Since the SARSCoV-2 virus spread from China to most of the world in February and March, we have all gradually become participants in textbook ethical dilemmas. Above all, the COVID-19 pandemic has presented overloaded health systems with the huge question of how to continue caring for patients in a secure, fair, and effective way.
And, worryingly, the crisis has highlighted not only the unpreparedness of politicians and health-care systems, but also our failure to develop relevant ethical norms. As the pandemic spread, many governments hastily implemented medical and social-distancing protocols that mirrored the Chinese authorities’ draconian response.
Until early this year, richer countries had been discussing access to new health-care tools such as robotics and artificial intelligence, or how the state might finance artificial reproductive technologies.
But in the blink of an eye, their health systems surprisingly and unhesitatingly accepted utilitarian ethics – not only by performing drastic triage in intensive-care units (ICUs), but also by refusing to offer a range of other muchneeded medical services.
Ethics textbooks contain numerous philosophical dilemmas that call into question the morality of always applying a utilitarian calculus to human lives. One of the most widely known was devised by the British philosopher Philippa Foot, and involves a runaway trolley rushing toward five people tied to a train track.
By pulling a switch, you can divert the trolley to another track and save those five lives, but the trolley will then kill one person on that track. What should you do? Based solely on the mathematical outcome of the choice, many will likely consider it right to intervene and sacrifice one human life in order to save five others.
But in both this dilemma and in real life, should we not take other values into account, too? After all, the COVID-19 pandemic is presenting health workers with tragic situations they have never experienced before.
And if there are not enough health workers, ventilators, or hospital beds, then patients often will need to be categorized and prioritized to determine who receives (or does not receive) which care, and where.
In mid-March, the Italian Society of Anesthesia, Analgesia, Resuscitation, and Intensive Care (SIAARTI) issued recommendations for allocating intensive-care treatment of COVID-19 patients.
These include adhering to the “first come, first served” principle in the worst-case scenario that no more ICU resources are available. And in April, the Hungarian Medical Chamber released a series of mostly utilitarian triage guidelines that focus on saving more lives and giving priority to patients with a higher chance of survival.
Our existing ethical frameworks were not devised for a pandemic – and it shows. Over the last few decades, bioethics has focused on new technologies, such as genetic intervention, biobanks, gene-editing, and artificial reproduction. Indeed, Europe’s most comprehensive and legally binding set of bioethical norms, the 1997 Oviedo Convention, prescribes that “The interests and welfare of the human being shall prevail over the sole interest of society or science.”