There have been many examples of heroism during the COVID-19 pandemic. We need look no further than the scores of health professionals around the world who put their lives at risk to care for COVID-19 infected patients. Many of these workers contracted the virus, and a good number have lost their lives caring for society’s most vulnerable.
Sadly, the pandemic has also left us with no shortage of examples of egregiously unethical behaviour. Political leaders have in many cases violated basic standards of transparency and decency. New York Governor Andrew Cuomo’s Office, for several months, deliberately concealed the true death rate from COVID-19 in the state’s aged care homes. In October 2020, British Prime Minister Boris Johnson is alleged to have said he would rather see the bodies piled “high in their thousands” than place his nation into another COVID-19 lockdown.
Unethical behaviour in the pandemic has not been confined to the upper levels of government and public health bureaucracy. Many British doctors are reported to have covertly issued Do Not Resuscitate (DNR) orders for patients in vulnerable population groups — including the elderly, people with disabilities and learning difficulties and people experiencing mental illness. The situation was bad enough to lead NHS officials to issue directives repeatedly reminding doctors to refrain from issuing blanket DNR orders for vulnerable societal groups. One directive went as far as to explicitly state:
The terms “learning disability” and “Down’s syndrome” should never be a reason for issuing a DNR order or be used to describe the underlying, or only, cause of death … Learning disabilities are not fatal conditions.
As we look with cautious optimism toward a post-pandemic world, how can we create a culture in which ethics comes to the fore in a crisis rather than being treated as an inessential feature of crisis management? How can we avoid the exploitation of power to promote self-interest at the expense of society’s most vulnerable?
The failure of utilitarianism and pragmatism
We can start with a consideration of what not to do in a public health crisis. The most sinister moral paradigm in public health debates in the past eighteen months has been a crude form of utilitarianism that seeks to justify widespread COVID-19 fatalities under the guise of restored personal liberty, economic productivity, and the interests of those who are fit and healthy (what might otherwise be termed “the greater good”). Boris Johnson’s alleged lockdown invective — described as “a punch in the stomach to all those grieving” by the COVID-19 Bereaved Families for Justice group — is one example. There have been many others.
The Italian Society of Anaesthesia, Analgesia, Resuscitation, and Intensive Care (SIAARTI) last year endorsed an explicitly utilitarian approach to the rationing of beds in Intensive Care Units (ICU), arguing in favour of explicit age cut offs and stating that “the allocation criteria need to guarantee that those patients with the highest chance of therapeutic success will retain access to intensive care.” Many other intensive care groups seemed tempted to follow suit, until disability activists and others pointed out that such policies would likely compound existing social injustices and lead to the further marginalisation of minority groups.
Nor is political pragmatism a justification for deceiving the public. After news of a cover-up in aged care homes hit the press, Governor Cuomo attempted to justify his actions by claiming that he feared that the Trump administration might pursue a politically motivated inquiry into the state’s handling of the outbreak in nursing homes — as if that were any consolation for the families of the tens of thousands who have died from COVID-19 in New York’s ravaged aged care system.
Toward an ethics of the common good
There is an increased awareness that societies cannot treat vulnerable members of the community as second-class citizens during a public health crisis. Rather, we must ensure that our COVID-19 exit plan includes a way to protect those people in the community who are most at risk from serious disease and death if infected with COVID-19. While more Australians are seeking an end to the cycle of lockdowns that has gripped our nation, the rhetoric now is no longer a stark trade-off between deaths and freedom, the fate of the vulnerable and economic productivity. The focus of discussion is instead the sluggish vaccine roll-out and how we can ensure that all Australians — especially those residing or working in aged care facilities — are protected when we loosen restrictions. Federal Treasurer Josh Frydenberg, for example, said in Melbourne last week: “We need, as a nation, to move our focus from the suppression of the virus, ultimately, to living with the virus and preventing hospitalisation, fatalities and serious illness.” While some may disagree with this sentiment, it should at least be acknowledged that Frydenberg’s language is a far cry from callous rhetoric of Boris Johnson.
Yet it is simplistic to believe that biotechnologies like vaccines provide a comprehensive ethical solution to the various moral challenges attendant to the COVID-19 pandemic. We need to move beyond the Enlightenment mentality that suggests technological progress offers an answer to many of the moral problems facing modern societies. Rather, political leaders and healthcare professionals alike need to cultivate a keen sense of the dignity and value of each human life affected by their decisions. We need to foster a mentality that leads one to look beyond a world of finite resources and entrenched political divisions toward a better world in which mutual respect and flourishing is possible for all members of society. We need to switch our focus from the greater good to the common good.
Life in a post-pandemic world
Ethical progress often occurs following dark chapters in human history. In the wake of the spate of unethical medical experiments performed by Nazi doctors during the Second World War, for example, authorities drafted the Nuremberg Code — a code of ethics that forms the basis of contemporary ethical standards in health and biomedical research, and which had a profound influence on post-war human rights discourse.
What will be our code of ethics as we emerge from the COVID-19 pandemic? Cultivating our consciences and moral imagination means reflecting on the lessons of the past eighteen months. While it may be the case that we have to learn to live with COVID-19, we should be deeply cautious about resigning ourselves to policies that are manifestly not in the interest of society’s most vulnerable. If there’s one thing we’ve all learned from lockdown, it’s that life in a post-pandemic world ought to be lived in solidarity rather than individualistic isolation.
Xavier Symons is a Postdoctoral Research Fellow in the Plunkett Centre for Ethics at the Australian Catholic University, and an Adjunct Lecturer in the Institute for Ethics and Society at the University of Notre Dame Australia. He is currently writing a book for Routledge on conscience and conscientious objection in healthcare.