Intelligence, Surveillance, and Ethics in a Pandemic

Jessica Davis
JustSecurity.org
Originally posted 31 March 20

Here is an excerpt:

It is imperative that States and their citizens question how much freedom and privacy should be sacrificed to limit the impact of this pandemic. It is also not sufficient to ask simply “if” something is legal; we should also ask whether it should be, and under what circumstances. States should consider the ethics of surveillance and intelligence, specifically whether it is justified, done under the right authority, if it can be done with intentionality and proportionality and as a last resort, and if targets of surveillance can be separated from non-targets to avoid mass surveillance. These considerations, combined with enhanced transparency and sunset clauses on the use of intelligence and surveillance techniques, can allow States to ethically deploy these powerful tools to help stop the spread of the virus.

States are employing intelligence and surveillance techniques to contain the spread of the illness because these methods can help track and identify infected or exposed people and enforce quarantines. States have used cell phone data to track people at risk of infection or transmission and financial data to identify places frequented by at-risk people. Social media intelligence is also ripe for exploitation in terms of identifying social contacts. This intelligence, is increasingly being combined with health data, creating a unique (and informative) picture of a person’s life that is undoubtedly useful for virus containment. But how long should States have access to this type of information on their citizens, if at all? Considering natural limits to the collection of granular data on citizens is imperative, both in terms of time and access to this data.

The info is here.

Social Distancing as a Moral Dilemma

E. Litvack
U. A. News
Originally posted 31 March 20

Here is an excerpt:

Q: At this point, is social distancing a moral imperative?

This is an interesting philosophical question. A moral imperative is a command to act in a certain way, which everyone should follow, and, in order to invoke one, we need to explain what makes a particular action right or morally good.

A: In the context of the current health crisis, we can plausibly make the claim that it is a morally good state of affairs if we save the greatest number of lives possible. Not everyone would agree with that claim, but I'll leave that argument aside for now and return to it later. For now, let's assume that promoting health and saving lives is a morally good goal for society. Given that premise – if we also accept the empirical evidence, which suggests that social distancing is a means to halt the spread of the virus – it's easy to see how one would defend their judgment that it is morally wrong not to practice social distancing.

Q: How might someone argue that saving lives isn't a moral imperative?

A: Some people might argue that there is a naturalistic and evolutionary reason to let the virus take its course. It would reduce human population, which, in the long run, could be a good thing in terms of having more resources for fewer people. Notice one thing this view entails, though: The person who holds it must be willing to accept that they or their loved ones might be among those who contribute to the population reduction.

Likewise, some might argue that certain people have more value than others and therefore deserve to live while others do not. This would require a set of criteria by which to judge the value of a life, and unless someone – or some entity – creates that criteria by fiat, then to define "a valuable life" requires us to circle right back around to our original premise.

The info is here.

How Trump failed the biggest test of his life

Ed Pilkington & Tom McCarty
The Guardian
Originally posted 29 Mar 20

Here is an excerpt:

Those missing four to six weeks are likely to go down in the definitive history as a cautionary tale of the potentially devastating consequences of failed political leadership. Today, 86,012 cases have been confirmed across the US, pushing the nation to the top of the world’s coronavirus league table – above even China.

More than a quarter of those cases are in New York City, now a global center of the coronavirus pandemic, with New Orleans also raising alarm. Nationally, 1,301 people have died.

Most worryingly, the curve of cases continues to rise precipitously, with no sign of the plateau that has spared South Korea.

“The US response will be studied for generations as a textbook example of a disastrous, failed effort,” Ron Klain, who spearheaded the fight against Ebola in 2014, told a Georgetown university panel recently. “What’s happened in Washington has been a fiasco of incredible proportions.”

Jeremy Konyndyk, who led the US government’s response to international disasters at USAid from 2013 to 2017, frames the past six weeks in strikingly similar terms. He told the Guardian: “We are witnessing in the United States one of the greatest failures of basic governance and basic leadership in modern times.”

In Konyndyk’s analysis, the White House had all the information it needed by the end of January to act decisively. Instead, Trump repeatedly played down the severity of the threat, blaming China for what he called the “Chinese virus” and insisting falsely that his partial travel bans on China and Europe were all it would take to contain the crisis.

The info is here.

The Ethics of Quarantine

Ross Upshur
Virtual Mentor. 2003;5(11):393-395.


Here are two excerpts:

There are 2 independent ethical considerations to consider here: whether the concept of quarantine is justified ethically and whether it is effective. It is also important to make a clear distinction between quarantine and isolation. Quarantine refers to the separation of those exposed individuals who are not yet symptomatic for a period of time (usually the known incubation period of the suspected pathogen) to determine whether they will develop symptoms. Quarantine achieves 2 goals. First, it stops the chain of transmission because it is less possible to infect others if one is not in social circulation. Second, it allows the individuals under surveillance to be identified and directed toward appropriate care if they become symptomatic. This is more important in diseases where there is presymptomatic shedding of virus. Isolation, on the other hand, is keeping those who have symptoms from circulation in general populations.

Justification of quarantine and quarantine laws stems from a general moral obligation to prevent harm to (infection of) others if this can be done. Most democracies have public health laws that do permit quarantine. Even though quarantine is a curtailment of civil liberties, it can be broadly justified if several criteria can be met.

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Secondly, the proportionality, or least-restrictive-means, principle should be observed. This holds that public health authorities should use the least restrictive measures proportional to the goal of achieving disease control. This would indicate that quarantine be made voluntary before more restrictive means and sanctions such as mandatory orders or surveillance devices, home cameras, bracelets, or incarceration are contemplated. It is striking to note that in the Canadian SARS outbreak in the Greater Toronto area, approximately 30,000 persons were quarantined at some time. Toronto Public Health reports writing only 22 orders for mandatory detainment [3]. Even if the report is a tenfold underestimate, the remaining instances of voluntary quarantine constitute an impressive display of civic-mindedness.

Thirdly, reciprocity must be upheld. If society asks individuals to curtail their liberties for the good of others, society has a reciprocal obligation to assist them in the discharge of their obligations. That means providing individuals with adequate food and shelter and psychological support, accommodating them in their workplaces, and not discriminating against them. They should suffer no penalty on account of discharging their obligations to society.

The info is here.

Pregnant and shackled: why inmates are still giving birth cuffed and bound

Lori Teresa Yearwood
theguardian.com
Originally posted 24 Feb 20

Here is an excerpt:

To convolute matters more, the federal government does not require prisons or jails to collect data on pregnancy and childbirth among female inmates. A bill introduced in September 2018 would have required such data collection. However, no action was taken on the bill.

Even the definition of shackling varies. Some states, such as Maryland and New York, ban all restraints immediately before and after birth, though there are exceptions in extraordinary circumstances. Other states, such as Ohio, allow pregnant women to be handcuffed in the front of their bodies, as opposed to behind their bodies, which is thought to be more destabilizing.

Then there is the delineation between shackling during pregnancy, active delivery and postpartum. Individual state laws are filled with nuances. As of 2017, Rhode Island is the only state that has what is called “a private right of action”, an enforcement mechanism allowing the illegally shackled woman to sue for monetary compensation.

The one constant: the acute psychological trauma that shackling inflicts.

“Women subjected to restraint during childbirth report severe mental distress, depression, anguish, and trauma,” states a 2017 report from the American Psychological Association.

“Women who get locked up, tend on average to have suffered many more childhood traumas, says Terry Kupers, MD, a psychiatrist and the author of the book Solitary: The Inside Story of Supermax Isolation and How We Can Abolish It. He implores prison staffs “to be very careful that we do not re-traumatize them. Because re-traumatization makes conditions like post-traumatic stress disorder much worse.”

Amy Ard, executive director of Motherhood Beyond Bars, a not-for-profit in Georgia, worries that the trauma of shackling takes a toll on the self-image of new mothers. Inevitably, this question looms in the minds of the women Ard works with: if I am someone who needs to be chained, how can I expect to also see myself as someone capable of protecting my child?

The info is here.

How Should We Judge Whether and When Mission Statements Are Ethically Deployed?

K. Schuler & D. Stulberg
AMA J Ethics. 2020;22(3):E239-247.
doi: 10.1001/amajethics.2020.239.

Abstract

Mission statements communicate health care organizations’ fundamental purposes and can help potential patients choose where to seek care and employees where to seek employment. They offer limited benefit, however, when patients do not have meaningful choices about where to seek care, and they can be misused. Ethical implementation of mission statements requires health care organizations to be truthful and transparent about how their mission influences patient care, to create environments that help clinicians execute their professional obligations to patients, and to amplify their obligations to communities.

Ethics, Mission, Standard of Care

Mission statements have long been used to communicate an organization’s values, priorities, and goals; serve as a moral compass for an organization; guide institutional decision making; and align efforts of employees. They can also be seen as advertising to prospective patients and employees. Although health care organizations’ mission statements serve these beneficial purposes, ethical questions (especially about business practices seen as motivating profit by rewarding underutilization) arise when mission implementation conflicts with acting in the best interests of patients. Ethical questions also arise when religiously affiliated organizations deny clinically indicated care in order to uphold their religiously based mission. For example, a Catholic organization’s mission statement might include phrases such as “faithful,” “honoring our sponsor’s spirit,” or “promoting reverence for life” and likely accords the Ethical and Religious Directives for Catholic Health Care Services, which Catholic organizations’ clinicians are required to follow as a condition of employment or privileges.

When strictly followed, these directives restrict health care service delivery, such that patients—particularly those seeking contraception, pregnancy termination, miscarriage management, end-of-life care, or other services perceived as conflicting with Catholic teaching—are not given the standard of care. Federal and state laws protect conscience rights of organizations, allowing them to refuse to provide services that conflict with the deeply held beliefs and values that drive their mission.6 Recognizing the potential for conflict between mission statements and patients’ autonomy or best interests, we maintain that health care organizations have fundamental ethical and professional obligations to patients that should not be superseded by a mission statement.

The info is here.

The Trump administration’s botched coronavirus response

German Lopez
vox.com
Updated 25 March 20

Here is an excerpt:

It’s also something that the federal government has done well before — recently, with H1N1 and Zika. “It’s been surprising to me that the administration’s had a hard time executing on some of these things,” Ashish Jha, director of the Harvard Global Health Institute, previously told me.

But it’s the kind of thing that the Trump administration has screwed up, while instead trying to downplay the threat of Covid-19. Trump himself has tweeted comparisons of Covid-19 to the common flu — which Jha describes as “really unhelpful,” because the novel coronavirus appears to be much worse. Trump also called concerns about the virus a “hoax.” He said on national television that, based on nothing more than a self-admitted “hunch,” the death rate of the disease is much lower than public health officials projected.

And Trump has rejected any accountability for the botched testing process: “I don’t take responsibility at all,” he said this month.

Jha described the Trump administration’s messaging so far as “deeply disturbing,” adding that it’s “left the country far less prepared than it needs to be for what is a very substantial challenge ahead.”

Even as the Trump administration has tried to escalate its efforts to combat the pandemic, Trump has continued to downplay concerns. Recently, he’s suggested that social distancing measures — asking people to stay home and keep their physical distance from one another — could be lifted within weeks, instead of the months experts say is likely necessary. “What a great timeline that would be,” Trump said.

The info is here.

The race to develop coronavirus treatments pushes the ethics of clinical trials

Olivia Goldhill
Quartz.com
Originally posted 28 March 20

Here is an excerpt:

But others are more pragmatic. Arthur Caplan, director of NYU Langone’s Division of Medical Ethics says that when doctors are faced with suffering patients, it’s ethical for them to use drugs that have been approved for other health conditions as treatments. This happened with Ebola, swine flu, Zika, and now coronavirus, he says.

Some of the first coronavirus patients in China, for example, were experimentally given the HIV treatment lopinavir–ritonavir and the rheumatoid arthritis drug Actemra. Now, as the virus continues its rampage around the globe, doctors are eyeballing an increasing number of treatment possibilities—and dealing with the challenging ethics of testing their efficacy while making the safest choices for their patients.

Controlled trials—with caveats

When choosing to use an experimental treatment, doctors have to be as methodical as possible—taking careful note of how sick patients are when given treatment, the dose and timing of medication, and how they fared. “It’s not a study, not controlled, but you want observations to be systematic,” says Caplan.

If, after a couple of weeks and 10 or 20 patients the drug doesn’t seem to cause active harm, Caplan says scientists can quickly move to the first stage of clinical research.

Many of the current coronavirus clinical trials are based on those early experimental treatments. Early research on lopinavir–ritonavir suggests that the drug is not effective, though as the first study was small, researchers plan to investigate further. There are also ongoing trials into arthritis medication Actemra,  antimalarial chloroquine, and Japanese flu drug favipiravir.

While clinical trials typically take months to years to get started, Li believes the current coronavirus trials will set records for speed: “I don’t think they could go any faster,” she says. It helps that there are a lot of coronavirus patients, so it’s easy to quickly enroll study participants.

The info is here.

Who gets the ventilator in the coronavirus pandemic?

Julian Savulescu & Dominic Wilkinson
abc.net.au
Updated on 17 March 20

Here is an excerpt:

4. Flatten the curve: the 'too little, too late' approach

There are two wishful-thinking approaches that try to make the problem go away.

The first is that we need more liberty to impose restrictions on the movement of citizens in an effort to "flatten the curve", reduce the number of coronavirus cases and pressure on hospitals, and allow everyone who needs a ventilator to get one.

That may have been possible early on (Singapore and Taiwan adopted severe liberty restriction and seemed to have controlled the epidemic).

However, that horse has bolted and it is now inevitable that there will be a shortage of life-saving medical supplies, as there is in Italy.

This approach is a case of too little, too late.

5. Paternalism: the 'greater harm' myth

The second wishful-thinking approach is that some people try to argue that it is harmful to ventilate older patients, or patients with a poorer prognosis.

One intensive care consultant wrote an open letter to older patients claiming that he and his colleagues would not discriminate against them:

"But we won't use the things that won't work. We won't use machines that can cause harm."

But all medical treatments can cause harm. It is simply incorrect that intensive care "would not work" in a patient with COVID-19 who is older than 60, or who has comorbidities.

Is a 1/1,000 chance of survival worth the discomfort of a month on a ventilator? That is a complex value judgement and people may reasonably differ. I would take the chance.

The claim that intensive care doctors will only withhold treatment that is harmful is either paternalistic or it is confused.

If the doctor claims that they will withhold ventilation when it is harmful, this is a paternalistic value judgement. Where a ventilator has some chance of saving a person's life, it is largely up to that person to decide whether it is a harm or a benefit to take that chance.

Instead, this statement is obscuring the necessary resource allocation decision. It is sanitising rationing by pretending that intensive care doctors are only doing what is best for every patient. That is simply false.

The info is here.