The coronavirus pandemic has, like many other large-scale crises, brought to the fore some crucial ethical questions that we must explore. Human beings are the only species considered capable of making a choice based on ‘free will’, i.e. based on reason and rationality. But when we look through the ethical glass, many a time what appears to be a choice is simply a foregone conclusion. Our ethical choices become less about what we “ought to” do and more about what we “have to” do owing to the contextual situation at hand. So how ethical are our choices? What makes them ethical in the first place? Are other choices equally ethical?
These questions need to be explored in the context of three critical ethical dimensions of the current pandemic, or ‘3Ps’ – (a) Proportionality of restrictions, (b) Priority of access to healthcare, and (c) Professional obligations of essential workers.
Proportionality of Restrictions
Breaking the chain of transmission has widely been accepted as the key to halting the spread of infectious disease, and involves restrictions to personal freedom such as isolation, social distancing, and even lockdowns. We temporarily sacrifice our ‘individual rights’ of movement and social interaction for the ‘common good’ of public health and safety. These restrictions become reasonable, legitimate, and acceptable only when they are proportional to the larger benefit to the community as a whole.
What happens when members of a community disagree over restrictive measures in place? The US, in particular, has seen widespread protests against lockdown measures and increasing calls to reopen the economy. Counterintuitively, many of those protesters are neither irrational nor delusional – they very well understand the associated risks of lifting lockdowns and yet are willing to risk their lives because they simply value the ‘individual liberty’ more than the ‘common good’. They are making an ethical choice.
Supposing everyone does agree on the issue, to what extent can we restrict basic freedoms to satisfy the test of proportionality? Surely for most of us who have enough savings, a steady supply of groceries and a stable job waiting for us, a lockdown becomes, at best, an inconvenience. Would we have been equally willing to support the ‘common good’ if we were sure to be cut off from our essential needs and lose our jobs? Certainly not.
But we forget that the same lockdown in fact causes disproportionate economic and mental distress to the less fortunate such as migrant and daily wage workers. We accept it anyway because of the ‘common good’ argument. Does it not fail the test of proportionality in this case? Do we silently accept the hardships of one community when we ourselves would not have accepted them?
Priority of Access to Healthcare
Under normal circumstances hospitals would be expected to follow the principle of ‘equality’ and ‘equitability’, i.e. all patients would be treated without discrimination and the ones with higher vulnerability would be prioritised. Amid a pandemic, however, resources can become extremely scarce. Many parts of the world have reported a lack of ventilators and an over-stretched healthcare workforce. In such a scenario, where patients get admitted at rates faster than the recovery rate, who should a doctor treat first?
Keeping the ‘equitability’ principle in mind, the natural conclusion is that the sicker patients should get priority of access to healthcare. But in the present pandemic, most of those affected are older and/or with existing co-morbidities. Can we then argue that the younger patients, who have better chances of survival and arguably a greater number of years ahead of them, should get priority? It sounds logical, but would we not be foregoing the principle of equitability by valuing one life over another?
For maintaining ‘equality’, each person irrespective of their social status deserves the same level of medical care as any other. Imagine a scenario where a doctor can save only one equally sick patient – an important dignitary such as a head of a state on one hand and a common person on another—who gets saved? No points for guessing, it is the former who lives. Why? Because here we have discarded the principle of ‘equality’ and applied the notion of ‘social value’. The loss of a head of state would have much higher ramifications to the society than the loss of a commoner. But does that make it ethical to value one life over another?
Let us take the above thought experiment slightly further. Again, the two patients are equally sick, but the commoner is already on life support when the dignitary is rushed in. Would we now take the life support away from the commoner and let him die so that the dignitary may live? Even the biggest rationalists amongst us would cringe at even the thought of such a horrid decision. However, this is exactly the ethical choice we made earlier – we decided that one life was more valuable over the other. Does the same principle not apply here? Why is the explicit action of taking life support away from a dying patient more objectionable than the previous choice to simply ignore his medical requirement in favour of the dignitary?
Professional Obligations of Essential Workers
Doctors and nurses are at work round the clock saving lives while putting their own lives at extreme risk. Many have fallen sick in the line of duty and some have even died. They have been hailed as heroes because they put ‘duty’ above their ‘right’ to self-preservation and safety. But are they ethically obligated to do so? It appears almost obvious that they are. After all, they took an oath. Most of us would argue that it is their duty to work in these trying circumstances and that the nature of their chosen job always has an implied risk factor. But is this obligation ‘deontological’ or ‘consequentialist’? In other words, are they on the job because it is the right thing to do or because they fear social embarrassment for refusing to work? Does the second reason make them less of a hero?
Talking of heroes, consider another category of workers – transporters, vendors and delivery workers who are maintaining the supply of essential goods and services. They face high threat by virtue of being points of contact and are also the least protected. While the previous category of doctors and nurses took an oath, these workers did not. In fact, they probably took up the job that paid the best in an already low-paid category. They just happened to be involved in these essential services when a pandemic struck. Are they then ethically obligated to keep working? The answer is perhaps no; they do not have a ‘deontological’ duty. They are on the job because of the ‘consequentialist’ reason that the alternative to working is to lose their livelihood. Does this make them less of a hero? Does it bear an ethical reflection on us as a society that in the toughest times we force a big chunk of our workforce to choose between their life and livelihood?
Expectedly, this article asks more questions than it answers. The purpose was as much. There are no right choices but only right intentions. Any choice we make is always associated with several ethical risks. But this should not dissuade us from making hard choices. Rather, it should compel us to think a bit deeper about the values we cherish and nurture. How the world will look on the other side of the pandemic will depend a lot on how we have responded as individuals, communities, and societies.
(The author holds a Master’s Degree in Philosophy. Views expressed are personal.)