JOHN CARMODY.- A ‘civil society’ or a ‘competitive society’?

I suspect that the Australian people have never really abandoned their ethical view that people’s lives supersede profits.

Margaret Thatcher, the British Prime Minister from 1979-1990, has much to answer for. Whether, as her supporters claim, she was misunderstood when she declared in 1987, “Who is society? There is no such thing!…….People look to themselves first”[1], she certainly influenced more than a generation – in Britain and elsewhere – to embrace individualism. Indeed, a selfish individualism.

It is true that she went to say, “There is a living tapestry of men and women and people, and the beauty of that tapestry, and the quality of our lives, will depend upon how much each of us is prepared to take responsibility for ourselves and each of us prepared to turn round and help by our own efforts those who are unfortunate.”.   Nevertheless, her real attitude was revealed in those words about taking responsibility for ourselves and the notion that our only further concern is the “unfortunate”, and certainly not our peers. Furthermore, her actions demonstrated her own moral and communal values: notably the social structures which she destroyed and the national outlook which she encouraged. In Australia, generations of politicians have mimicked those solipsistic attitudes. Too many of them are, fundamentally, hostile to the philosophy of a “civil society”: “competitive society”.is their mantra and goal. They see governments’ role as running economies; the different, suppressed, ethic is that they should supervise and serve societies.

Yet, amongst the many things which we are learning from the current COVID-19 pandemic, is that we do live in a society, and that, like our own bodies, everything in it is inter-connected and inter-dependent. No part of it can be damaged without an adverse influence on the rest of that complex and necessarily co-operative organism. Thatcher’s rather greater predecessor, John Donne, expressed this more poetically, “No man is an island unto himself but a part of the main”.  The eminent historian, Dr Paul Collins, has rightly reminded the readers of Pearls and Irritations of the wider biological dimension of that social interconnectedness.[2]PAUL COLLINS. COVID-19. A chance to rethink the deeper moral and human issues

What is fundamentally being asked of us, notwithstanding our Prime Minister’s banal appeal to patriotism, is to behave at our best as people, not as units in an economy. That is, itself, a thorough-going repudiation of contemporary capitalism. But an even more profound possibility is that we may be living through a fundamental and corrective change in the values of our nation. Phrases like “for the greater good” are increasingly being used by people in authority.

For all that our salesman Prime Minister spruiks otherwise, I suspect that the Australian people have never really abandoned their ethical view that people’s lives supersede profits. We may have appeared to accept the tenets of modern capitalism – with its demolition of communal assets; its relentless casualisation of the workforce in the interests of “flexibility” (which is, essentially, a pseudonym for private profits and wealth); its interpretation of “globalism” as the advantageous trans-national movement of capital to avoid taxation; and of manufacturing to exploit the poor in order to optimise financial returns, notwithstanding the immense social and environmental costs – but we have always disliked it, while ignoring those reservations and choosing to “gain” from it.

That economic reawakening is also a fundamental ethical matter. We might feel besmirched by the exploitation involved; we may even resent the assault on our society and its values. Who knows what punishment we might yet seek to inflict on governments which have principally served the rich, whilst deceiving the people. We have in recent weeks realised that everyone – no matter how wealthy or educated — has an important rôle to play in the congenial and supportive operation of our society, be they doctors and nurses, teachers, garbage collectors, public-transport operators, musicians, restaurateurs, farmers, journalists, and – yes – even politicians (for all that many have appeared to want to run away from crises). Hosts of others, as well. They are all important (as much for their humanity as their work) and it would be as foolish as it is unethical for us to disregard their contributions or their vulnerability.

The COVID-19 virus – no matter that it might (like measles) become less serious as the population experience of it increases – causes a serious enough illness to result in hospitalisation of about 20% of diagnoses and, more ominously, have about of those cases 5% requiring a respirator in an Intensive Care Unit[3]. It is claimed that there are currently only 2000 such machines in Australia[4]. Plainly, the need for their use for other patients does not disappear during such a disease as COVID-19; thus, if as many as 1000 were available for the current disease, that availability would essentially be exhausted when the number of hospitalised patients reached 4,000 here (i.e. a total of 20,000 in the overall Australian community). Then, truly horrific ethical questions would arise about the allocation of those ventilators: to which patients – to which age-groups – would they be available? This is not a theoretical question. Admittedly there are, in Australia, currently almost 600 confirmed cases but the records from China should give us serious concerns.

According to a very recent paper in the Journal of the American Medical Association (which cited highly plausible data from the Chinese Center for Disease Control and Prevention), until the end of December 2019 daily numbers of new cases in China were in single figures; by 24 January those figures were 2500-3000/day[5]. That information should lead us to suspect that within the next 2-3 weeks the case-load in Australia could be 1500 new patients each day – with tens of thousands still ill. Such clinical figures would certainly surpass the availability of essential respirators. That has happened in Italy where 76% of cases have been in people older than 50. Reportedly, Italian clinicians felt compelled to refuse admission to ICU’s to patients who are over 80. Yet they are also human beings

Australian nurses and doctors are highly likely to face such awful ethical choices, too. Which patients will benefit most from the use of a scarce respirator? Who will not be put onto one, and will, thereby, be left at far greater risk of death? Perhaps these are never thought of as “moral” questions rather than “ethical” ones, which do not sound so grave.

Some may say that past decisions about the numbers of items of critical apparatus which our hospitals can purchase are administrative — or even political — decisions. But they are also ethical ones: their consequences cannot be evaded by niceties of terminology. The truth is that that our community (including its politicians and bureaucrats) has, over recent decades, become dangerously complacent about infectious disease, the AIDS years notwithstanding. I recall, years ago, hearing a senior medical figure in the US assert that our battle against infections disease had been won; a more sagacious colleague asked, “By which side?”

In past years humanity was far more cognisant of and worried by infectious disease, in general, and epidemics in particular. Think of the social and artistic power of the “Black Death”, for example. We’ve been lulled by the efficacy of antibiotics (for all that we’ve ignored or downplayed the crescendo of bacterial resistance to them) and the success of vaccines. Blind to those realities and seduced by the siren of redevelopment and the accrual of profits, Governments have closed most of our specialised infectious disease hospitals (Prince Henry in Sydney and Fairfield in Melbourne, for instance; in Sydney the Quarantine Station at Manly was turned into a hotel [while conceding that, before the present era of mammoth cruise-liners, most arrivals were no longer by sea, I would think that a prudent – even an “ethical” – government would have re-located that service, not aborted it]). Pari passu with that transient nadir of contagious illnesses, has come a disturbing unfamiliarity with death – to the point of its virtual denial and the preference for euphemisms when we are forced to mention in in public.

We are born, we live the best life that we can, and then we die. Where is the morality of denying or turning our backs on one of those human realities? As Donne also observed, “Ask not for whom the bell tolls — it tolls for thee.”. The truth is that, in his lifetime, everyone could hear those bells. Nowadays, even if we are deaf to them, we should not be deaf to the human realities which their chimes declare. Nor to the associated ethical and moral realities which those metaphorical bells should remind us of. None of our actions is without cost, least of all our loss of the understanding of community.

Morality envelops us all and to ignore it has a high cost.

John Carmody was a member of the Faculty of Medicine at the University of NSW for 40 years. He writes regularly for the “Australian Dictionary of Biography”.

[1] Thatcher, Margaret. 1987. ‘Interview for “Woman’s Own” (“No Such Thing as Society”).’ in Margaret Thatcher Foundation: Speeches, Interviews and Other Statements. London.

[2] Collins, P: “COVID-19. A chance to rethink the deeper moral and human issues”, Pearls and Irritations, 17 March 2020.

[3]   Wu and McGoogan (2020), op. cit.

[4] Sydney Morning Herald, 14 March 2020; https://www.smh.com.au/politics/federal/australia-needs-2000-extra-ventilators-to-cope-with-catastrophic-outbreak-20200313-p549u7.html; accessed 16 March 2020.

[5]    Wu Z & McGoogan JM: “Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72,314 Cases From the Chinese Center for Disease Control and Prevention”, JAMA. (published online February 24, 2020). doi:10.1001/jama.2020.2648 – accessed 16 March 2020.

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