Louise CampbellBMJ Blogs
Originally posted 26 May 20
The COVID-19 pandemic has catapulted ethics into the spotlight. Questions previously deliberated about by small numbers of people interested in or affected by particular issues are now being posed with an unprecedented urgency right across the public domain. One of the interesting facets of this development is the way in which the questions we are asking now draw attention, not just to the importance of ethics in public life, but to the very nature of ethics as practice, namely ethics as it is applied to specific societal and environmental concerns.
Some of these questions which have captured the public imagination were originally debated specifically within healthcare circles and at the level of health policy: what measures must be taken to prevent hospitals from becoming overwhelmed if there is a surge in the number of people requiring hospitalisation? How will critical care resources such as ventilators be prioritised if need outstrips supply? In a crisis situation, will older people or people with disabilities have the same opportunities to access scarce resources, even though they may have less chance of survival than people without age-related conditions or disabilities? What level of risk should healthcare workers be expected to assume when treating patients in situations in which personal protective equipment may be inadequate or unavailable? Have the rights of patients with chronic conditions been traded off against the need to prepare the health service to meet a demand which to date has not arisen? Will the response to COVID-19 based on current evidence compromise the capacity of the health system to provide routine outpatient and non-emergency care to patients in the near future?
Other questions relate more broadly to the intersection between health and society: how do we calculate the harms of compelling entire populations to isolate themselves from loved ones and from their communities? How do we balance these harms against the risks of giving people more autonomy to act responsibly? What consideration is given to the fact that, in an unequal society, restrictions on liberty will affect certain social groups in disproportionate ways? What does the catastrophic impact of COVID-19 on residents of nursing homes say about our priorities as a society and to what extent is their plight our collective responsibility? What steps have been taken to protect marginalised communities who are at greater risk from an outbreak of infectious disease: for example, people who have no choice but to coexist in close proximity with one another in direct provision centres, in prison settings and on halting sites?
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