Covid-19: Ethical Issues and Dilemmas

What is the issue?

The world is faced with an unprecedented challenge to contain the outbreak of coronavirus which has now resulted in lakhs of deaths out of a crore of confirmed cases. Widespread restrictions have been placed on individuals, groups, communities, cities and even entire countries. These restrictions involve decisions where trade offs are involved among the many public policy goals. They have thrown up fresh ethical questions.

How can we analyse the ethical dilemmas?

There are three schools of ethics that we need to keep in mind while taking ethical positions on Covid-19-related ethical issues, or for that matter any ethical dilemmas:

Virtue ethics is a philosophy developed by Aristotle and other ancient Greeks. It proposes that through virtuous behaviour like being honest, brave, just, generous, and so on, a person develops an honorable and moral character.
Deontology says that there are absolute rules for ethical behaviour under all circumstances and they should be respected so that human dignity is protected. It is closely associated with German philosopher,Immanuel Kant.It does not allow treating a person as a means to an end. Every person is an end in himself.
Utilitarianism is an ethical theory that determines right from wrong by focusing on outcomes.Utilitarianism holds that the most ethical choice is the one that will produce the greatest good for the greatest number.

What are the ten ethical issues and dilemmas posed by the current pandemic period?

First is China’s wet markets. These are the places where live animals are often slaughtered and sold for human consumption — including, in some cases, wildlife like bats and pangolins.Market vendors cage animals of different species in close proximity, where the animals potentially bleed or salivate on other animals . That is why the markets create the perfect conditions for pathogens to jump between animal species and then to humans. This issue highlights the cruelty to animals and also causing zoonotic diseases.

Second is the moral challenge of balancing life with livelihoods. Lock down is necessary for health and prevention of death. But unlocking is equally necessary for jobs,businesses,mental health, prevention of isolation, restoration of social life etc.

Third is the ethical way of using the highly overburdened health infrastructure. The following are some of the ethical dilemmas witnessed currently:

Let's suppose, there are three patients — a 16-year-old boy, a 25-year-old pregnant woman and a 75-year-old person. Only one ventilator is left. Who gets it?
Should we allocate intensive-care beds on a first-come, first-served basis?
Do we remove one patient with a limited chance of survival off a ventilator to give it to another with better chances?
If two patients have equal medical need and likelihood of recovery, should we choose the youngest? Or the one with the greatest number of dependents?

Fourth is the ethics of social distancing. It is necessary to cut down transmission. But it needs lockdowns.We have a right to community and to travel, because doing so is deeply important for humans. Social distancing can limit our opportunities.The dilemma is about how far should we leave it to people to do so voluntarily as in Sweden.

Fifth is the moral issue related to the development of vaccine. An effective vaccine could prevent millions of deaths. Some altruistic people volunteer to have the virus introduced into them to provide data for the development of vaccine. Some of them may die while some may develop side effects like disabilities. The dilemma relates to how to minimise the loss while allowing them to volunteer. It is called the human challenge.

Sixth is about the rights and obligations of the health care workers. The dilemma is about declaring them to be an essential service and compelling them to work without proper health gear.

Seventh is about conducting clinical trials. The issue is the level of information that should be provided to the humans on whom the randomised control trials(RCT) are conducted. The dilemma is about whether the protocol can be diluted to conduct clinical trials on patients without giving them proper information about trials.
Seventh ethical issue is also about pricing the vaccine as and when it is possible. Agreement on Trade-Related Aspects of Intellectual Property Rights(TRIPS) of the World Trade Organization allows monopoly pricing but it goes against public interest. It is necessary that safeguards should be allowed against expensive pricing.

Eighth ethical issue is the one related to privacy. There are two aspects to it. One is that the various contact tracing apps are seeking more information than required and thus violating privacy. The moral issue concerns the proper balance between public health and privacy. Another aspect is the confidentiality of the medical information of the patient which is vital for his social acceptability and dignity. It is the other side of the right to privacy.

Ninth ethical challenge is to ensure that centralisation and technocracy of decision making during a pandemic does not make the state authoritarian. Therefore, people need to be taken into confidence at every turn.

Tenth ethical challenge relates to opting for the right trade off between dismissing employees and retaining them with limited benefits with the possibility of restoration of normalcy later.