Pandemic Ethics

covid19

Pandemics present a number of daunting ethical challenges to the economic and social wellbeing of any country, as well as a serious risk to the health of its population.  Sensible and proportionate preparation and response by the government, businesses, the media and communities can help to mitigate its effects, however there are many important ethical issues that need to be considered, such as priority of access to healthcare resources with increased demand and possible shortages; obligations of healthcare workers in light of risks to their own health; and the fine balance between reducing disease spread through isolation and travel measures whilst protecting the right of individuals to freedom of movement.

Coronavirus (COVID-19)

On 31 December 2019, The World Health Organization was informed of a cluster of cases of pneumonia of unknown cause detected in Wuhan City, Hubei Province of China. The coronavirus disease (COVID-2019) was identified as the causative virus by Chinese authorities on 7 January.  In less than three months, the number of COVID-19 cases surpassed 300,000 globally with more than 14,500 deaths and on 11 March, WHO officially declared COVID-19 a pandemic.

Below are links to online resources, blogs, interviews etc that OUC Researchers have posted in response to the outbreak.

laRegione: Alberto Giubilini, 23 May 2020
L’equità di un vaccino obbligatorio
Immunity is a public good and as such everyone must contribute.
(Swiss newspaper, interview in Italian)

news.com.au: Alberto Giubilini, 17 May 2020
Coronavirus vaccine: French government demands equal access in COVID-19 vaccine distribution row
Tough decisions will need to be made about who should receive priority access to potential vaccines.

ABC The World: Julian Savulescu, 30 April 2020
TV Discussion of UK Coronavirus policies. 

CNN: Julian Savulescu, updated 24 April 2020
The dangerous morality behind the 'Open it Up' movement
A healthcare worker in green scrubs stands in the middle of an intersection, staring down a traffic jam of screaming protesters demanding a return to their livelihoods and...

The Atlantic: Alberto Giubilini, 16 April 2020
Is It Ethically Okay to Get Food Delivered Right Now?
A guide to this and other pandemic food dilemmas.

The New York Times: Julian Savulescu, 8 April 2020
14 Days With a Quarantine Tracker Wristband: Does It Even Work?
Hong Kong’s bracelets seem to obliterate the temptation to go outside, even if they appear to be just a simple piece of paper.

ABC Radio National Breakfast: Dominic Wilkinson, 7 April 2020
UK and Germany consider issuing immunity passports to ease lockdowns
Expert commentary on immunity passports

Al Jazeera News: Julian Savulescu, 5 April 2020
Can an 'immunity passport' ease coronavirus lockdowns? [2:30 on the clock]
There is one idea out there that is already in the works, with the hope that it may ease worldwide lockdowns.

BBC Radio 4 Sunday: Dominic Wilkinson, 5 April 2020
Covid ethical dilemmas; Plants for Passion; Holy Howlers [approx 34 mins on the clock].
The Covid pandemic has created ‘battlefield’ conditions for UK doctors who may soon have to make very difficult decisions about who to prioritise for life-saving treatment.

Al Jazeera Inside Story: Dominic Wilkinson, 5 April 2020
How long does immunity last?
Some countries are considering issuing 'immunity passports' for those who have recovered from the coronavirus. But would that work?

Der Spiegel: Roger Crisp, 28 March 2020
Die Jüngeren sollten den Vorzug erhalten
The UK Government's strategy on Covid-19 - younger people should be prioritised for life-saving treatment.
Subscription required for online edition or read/download PDF here (in German).

New Scientist: Julian Savulescu, 26 March 2020
Which covid-19 patients will get a ventilator if there's a shortage?
Many countries are prioritising treatment to COVID-19 patients with the best chance of recovery, however we don’t yet fully understand which health conditions affect the chance of survival.

The Guardian: Julian Savulescu, 25 March 2020
Is it right to cut corners in the search for a coronavirus cure?
Vaccine and drug trials are slow, to account for safety. But in a pandemic time isn’t just money – it’s lives.

ABC Radio The Religion and Ethics Report: Xavier Symons, 25 March 2020
Who lives and who dies?
If the Coronavirus overwhelms our health system – which, as we discussed last week, it’s done in Italy – what sort of choices could face Australia’s medical professionals?

The Independent: Dominic Wilkinson, 24 March 2020
Coronavirus: Families should start planning for how virus affects most vulnerable, warns top medic
New research from Oxford University has cautioned that people concerned about becoming seriously ill due to the coronavirus should begin planning for how the disease might affect them.

El Pais: Carissa Véliz, 24 March 2020
La privacidad en tiempos de coronavirus
Privacy in times of coronavirus: The most effective measures against the pandemic do not go through apps that affect our rights.

Wall Street Journal: Article by Denise Roland, quotes Julian Savulescu, 19 March 2020
Wanted: People Willing to Get Sick to Find Coronavirus Vaccine
Thousands of people have volunteered to be infected in the hope of finding a vaccine for the new coronavirus.
"There's a positive ethical rationale for doing challenge study experiments," said Julian Savulescu, who leads research on collective responsibility in infectious disease at the University of Oxford. "This kind of research is one of the arrows in the quiver of tackling this kind of catastrophe."

The Guardian: Carissa Véliz, 18 March
Is it safe – and ethical – to order food online during the coronavirus outbreak?
Online services such are dealing with huge surges in delivery orders. This raises an ethical dilemma: is it morally acceptable to ask others – normally in less secure jobs with worse pay – to take on a risk that you don’t want to?

ABC: Julian Savulescu and Dominic Wilkinson, Updated: 17 March 2020
Who gets the ventilator in the coronavirus pandemic? These are the ethical approaches to allocating medical care
It is undeniable that people should have an equal chance when there are sufficient resources. Someone should not be denied medical treatment that is available because of their sex, race, age, disability or any other factor. That would be unfair discrimination. But when there are limited resources, doctors do take various factors into account.

The Sydney Morning Herald: Xavier Symons, 13 March 2020
Rationing care to cope with COVID-19 should never be based on age alone
As Australia’s coronavirus outbreak worsens, health authorities are bracing for an unprecedented increase in hospital admissions and demand for acute care. Authorities in NSW are anticipating as many as 1.5 million people in the state to be infected with COVID-19. Hospitals are being asked to double their intensive care capacity in anticipation of a surge of patients.

pri.org: Alberto Giubilini, 06 March 2020
As Italy's students rejoice over school closures, families worry about economic toll
“The government is adopting a ‘better safe than sorry’ approach, choosing to impose the most extreme measures. I think it is justified in this case, even though it will be disastrous for many families and for the economy. But the priority right now is public health, so even harsh measures are justified. [...] The government should invest money into compensating the victims of these measures, even if this will worsen the financial crisis already caused by the virus. But if it does not, it is just using people as mere means to an end, which is not ethically acceptable. These people are not necessarily responsible for carrying the disease, but they pay the price.” 

BBC Radio 4 Moral Maze: Dominic Wilkinson, Released: 04 Mar 2020
Should we do everything we can to protect the most vulnerable in our society, even if the knock on effect to the global economy has the potential to cause suffering and death for many more people further down the line? With Dr. Tony Booth, Dr. Norman Lewis, Julian Sheather & Professor Dominic Wilkinson.  Chaired by Michael Buerk.
Available on BBC Sounds for over a year.

Al Jazeera Inside Story: Dominic Wilkinson, 27 February 2020
Is the spread of coronavirus out of control? [5:15 on the clock]

What are the current UK lockdown measures, and how should we interpret them?

A bird’s eye view on the ethics of exercise during COVID-19 lockdown measures, with Guest Speaker, OUCs Dr Jonathan Pugh (7 May 2020)


Thinking Out Loud: Corona Edition

In this video, Katrien Devolder announces a new video series with philosophers and other experts discussing ethical issues raised by the corona-crisis.

Interviewees include Professor Peter Singer, Dr Marco Vergano, Dr Ganguli Mitra and Professor Udo Schüklenk. Full playlist here.

 

 

Zoe Fritz, Richard Huxtable, Jonathan Ives, Alexis Paton, Anne Marie Slowther, Dominic Wilkinson: BMJ Editorial (21 May 2020)
Editorial: Ethical road map through the covid-19 pandemic, BMJ 2020; 369: m2033
We must follow the ethics, not just the scienceThe covid-19 pandemic has created profound ethical challenges in health and social care, not only for current decisions about individuals but also for longer term and population level policy decisions.


World Health Organization Report 'Key criteria for the ethical acceptability of COVID-19 human challenge studies' cites papers by Julian Savulescu, Tom Douglas, Hannah Maslen and Alberto Giubilini, (6 May 2020)

Controlled human challenge studies involves the deliberate infection of healthy volunteers.  They are particularly useful for testing multiple vaccine candidates quickly and efficiently, as well as providing data on the processes of transmission, infection and immunity. Aimed at scientists, policy-makers and regulators, the report outlines the criteria that would need to be met for human challenge studies on COVID-19 to be ethically acceptable.

OUC papers cited


Doug McConnell, Journal of Medical Ethics, (24 April 2020)
McConnell, D., (forthcoming), 'Balancing the duty to treat with the duty to family in the context of the COVID-19 pandemic', Journal of Medical Ethics, Vol: online first
Healthcare systems around the world are struggling to maintain a sufficient workforce to provide adequate care during the COVID-19 pandemic. Staffing problems have been exacerbated by healthcare workers (HCWs) refusing to work out of concern for their families. I sketch a deontological framework for assessing when it is morally permissible for HCWs to abstain from work to protect their families from infection and when it is a dereliction of duty to patients.


Jonathan Pugh, Journal of Law and the Biosciences, (29 April 2020)
Pugh, J., (2020 forthcoming) 'The United Kingdom’s Coronavirus Act, Deprivations of Liberty, and The Right to Liberty and Security of the Person', Journal of Law and the Biosciences, Vol: online first [Open access, freely available]
In this paper, I use the Coronavirus Act introduced in the UK as a case study of how emergency legislation enacted in a pandemic may conflict with human rights law enshrined elsewhere in domestic law. Having outlined key features of existing statutory powers in the UK, and how they are extended under the Coronavirus Act, I briefly consider how the European Court of Human Rights has interpreted the public health exception to Article 5 rights.


Julian Savulescu, James Cameron and Dominic Wilkinson, British Journal of Anaesthesia, (20 April 2020)
Savulescu J, Cameron J, Wilkinson D. (in press) Equality or Utility? Ethics and Law of Rationing Ventilators, British Journal of Anaesthesia [subscription required for link, or see preprint PDF]
NICE guidelines allow rationing of ventilators and other limited resources according to the probability of survival. There are two main ethical theories relevant to rationing limited resources and distributive justice in medicine: egalitarianism and utilitarianism. While both equality and utility are important values for distributive justice, current practice represents an unstable and incoherent compromise.


Dominic Wilkinson and Mike Linney, Royal College of Paediatrics and Child Health, (16 April 2020)
Ethics framework for use in acute paediatric settings during COVID-19 pandemic
The focus of the ethical framework provides guidance for a situation where there is extremely high demand and limited critical care capacity. However, it is important to note that at the time of writing (14 April 2020) there is enough paediatric critical care capacity across the UK. 


Dominic Wilkinson, Journal of Medical Ethics (1 April 2020)
ICU triage in an impending crisis: uncertainty, pre-emption and preparation
The unpalatable question facing clinicians as the COVID-19 crisis escalates is which patient to save. How should resources be allocated as demand outstrips supply?

 

Thinking Out Loud: Corona Edition Podcast Series

Thinking Out Loud provides audio-podcasts based on a series of videos produced by OUCs Katrien Devolder in which she talks to leading philosophers from around the world on topics related to practical ethics. The podcast and videos are meant for a non-specialist audience. You can watch the videos on the Practical Ethics Channel or subscribe to the iTunes and/or Oxford Podcasts albums here.
Episode 1: Peter Singer 'What caused the coronavirus pandemic?'
Episode 2: Marco Vergano 'Triage in an Italian ICU During the Coronavirus Pandemic'
Episode 3: Agomoni Ganguli-Mitra 'Is the coronavirus pandemic worse for women?'
Episode 4: Udo Schüklenk 'Is it morally permissible for healthcare workers to stop working if they lack protective equipment?'


Practical Ethics in the News Blogs

Thomas Douglas, Jonathan Pugh and Lisa Forsberg, 13 May 2020
Pandemic Ethics: Compulsory treatment or vaccination versus quarantine
Cross posted with the Journal of Medical Ethics Blog

Alberto Giubilini, 6 May 2020
Contact-tracing apps and the future COVID-19 vaccination should be compulsory. Social, technological, and pharmacological immunisation

Stephen Rainey, 5 May 2020
Following the Science Without Forgetting Values

Julian Savulescu and Dominic Wilkinson, 24 April 2020
Pandemic Ethics: Extreme Altruism in a Pandemic
Cross-posted with the Journal of Medical Ethics Blog

Doug McConnell and Dominic Wilkinson, 22 April 2020
Pandemic Ethics: Key Workers Have a Stronger Claim to Compensation and Hazard Pay for Working During The COVID-19 Pandemic Than The Armed Forces Do When on Deployment
Post originally appeared on the Journal of Medical Ethics Blog

Julian Savulescu and James Cameron, 22 April 2020
Pandemic Ethics: Why Lock Down of the Elderly is Not Ageist and Why Levelling Down Equality is Wrong
Cross-posted with the Journal of Medical Ethics Blog

Bryce Goodman, 21 April 2020
Pandemic Ethics. Social Justice Demands Mass Surveillance: Social Distancing, Contact Tracing and COVID-19

Ben Davies and Joshua Parker, 14 April 2020
Maximising Ventilators: Some Ethical Complications

David Killoren, 13 April 2020
Guest post: Pandemic Ethics-Earthquakes, Infections, and Consent

Ben Davies, 8 April 2020
The Perfect Protocol? Ethics Guidelines in a Pandemic

Dominic Wilkinson, 8 April 2020
Cross Post: Boris Johnson Will Be Receiving The Same Special Treatment Other Patients Do In NHS Intensive Care
Cross posted in The Conversation

Alberto Giubilini, 4 April 2020
Why You Should Not (Be Allowed To) Have That Picnic in the Park, Even if it Does Not Make a Difference
An expanded version of this blogpost is to be published in journal Think (link to article to follow)

Neil Levy, 30 March 2020
The Coronavirus: Signs of Hope?

Julian Savulescu, 25 March 2020
Pandemic Ethics: Is it right to cut corners in the search for a coronavirus cure?
Cross-posted from The Guardian

Julian Savulescu and Dominic Wilkinson, 24 March 2020
Pandemic Ethics: Who gets the ventilator in the coronavirus pandemic? These are the ethical approaches to allocating medical care
Cross-posted from ABC Online

Stephen Rainey, 24 March 2020
Politics, Ethics, and Shutting Down in the Face of Covid-19

Hazem Zohny, 24 March 2020
Pandemic Ethics: Covid-19 Shows Just How Much of Ethics Depends on (Good) Data

Stephen Rainey, 24 March 2020
Politics, Ethics, and Shutting Down in the Face of Covid-19

Dominic Wilkinson, 23 March 2020
Coronavirus: The Conversation We Should Have With Our Loved Ones Now – Leading Medic

Anders Sandberg, 21 March 2020
Pandemic ethics: Never again – will we make Covid-19 a warning shot or a dud?

Charles Foster, 18 March 2020
Coronavirus: Dark Clouds, But Some Silver Linings?

Jonathan Pugh and Tom Douglas, 16 March 2020
Pandemic Ethics: Infectious Pathogen Control Measures and Moral Philosophy

Doug McConnell, 13 March 2020
Pandemic Ethics: How Much Risk Should Social Care Workers and Their Families Be Expected to Take?

Anders Sandberg, 4 March 2020
Pandemic Ethics: the Unilateralist Curse and Covid-19, or Why You Should Stay Home

Dominic Wilkinson, 26 February 2020
Pandemic Ethics: Should Frontline Doctors and Nurses Get Preferential Treatment?


External blogs and podcasts

OUP blog: Guest post by Alberto Giubilini and Julian Savulescu, 4 April 2020
Why vaccines should be compulsory
Vaccines are like a seat belt against infectious diseases, and that vaccination mandates are justified for the same reasons seat belt mandates are [...] if you fail to vaccinate yourself or your children there is a much larger risk of harming other people who are not vaccinated (for example those who are immunosuppressed, young children or those whose immunity has waned over time), besides imposing an easily preventable risk on you and your children.

Animal Politico: Guest blog by César Palacios González, April 1, 2020
El gobierno se equivoca al no hablar sobre las muertes que vienen por COVID-19
The government is wrong not to talk about the deaths that come from COVID-19
There are three reasons that show us that the Mexican government's strategy of not talking about possible deaths from COVID-19 is wrong.

Philosophical Disquisitions: Tom Douglas and Jonathan Pugh, 25 March 2020
Podcast:  COVID 19 and the Ethics of Infectious Disease Control
Tom and Jonathan discuss the ethics of pandemic control measures with John Dahaher, based on their recent blog post. 

Stockholm Centre for the Ethics of War and Peace: Tom Douglas, 24 March 2020
Flouting Quarantine
The outbreak has brought the ethics of quarantine, isolation and enforced social distancing to public attention.

animalpolitico.com: César Palacios González, 21 March 2020
Coronavirus: los escenarios para México
The [Mexican] government has not been clear about the number of deaths it expects or the effects its public health policies will have on the death rate.

Leiter Reports
Brian Leiter: News and views about philosophy, the academic profession, academic freedom, intellectual culture, and other topics.
A useful source of posts and links on the COVID-19 pandemic and global response.

World Health Organization
https://www.who.int/emergencies/diseases/novel-coronavirus-2019/global-research-on-novel-coronavirus-2019-ncov
WHO global research and publications on COVID-19

World Health Organization Report 'Key criteria for the ethical acceptability of COVID-19 human challenge studies' cites papers by Julian Savulescu, Tom Douglas, Hannah Maslen and Alberto Giubilini, (6 May 2020)

Controlled human challenge studies involves the deliberate infection of healthy volunteers.  They are particularly useful for testing multiple vaccine candidates quickly and efficiently, as well as providing data on the processes of transmission, infection and immunity. Aimed at scientists, policy-makers and regulators, the report outlines the criteria that would need to be met for human challenge studies on COVID-19 to be ethically acceptable.


Frontiers
Coronavirus Knowledge Hub
The Frontiers Coronavirus Knowledge Hub provides an up-to-date source of trusted information and analysis on COVID-19 and coronaviruses, including the latest research articles, information, and commentary from our world-class scientific community.


World Economic Forum
COVID Action Platform
The spread of COVID-19 demands global cooperation among governments, international organizations and the business community. This multistakeholder cooperation is at the centre of the World Economic Forum’s mission as the International Organization for Public-Private Cooperation.