Pandemic pondering - 10 new ethical problems

07 May 2020 | 8 mins

As WA works out how to wind back some of its COVID restrictions without becoming complacent, there are still many important ethical issues that we are grappling with as a society. UWA's Dr Nin Kirkham, who teaches Critical Thinking, Continental Philosophy and Ethics in the School of Humanities, helps us hone in on the key issues.

WA is fortunate to be in a low-COVID bubble, while much of the rest of the world battles the COVID storm. How do we deal with the ethical problems that arise from that?

“In some ways, the ‘ethical problem’ of living in WA in a low-COVID bubble is just a more immediate and obvious ethical problem that besets people in western liberal democracies the world over, and people living in WA especially. ‘Why should we have it so good, and be so protected from the hardships and privations that the majority of people in the world face? Why shouldn’t we?’ These are hard questions to answer.”

Who should be involved in making the decision about when we eventually open up our borders again to those from other states and countries?

“Obviously, the decisions will fall to those whose jurisdiction it is, so state borders to the Premiers and their Cabinets in consultation with the Federal Government, international borders to the Prime Minister and Cabinet in consultation with State Premiers. Should there be expert advice taken from virologists, medical experts, economists, advice from the experience of other countries etc? Yes, of course, but ultimately in a representative democracy the decision must be taken by our elected representatives on the best expert advice from the relevant areas.”

How do you weigh up the needs of the health sector (programmed to keep as many people alive as possible and save lives) against the needs of the economy?

“First, it is arguable that either the ‘health sector’ or the ‘economy’ themselves have needs in any meaningful sense. The needs in question are the needs of the population at large and these different sections of our society are there in order to service those needs, not to become ends in themselves. Second, I think the framing of the question can lead us into a bit of a false dilemma. Pitting the so-called needs of the economy against the needs of the health sector to save as many lives as possible makes it sound as if the economy only exists to make money in a way that has no bearing on the wellbeing of people. Clearly, economic hardship and downturn have major and ongoing impacts on people’s lives. While those impacts may not be as immediate as the impacts of coronavirus, they are extremely serious in terms of people’s ability to survive and to flourish.”

How do I weigh up the needs of the grandparents at risk of dying from COVID-19, against the needs of my children whose mental health is suffering from being restricted from seeing friends and with my need to find work and put food on the table? Who wins?

“This kind of weighing up is never going to be a zero sum game (I win, you lose/you win, I lose). There is no real formula that you can use to do it either, and so much will depend on particular circumstances and contextual factors. Sweden has taken an interesting approach to this. Rather than imposing a full-scale lockdown on the entire population, they have advised those who are most vulnerable to COVID-19 (the aged, those with underlying medical conditions etc) to quarantine for their own protection. Those who are less at risk if they contract the virus are encouraged to take reasonable precautions (handwashing, social distancing). How this plays out in the long term is anyone’s guess. At this stage, it doesn’t look like it will be catastrophic.”

How do I decide about downloading the new government COVIDSafe app when I have both concerns about information privacy and keeping my family safe from infection from COVID-19?

“I would think the most important thing in making this decision is to get the most accurate information. So, find out as much as you possibly can about the privacy afforded to individuals who download this app. Then consider whether that level of privacy is something you are comfortable with. For many Australians, the ability to access a great deal of erstwhile ‘private’ information has already been given to private companies through apps like Facebook, TikTok, Snap Chat, Instagram and so on, so the particular concerns related to allowing the Government to access private location information will not seem especially relevant or worrying. For others, who have chosen not to engage in social media, or to limit engagement, the concerns might be very real. It will just depend on people’s level of comfort with this kind of technology, balanced against their sense of social responsibility.”

To what degree can you suspend basic rights (to go outside, to see my family) to introduce new laws for the good of the state. How should we decide on this?

“This is the ‘million dollar’ question for any society that subscribes to the notion that human beings have basic civil rights and/or human rights. Personally, I think the answer has to be pragmatic and is something like ‘only just as much as you need to for the greater good, and only so much as to avoid major civil unrest, in response’. But of course, where that determination lands will depend on facts about the severity of the threat (which may not be accurately known) and facts about the kind of societal expectations people have with regard to their rights and freedoms. That said, many, if not most, of our civil rights have been hard fought for over a long period, so we should be very careful about giving any of them up without an extremely compelling reason.”

How do health workers deal with the dilemma that doing their job puts their family at risk from the virus?

“I don’t know, to be honest. How does anyone deal with that dilemma? I suppose in the same way we all do. We weigh up the risks and benefits as we perceive them and decide on the appropriate course of action. It’s hard but, unfortunately, it’s not unusual. We would be very lucky to not face a situation in our lives where we have to make sacrifices, or put ourselves and our loved ones at some risk, in order to survive and to do what we know is right.”

In regard to consent for COVID-19 experimental treatments, should we look at a system where people can give consent in advance before they get unwell or a whole-population opt out system? COVID cases go downhill very quickly – sometimes there is not much time between walking through a hospital door and being put on a ventilator.

“Opt-out systems are notoriously problematic and often very poorly received by the broader population. The kind of justification that might be put forward for an opt-out system for COVID-19 experimental treatments would be utilitarian – basically, we might choose to use experimental treatment on very unwell patients in cases where they are unable to give meaningful informed consent, and haven’t opted out prior to becoming unwell, in order to produce important scientific results that could have a significant net benefit to society as a whole. Making decisions on these grounds ‘for the greater good’ might sound plausible and attractive, but it is easy to see how all sorts of impositions on people’s fundamental rights and freedoms might be justified in the same way. It is important that the application of utilitarian reasoning runs up against some hard barriers, and in this case, the barrier is informed consent. The idea that we should assume someone is consenting unless they explicitly say they are not is fairly obviously a pretty morally dubious view. Apply it to other areas where consent is an issue and see how it might work, or not.”

Ventilators are in limited supply. How do we decide who gets one and who does not? Should it be an individual hospital decision, like in some other countries, or a national uniformed decision?

“Decisions concerning the distribution of limited essential resources are notoriously difficult, but unavoidable in a range of contexts. Many hospitals have taken the decision out of the hands of the doctors and nurses on the frontline of care, who might be both vulnerable to various biases that impinge on impartial decision making, and fully occupied by all of the other difficult treatment decisions they are having to make. Such hospitals have instituted small, expert panels for making those decisions. There are costs and benefits to such an approach. However, one might also argue that those in the frontline of care are best placed to make difficult decisions about resource allocation, given that they are immediately aware of the particularities of the context.”

How do we deal with requests from seniors with COVID-19 who turn down a ventilator, believing someone younger should have it?

“Many people intuitively believe that if we had to choose between saving the life of a child versus an older person, the child’s life should be the one we save. But our intuitions are much less clear when it comes to deciding between adults of various ages. Personally, I think it would be extremely hard to put forward a defensible principle that would allow us to determine who should get a ventilator in every context, but in a situation where there was truly a desperate lack of ventilators available, and if a kind senior of sound mind chose to forego their access to one on the grounds that they had already more opportunity to live than a person younger, I don’t see what reason we would have to doubt their sincerity or reject their offer.”

Media references

Simone Hewett

UWA Media and PR Manager

08 6488 3229 / 0432 637 716

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