or take on the responsibility of physical distancing? What is being done to support people of low socioeconomic status who are at disproportionate risk?
Schwartz’s current research, which involves collaborating with the WHO to explore the experiences of healthcare workers making triage decisions under the stresses of dwindling supplies, highlights the intense mental burden of these choices and the weaknesses in the existing system that resulted in this lack of support and resources.
“Any future measure of success should not just be the return to business as usual. Business as usual did not represent equity and we could be doing better on that. The best use of resources needs to be based on the best evidence and the shared values of our community.”
Here, Schwartz answers questions from the audience.
In an ideal world, we’d hope individuals would voluntarily subsume a portion of their autonomy for the greater good (e.g. frontline workers). For those who don’t share this “sense of duty,” do you think there’s a role for government in encouraging such an approach? What would be the ethical argument?
Personally, I believe we should. Human beings are social animals. We live in communities and rely on them to keep our lives going and make our lives better. I’d turn to John Rawls’ arguments about enlightened self-interests, understanding that we’re part of the same global community and it’s not enough to just look to ourselves and live locally. I think we have local obligations, but in a globalized world, we’ll be aware of the suffering of people in other contexts. If we know about it, we have an obligation to respond to it. I begin with enlightened self-interest as an ethical argument mainly because it speaks even to selfish motivations: understanding that ‘I am’ because ‘we are’, as expressed by the African concept of Ubuntu, and so we have to respond to general interests to preserve our own interests. This can also be characterized as a more ecological approach. We can see the benefits of compassion and mutual interdependence with one another are necessary for everyone to be lifted out of this problem, rather than the sense that we’ll step on others to improve our experience.
It seems like there’s going to be a greater infringement on personal security following this pandemic (e.g. cell phone location of COVID-19 patients tracked by Google and Apple). What ethical issues do you foresee?
It’s a big issue. Realistically, most of us are already open to sharing data in different ways. This includes anybody who has Facebook, or for me, carrying my cell phone everywhere. I think that we’re open to security and privacy breaches in ways we should be very attentive to. That’s not just a problem for COVID-19. The question is, ‘are we singling any particular people out?’ We need to be very cautious. Contact tracing is very important, but we already have ways to do that which doesn’t unnecessarily infringe on personal liberties. We have to be asking, how far do we really need to go to manage this question electronically? We have methods of doing contact tracing, for hundreds of years, and they’ve been very effective without infringing on individual liberty. So that would be my first question – is this necessary? Moreover, what will be the measures taken to limit access and abuse of this information further on?
In many developing countries, people need to work every day to eat. So, they’re forced to make the decision to stay home and starve or work and risk COVID-19. What you think could be done to combat these problems?
Our first response should be to share the resources we have to make sure that members of the high income countries provide support, whether through PPE on a large scale, or if it’s attention to medication or access to vaccines that are being developed, we have to make sure that response is made available in ways that are cost-effective – or more importantly it shouldn’t even be about cost, they should just be available. We need that ecological approach. Our interests will be improved if we share in that way. There is a collective response that needs to be attended to, which is very much for a task being taken on by humanitarian organizations, advocating to the governments right now. That sense of sharing and shared interest needs to come to fruition.
How is mental health implemented in decision making regarding restrictions and isolation?
As an ethicist, I’d have to say that any decision made needs to take into consideration the evidence and the principals of non-abandonment. Individuals asked to take these sacrifices, such as lock downs that create financial distress, should be assured that their mental health needs will be responded to. We’ve seen that in the Canadian government’s response. It’s probably not perfect as there are still people who are left alone and abandoned, but part of the response has been to ensure people aren’t worried about their financial situation. Attempts have been made to help people manage their finances, and there are other, grander gestures that can be made. But at least there’s been some attention paid to it. Any time an individual is asked to make a sacrifice of their liberty for the greater good, we’ll have to engage in principals of reciprocity and understand that for any of us making that sacrifice, we need to be aware of who is being negatively affected. I think in the end we’ll probably look back and see that mental health was one of the greatest of injuries and some of the worst sufferings sustained in COVID-19, because it will be so widespread. Finding ways to support people will be a necessary and ongoing project.
Many hospitals have had to close down operating rooms to make room for patients and have cancelled all elective surgeries. Some have been forced to cancel cancer surgeries. Could you speak to the ethical considerations?
It’s true that publicly funded health care has had to rearrange priorities, with decisions guided by safety concerns for patients to ensure they’re not exposed to COVID-19. The initial response was a sort of automatic one: if you’re not dying, then care must be deferred. But we’ve begun to see that the equity of this approach was not ideal. Patients needed to remain on treatment or even study interventions to receive treatments, and in some cases stopping treatment or studies was more dangerous than the risk of being exposed to COVID-19 in treatment centers. So, while we were doing all we could – pulling all resources toward the pandemic – this approach has revealed that perhaps we need to strategize more carefully with respect to pandemic planning and response. Prioritization as we come back will need to rely on principles of equity and non-abandonment to help guide these plans.
Why do you think the Health in All Policies (HiAP) is imperfect?
In ordinary circumstances, if every policy is made around health considerations, then there’s a danger that it’s going to devalue other resources that significant in our community. We fund the arts community, for example, because we believe that arts are inherently valuable. And if we started creating every policy to ensure that it was about ‘health through arts’ then we would be diminishing the value of the contributions that arts have to begin with. So, while I appreciate that policies about the arts, education, etcetera, should be attentive to health concerns – just as they should be attentive to inclusivity, equity, lack of gender bias and so on – I think health value is and important but limited approach most of the time. The danger is that it diminishes the value of other goods in our society by focusing on their health benefits. On the other hand, in the midst of a pandemic, maybe the policies we develop really should be about mitigation and management and trying to keep health at the focus of that.
Chen Qiushi and Fang Bin are two citizen journalists who’ve been missing for over two months after sharing pictures and videos early on during the outbreak in Wuhan. Reports claim they were arrested. Is there anything we can do to address governments’ impingement on civil liberties? What are the implications of allowing human rights abuses by other countries to occur unchecked?
A major concern and undercurrent in pandemic response is that governments may take the opportunity to restrict the liberties of their citizens, imposing harsh restrictions for reasons that go beyond protecting the health of citizens. Proportionality is exceptionally important when governments are making decisions about how much restriction they will impose. So, I think governments widely should be scrutinized for the kind of restrictions that they might be taking advantage of. While I can’t comment on the specifics of this case, I will say that the lens we should be using, when it comes to restricting liberties, is a lens of proportionality and that restrictions should meet requirements of necessity and legality. Where the media and journalism are concerned, it’s difficult because it’s the role of reporters to report and they need to be protected for us to be able to benefit from having the information that we need to act autonomously. So, we need to have a free and open media. In terms of what can be done about it, the first step would be to find out more and then put pressure on governments to allow for a level of free speech that we think is necessary to flourish.
Missed the webinar? Watch it here
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