MILES LITTLE. Coronavirus – more than an ethical problem

There are support groups springing up at community level in various places, offering contactless food delivery for self-isolating people and for the elderly left without carers, and regular telephone calls for the isolated.

Hard upon bushfires comes the coronavirus, COVID19. The bushfires were ‘unprecedented’; so is the virus. The fires disrupted large swathes of Australia, particularly in its eastern parts. The virus’s impacts are effectively worldwide. Both either were or are socially disruptive, demanding that we accept new norms and new normals while they remain active. What the virus is doing to our social lives and experiences is even more disruptive than the fires because more of the world is affected by lethal threats and the social consequences are so fundamental to our customs and habits, and to our expectations of our lives.

In order to limit the speed of spread, we are being asked to change our sociality, to distance ourselves socially from each other, to greet in different ways, to avoid large gatherings and to maintain a physical distance of a meter or more between people. We are required to self-isolate if we have the virus, and every state now has penalties in place for those who don’t comply. Travel has been restricted into the country, and there is advice to defer travel out of the country. Supermarkets have been forced to restrict sales of hand sanitizer and loo paper, and their shelves have been emptied of canned foods and other durable foodstuffs.

Measures of this kind can temporarily limit the explosive spread of the disease, which is a clearly justified practical measure given the limits to health care resources. It leaves behind, as the UK has reasoned, a different problem. Those who have been protected by these constraints will remain without future immunity until an effective vaccine has been developed and proven safe. Herd immunity will have to wait until successive waves of virus infection do their work in a staged evolutionary fashion or until a vaccine can achieve the same end with less morbidity and mortality.

All these considerations have ethical implications. They test public willingness to be altruistic in many ways. We insist upon rights of movement, belief, expression, association, education, travel, health care – but we are being asked to limit those rights within a democratic society. We are to surrender our individual rights to the rights of our community. And we are asked to do this because compliance will be better for humanity in the long run.

There is a tension between responsibilities in this scenario. On one hand, we are all dependent on political and health expertise. On the other, that expertise has no purchase unless the public takes its responsibilities seriously. Police may have the right to arrest the non-compliant, to fine and even imprison them, but the policing forces are finite in their resources, just as health care is finite.

Furthermore, we ask of front-line workers that they embrace their service requirements at increased personal risk to themselves. When they become sick, they cease to effective members of the front-line, and, of course, they may die. Demanding such dedication involves both physical and moral hazard across the community. As it does when the old must be triaged out of intensive care in favour of the young, as is happening in Northern Italy.

These moral tensions are compounded by uncertainty about the behavior and potential of the new virus. It may mutate – as is the wont of coronaviruses – and become more lethal than it already is. It may well become endemic, so that we may have to expect a coronavirus season each year. We remain unsure of case fatality rate.

We think we may be able to decrease its rate of spread, limiting the potentially overwhelming load on hospitals, intensive care services and health care workers. But we can only argue from imperfect data, since we cannot know the true incidence in each part of the world. Drive-by testing is resourceful and efficient, but not everyone drives by, and there may be more asymptomatic cases than we can know.

There are a few things we can be sure of. Coronavirus can cause serious and fatal illness in humans. It can spread from person to person by contact and by droplet infection. The virus can survive on surfaces for days and it can be transferred from hands. It selectively attacks the respiratory tract, and can be passed to mouth or nose when we touch our faces with contaminated hands. The disease has reached pandemic proportions because it has now spread to most countries

There are other things which seem to be true. Social distancing probably helps to limit spread. Hand sanitizing is logical because it works with other infections. Isolation of those with infections is as logical as it was in the 14th century for those with plague or contact with others infected with the plague.

In such extreme circumstances as these, the logic of ethics as some universal and eternal set of laws and guidelines seems unconvincing. In particular, the language of rights is precarious. Rights have always been subject to trumping by other rights. The right to freedom of movement in a liberal democratic society usually goes unquestioned, but not in present circumstances, where rights of free movement for some may be trumped by the rights of others to be protected from infection.

Virtue ethics, encouraging altruism and consideration of personal responsibility, may be more concordant with what we need from the public. Kantian deontology, the ethics of obligation, also work well enough in describing the commitments we might all undertake. Consequentialism, concentrating on welfare and happiness as outcomes of actions, is also fine in its way, although the sheer quantity of unknowns makes the so-called ‘felcific calculus’ difficult. None of these tried approaches offers any startling insight into what we should actually do in this extraordinary context.

We are instead locked into a kind of pragmatism that relies on the innate desire that humans have to survive, feel secure and flourish. The closure of large gatherings and sporting events, of schools and universities, cultural and memorial events reveal a determination to privilege security and survival over flourishing, at least for the moment. Because we value the communities in which we live, their habits, customs and their existence, we are being asked to set aside many of the activities that constitute our flourishing in order to secure a sense of security and our actual survival.

Ethics can comment on the practical measures that are being taken, but it cannot prescribe or proscribe courses of action. Much of what is to happen falls into the hands of politicians, health experts and policy makers. It will also depend on the all important decency of the commons, as did the disastrous bushfires. There are support groups springing up at community level in various places, offering contactless food delivery for self-isolating people and for the elderly left without carers, and regular telephone calls for the isolated (see this link for one example: https://drive.google.com/file/d/1L_8GoI1zQ572fBZtElFfQZI9vNEwK7Rf/view?fbclid=IwAR15INB5Zhs0xEr_mMrE6c_7nXDfwr_eJJtyvgFP5joMfXJ6HV9bLVCOY8E)

In the end, this kind of voluntary support may represent the ethics of the moment, the ultimate demonstration of human response to human frailty and vulnerability, better encapsulating what ethical relationships mean than any formal system of ethics can.

Miles Little is a retired surgeon who started Sydney Health Ethics at the University of Sydney

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1 Response to MILES LITTLE. Coronavirus – more than an ethical problem

  1. Mike Scrafton Mike Scrafton says:

    ‘Ethics can comment on the practical measures that are being taken, but it cannot prescribe or proscribe courses of action.’

    A very fine piece. But it seems to me that if governments in a crisis don’t infused their policy making within an ethical framework, and especially in how they set their objectives, they run the risk of pragmatic solutions slipping into causing great harms. Saving the maximum amount of lives as an objective is a recognition of the value of individual lives and provides a sound guide to policy. Talking about flattening curves and herd immunity is not an ethical approach in terms of the obligations of representative governments. Without an ethical framework expediency and knee jerk reactions are likely to dominate as pressure mounts.

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