Covid-19: An Ethical Dilemma for the Ages
The images are striking. The lines of cars miles long waiting for food. The lines of caskets being held in truck trailers because there are so many deaths. The pictures of protestors with guns and signs demanding a return to normalcy. Similar pictures of nurses and doctors with masks and signs asking people to stay home.
And so the tension grows between the providers and the oppressed. What is to be made about the debate pitting the public health against economic insecurity? What’s a society to do for the most vulnerable when “vulnerability” takes many shapes?
The pandemic has put society in the midst of a debate about “rights” — the rights of the individual versus the rights of the many. The challenge becomes one of how to do the best thing.
Often the discussion revolves around how we balance the burdens and benefits of tough decisions so that they do not adversely affect groups in disproportionate ways.
In the case of the pandemic, how do we ensure the safety of our citizens while meeting their basic needs for food clothing and shelter that have been taken away by the shelter in place directives?
Moral Injury
People are being more generous and caring of their friends and neighbors than ever before. We have developed informal families of support through gestures of kindness and support, distanced happy hours and neighborhood concerts and cheering galleries. In the midst of all of this we see the incredible sacrifices on the part of our healthcare professionals and first responders taking a dramatic toll on physical and mental health. They are experiencing a crisis of what Talbot and Dean call “moral injury”^. It is defined as this feeling of depression, hopelessness and exhaustion. It centers on the struggle between idealism and reality — that we could give better care if we had the resources and tools that our government and hospitals are supposed to provide for us. Instead, the guilt of not being able to provide that care because of inadequate resources leads some health care workers to give up.
The Ethical Challenges of the Pandemic
The business of ethics is usually guided by principles and theories that act as a roadmap for making difficult decisions faced by societies and the individuals within it. The ethical principles focus on the individual’s right to decide (autonomy); being a benevolent society (beneficence); doing no harm (nonmaleficence); and treating everyone fairly (justice).
Over the past few weeks we have seen each of the ethical principles at work. We engaged the principle of nonmaleficence by sheltering in place. Then we legislated an unprecedented benefit package (beneficence). Second and third packages were passed to try to provide support to as many people as possible (justice). And now we consider loosening restrictions as a growing number of people are clamoring for an end to the personal restrictions (autonomy).
The theories of ethics which are designed to guide policy and behavior include Utilitarianism (the best course of action for the most people); Deontology (what our duties and obligations are as a society); andConsequentialism (the rightness or wrongness of any action must be viewed in terms of the consequences of that the action).
Some would argue that if people are against the shelter in place order, they do not have to go out when restrictions are lifted. Opponents would argue that if lifting the restrictions allows a few to resume normal activities and the virus proliferates again, it presents a risk to everyone! So how do we proceed? What is the most effective way to honor peoples’ rights?
A Matter of “Rights”
What is a right? A right is a justified claim on others. For example, if I have a right to freedom, then I have a justified claim to be left alone by others.
Immanuel Kant, an eighteenth century philosopher maintained that each of us has a worth or a dignity that must be respected. Valesquez et al** suggest that “this dignity makes it wrong for others to abuse us or to use us against our will and that a right to freedom, then, implies that every human being also has a fundamental right to what is necessary to secure a minimum level of well-being”.
Critics of sheltering in place would argue that these rights ensure that the freedom and well-being of each individual be protected from actions which threaten their freedom and/or economic well-being.
But proponents of the Utilitarian theory of ethics would counter that rights should not be the sole consideration in ethical decision-making. In some instances, the social costs that would result from respecting a right are too great, and “relying exclusively on a rights approach to ethics tends to emphasize the individual at the expense of the community” **. The utilitarian approach invites us to recognize our relatedness—that sense of community, shared values, and the common good which lends itself to an ethics of care, compassion, and concern for others.
Rising to Meet the Challenge
As the debate about a return to “normalcy” continues I fear more about social unrest than the virus itself. Many of us can control our daily activities to insulate against health risks, but what of the social behavior that flies in the face of common sense. Crowded beaches, gatherings in other public places, a rush to establish economic equilibrium? The fear of a loss of livelihood has exceeded many peoples’ fears for their own personal health and that of their families and communities. The fear is a legitimate one and must be addressed through education, information and solid policy. A lack of leadership has exacerbated the problem at all levels of our society and the starting place for us as professionals is at the most local levels in our neighborhoods and community forums.
People want information they can trust. They want to know that our leaders have their well-being in mind, (That is what drove almost universal compliance to the original shelter in place order).
Moving forward we have to support the activities that have served us well since the onset of the pandemic. I would encourage us to think proactively in three areas. First of all, science matters. Our intervention strategies must be based on the scientific knowledge while resisting the culture of politics. Secondly, innovation and collaboration are a must. Over the past couple of months, we have seen wonderful examples of innovators and collaborators working side by side in new and exciting ways. And finally we need to be transparent with our citizens. We are a resilient group and having solid information, even if it is bad, is the key to developing realistic solutions and fostering the type behavior that is required for healthy communities.
Resources
**Issues in Ethics V3 N1, Manuel Velasquez, Claire Andre, Thomas Shanks, S.J., and Michael J. Meyer (Winter 1990)
^^Burnout on the Front Lines Caring for Coronavirus Patients Neesha Nadkarni April 1, 2020 The Mercury News
^Physicians Aren’t ‘Burning Out.’ They’re Suffering From Moral Injury. Simon G. Talbot and Wendy Dean, July 26, 2018, STAT
