Why ethicists are needed to help societies cope with ‘new normal’

Decision-making during a pandemic has a crucial, although often hidden, ethical dimension. And academic ethicists around the world argue that their discipline can help clarify thinking and offer essential pointers to governments.

But are governments making sufficient use of the discipline in the coronavirus crisis? And how can ethicists get their perspective across to policymakers?

Take Angie Hobbs, who has a prominent role as professor of the public understanding of philosophy at the University of Sheffield. Much of her work is on “the ethics of flourishing”, and she believed that philosophers could play an important role in bringing “to the surface the values which are currently being implicitly used [by governments and public health authorities], so we can examine them and see if we want to tweak them”.

She added that “it’s not good enough to have vague assumptions” such as “prioritising the young over the old”.

As we emerge from the immediate crisis, Professor Hobbs went on, philosophers could step forward and say: “Here are the ethical opportunities and here are the dangers.”

This could include making the case, for example, that businesses should “focus on resilience and sustainability rather than solely on profit”, while warning against “losing interest in renewable energy sources while oil is so cheap and while people are nervous about using public transport”.

While Professor Hobbs acknowledged that “of course, other people can do that too”, philosophers could offer insights based on “very specific ethical approaches and models, tensions and resolutions”.

Across the Atlantic at York College of Pennsylvania, Rory Kraft, assistant professor of philosophy and chair of the department of arts and humanities, also argued that “ethicists have training and background in weighing competing values, like public safety and personal freedom”, which could provide clarity to policymakers.

In the past, he explained in a recent article, he had used examples such as “the obesity epidemic” and the advent of face transplants to think through ethical dilemmas in his classroom.

In recent weeks, however, he had tried to show his students that “the moral concerns surrounding Covid-19 were far deeper than hoarding of toilet paper and if middle-school students had adequate internet access”, as well as “how this crisis is exposing the underlying problems in US healthcare”. They had also explored “questions of triaging patients”.

Broader questions of triage are, of course, at the heart of governmental responses to the coronavirus. It is seldom made explicit, but there are inevitably trade-offs between saving every possible life in the short term and avoiding the kind of economic collapse that will lead to much suffering (including deaths from other causes) in the longer term.

So, what insights can ethicists offer policymakers as they face such dilemmas?

For Wendy Rogers, professor of clinical ethics at Macquarie University, any such “decisions should be made in solidarity rather than pitting the economy against health…We must take account of where the harms and benefits fall − whose lives are lost and saved.

“The deaths from Covid-19 disproportionately affect identifiable groups such as the elderly. Likewise, the job losses from the lockdown disproportionately affect those who have precarious employment and few savings and resources to see them through; and the school closures are particularly harmful for children who have no access to educational resources in their homes and who rely on school meals.

“The pandemic provides an opportunity to develop policy responses that aim to reduce rather than exacerbate existing and emerging inequalities, and to protect and support the vulnerable,” she said.

Meanwhile, Karen Stohr, associate professor of philosophy at Georgetown University and senior research scholar at the Kennedy Institute of Ethics, added that: “We are rightly queasy about sacrificing human life for other things, especially when the exact nature of the trade-off is stated explicitly.

“And this is exactly why it’s important to be honest about what we’re sacrificing and especially who is being sacrificed. It’s essential to have public discussions about the moral ramifications of the trade-offs being made in our names. Government officials have hard choices to make, but academic ethicists can help them make better ones.” 

Yet there are few signs that governments are willing to listen. Alongside his teaching, Dr Kraft also brings such perspectives to the bioethics committee at a local hospital. But he noted that, “at least in the US...there has been a hesitancy for both universities and governments to reach out to moral philosophers for assistance”.

Dr Stohr agreed. Now that the pandemic had “brought ethical issues about racial disparities in healthcare resource access and healthcare outcomes to the forefront of public discussions”, she hoped to see them “taken up systematically”.

Yet she suspected that “we will need a very different political climate for there to be anything like a systematic effort to produce and consider advice from ethicists, at least at the federal level. I am more hopeful about the ability of ethicists to contribute productively to state and institutional discussions.”

Professor Hobbs was equally clear that “the UK government has not asked philosophers and theologians and historians to advise them” and reflected that “the only country I know of where philosophers have formally been invited on to public bodies is Germany”.

She once attended the World Economic Forum in Davos for a week to give a handful of talks and, while there, “the governments I was most impressed by – including New Zealand and Canada – had ministers and political advisers who were much more open to philosophical issues...It would be interesting to see whether they are coping with the pandemic differently.”

Although she had little hope of influencing UK government ministers, Professor Hobbs was trying to make an impact through contact with members of the House of Lords, civil servants (who actually draft the legislation) and business leaders, who were often “much more open” to philosophical and ethical reflection.

However, there are more positive stories about ethicists influencing policy emanating from Australia.

Hugh Breakey, president of the Australian Association for Professional and Applied Ethics, had noticed that “ordinary people are interested in hearing opinions about how they and others might make ethical decisions about the ‘new normal’”.

The senior research fellow in moral philosophy at Griffith University’s Institute for Ethics, Governance and Law had “personally done more radio and web interviews in the last month on such topics than I’ve had interviews in the preceding year”.

Australian policymakers seldom paid much attention to ethicists, however, Dr Breakey pointed to a significant exception in the case of the government’s COVIDSafe app for smartphone tracking of contacts, which it wanted to convince the population to voluntarily download. Ethicists had joined forces with “domain-specific experts such as lawyers and technology commentators” in raising concerns over “privacy considerations”, to which the government “made genuine efforts to respond”.

As we begin to take tentative steps out of the crisis, Dr Breakey hoped for more ethical reflection on whether it “created more discord and division among polities and the institutions that govern them” or whether it had perhaps “improved solidarity”.

Although national politicians and bodies were unlikely to be interested, at a lower level we might see “public agencies and servants reaching out to ethicists with particular domain specialities − technology, human rights, ethical decision-making − to help them execute policy more successfully”, he suggested.

While this offered valuable opportunities for philosophers, Dr Breakey also warned them to tread carefully: “Ethicists will need a lot of experience in the area to be able to offer constructive advice; direct applications of abstract moral philosophies are usually worse than useless.”

Macquarie’s Professor Rogers, meanwhile, has already been asked to “provide advice to state government [as well as a local health district] on ICU/ventilator triage protocols, as part of a committee. The guidance we developed is currently making its way through consultation and other processes before becoming policy, so it’s unclear at this stage what will be retained of the original, but the work had a generally positive reception.”

If they wanted to continue to make a difference, in Professor Rogers’ view, ethicists needed to show they had learned from the past and could contribute powerfully to urgent debates.

Although there had been “a lot of ‘pandemic ethics’ in the wake of Sars and fear of pandemic bird flu in the mid- to late-2000s”, she explained, Covid-19 had thrown up a number of issues that “did not feature in that literature” but were now likely to become “the subject of sustained analysis”.

She pointed, for example, to questions of “how to respond to the apparently increased susceptibility of people from BAME populations” and “how to protect the aged in residential facilities”.

Along with this important research agenda, Professor Rogers believed that “the pandemic will influence teaching, as it’s a real-life example of a public health emergency in which difficult decisions were made in conditions of uncertainty. Public health ethics can seem abstract or less relevant than clinical ethics, but now all of the students have experienced this pandemic, the issues are no longer abstract.”

matthew.reisz@timeshighereducation.com