Covid-19 has brought to the fore a range of ethical issues affecting individuals, organisations, and governments.

As individuals, we have moral obligations towards ourselves and others. Clearly, the man who on his way to the cinema walks into a crowded train, visibly unwell, and coughs and sputters everywhere is acting in a way that is ethically reprehensible.  He is causing distress and putting himself and others at risk of harm without good reason. Similarly, it would be irresponsible to allow young children, who may be asymptomatic carriers of the virus, to spend time with their elderly and frail grandparents, or for us to burden the health system with non-urgent matters.  

These examples illustrate the different standards of law and ethics. It may not be illegal to ignore the advice of washing our hands and covering our mouths when we cough but it is certainly unethical.  We cannot claim to have discharged our personal duties simply by saying we have acted lawfully. Ethics in these pandemic times may require us to endure sacrifices on our personal freedom or comfort, such as social distancing or avoiding a visit to the doctor.  As someone who has spent the last three days scouring the city for toilet paper, I invite my fellow citizens to exercise restraint on that front too. It is a limited resource.

Organisations and employers have moral (and legal) duties towards those who work for them and the broader public. For example, they should keep abreast of official advice, conduct risk assessments, promote good hygiene, and implement policies that will keep staff as safe as reasonably practicable. News outlets and journalists have duties to convey information about the disease accurately and responsibly. Their stories, and even their choice of words, can help or hinder public health efforts.

The NHS is in a particularly challenging situation.  It has duties of care towards patients and staff. As resources such as beds, equipment and manpower will be limited, the NHS may have to decide who gets treatment and who does not. If intensive care beds or ventilators are in short supply, how will they decide who gets the bed or ventilator? What criteria will they use? What will happen to the unlucky patients who are not selected? It must offer training and protection to staff, including suitable protective equipment, with psychological support.  

France has put in place “ethical support units” in hospitals to help clinicians determine which patients to prioritise if resources are lacking. No doubt hospitals in the UK are making similar plans and it is hoped they will not be making decisions in isolation or without the benefit of lessons learnt during previous pandemic preparations.

Governments too have duties towards its citizens, organisations, and other nation states. They should collect accurate data and share them with others. They should cooperate with each other, investing in research in epidemiology, diagnostics, vaccines and treatment. They should provide adequate funding for organisations such as the NHS and emergency and community services. They should provide advice on disease prevention to individuals and businesses, and be honest with their citizens without causing undue panic.  

In implementing measures to tackle the disease, such as closing schools or borders, they should act on the basis of sound evidence, proportionately, and looking broadly at the potential impact of each measure on society, businesses, and on particular groups of people. They should ask, for each new measure, who are the winners and the losers and how can we make it less painful or reduce any stigma for the losers? In Ebola epidemics, healthcare workers are often a stigmatised group. This is also a risk with covid-19.

The UK government is starting to receive criticisms for its handling of the virus. Last Saturday, 14th March 2020, nearly 300 academics called for more stringent measures to restrict the spread of the disease.  For governments, criticism is inevitable. It is simply impossible to balance all the competing interests without causing harm to one group or another. The same holds true for the NHS and its decision-making, and it would be naïve to think that some patients who suffer from those decisions will not seek a remedy for their loss by arguing that the decision was wrong. 

In resolving the ethical conundrums of Covid-19, what matters most is the fairness and integrity of the decision-making process.  If that is done right, with no relevant factors ignored, the final decision can hardly be attacked as ethically indefensible.  

Daniel Sokol is a medical ethicist and barrister at 12 King’s Bench Walk.  He is the author of ‘Tough Choices: Stories from the Front Line of Medical Ethics’ (Book Guild, 2018). @DanielSokol9 

Competing interests: None declared