{"id":48876,"date":"2020-10-22T16:57:35","date_gmt":"2020-10-22T15:57:35","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=48876"},"modified":"2020-10-29T13:01:16","modified_gmt":"2020-10-29T12:01:16","slug":"covid-19-and-the-ethics-of-risk","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2020\/10\/22\/covid-19-and-the-ethics-of-risk\/","title":{"rendered":"Covid-19 and the ethics of risk"},"content":{"rendered":"<p class=\"standfirst\"><span style=\"font-weight: 400\">How can we fairly distribute risks across individuals and groups within societies? Jonathan Wolff, Sridhar Venkatapuram, and Nicole Hassoun consider<\/span><\/p>\n<p><!--more--><span style=\"font-weight: 400\">Life is full of risks, some welcomed, some distinctly unwelcome. The pandemic has increased risks for everyone, raising vital questions about their fair distribution. Aside from managing personal and family risks, we are also forced to consider the circumstances under which society can legitimately expect some people to take risks they might not understand or would prefer to avoid. Most prominent among these are threats to the physical health of certain groups of people, such as health workers, delivery drivers, teachers, and shop workers, although the mental health and economic wellbeing of many others are also at risk.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Several general frameworks for thinking about the fair distribution of risk have been proposed. The first is the most obvious. No one should have to experience a risk of harm unless they consent. This is the <\/span><i><span style=\"font-weight: 400\">rights against risk<\/span><\/i><span style=\"font-weight: 400\"> theory. But it has at least three problems. First, we can\u2019t always get enough people to consent to accept a risk (for example, no one works in grocery stores during lockdowns even if wages are increased). Second, offering already vulnerable people money to take exceptional risks can be exploitative. Third, and most critically, it\u2019s an impossible theory to follow. Driving a car exposes countless people to risk. But it\u2019s not possible to get the consent of them all. Indeed, all actions carry some risk of harm to others.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">The second theory, <\/span><i><span style=\"font-weight: 400\">compensation after<\/span><\/i> <i><span style=\"font-weight: 400\">harm,<\/span><\/i><span style=\"font-weight: 400\"> suggests we can expose each other to risk, but must compensate anyone who thereby suffers harm. There is something liberating here, but the theory is deeply flawed. Most obviously, you cannot truly compensate someone, or even their family and friends, for their death and, arguably, even for grave injury. Second, if we know we are subject to harm at any time by others we might live our lives in fear. And if no adverse event happens, who will compensate us for our fear? So a more precautionary attitude is needed.<\/span><\/p>\n<p><span style=\"font-weight: 400\">A third approach applies social <\/span><i><span style=\"font-weight: 400\">cost benefit analysis<\/span><\/i><span style=\"font-weight: 400\"> to risk. Only allow the risk of harm to others if the expected benefits outweigh the costs. This is not a trivial condition. Reckless risk taking, where the probable costs greatly outweigh the probable benefits, is all too common. However, the converse\u2014always allow a risk if the expected benefits outweigh the risks\u2014is highly problematic. It could lead to a situation in which all the benefits go to one already privileged group, and all the costs go to the under-privileged. For example, the tradeoff of the economy versus health is more accurately some people\u2019s economic wellbeing versus the health of others. Indeed, this was the situation in lockdown, with low paid workers facing higher risks while serving those fortunate enough to work from home.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Finally, a fourth theory appeals to a hypothetical social contract. Employing John Rawls\u2019 theory of justice, it asks you to imagine the risk related principles you would agree to if you didn\u2019t know how you would be personally affected. It could be you running the risk, or others taking it on your behalf. What would you agree to? Our proposal, building beyond the other theories, is this:\u00a0<\/span><\/p>\n<p><em><span style=\"font-weight: 400\">Don\u2019t impose the risk unless the benefits outweigh the cost (irrespective of who gets either).\u00a0<\/span><\/em><\/p>\n<p><em><span style=\"font-weight: 400\">Try to find qualified volunteers or people who will accept extra pay to run the risk but not on exploitative terms.<\/span><\/em><\/p>\n<p><em><span style=\"font-weight: 400\">If the adverse event happens, compensate insofar as possible.\u00a0<\/span><\/em><\/p>\n<p><em><span style=\"font-weight: 400\">Take special care to minimise the risks in question.<\/span><\/em><\/p>\n<p><span style=\"font-weight: 400\">Applying these principles to covid-19, frontline workers should receive extra pay, and get high priority if they fall ill. They should also be provided with high quality personal protective equipment, and should be in the first groups for vaccination. We need people to take risks on our behalf, but it\u2019s a grave injustice if we take their service for granted without special protection, pay, and compensation. Similar concern may require priority for other groups too\u2014for example, older people who have contributed a great deal to society already and are at very high risk due to the illness, or people who are poor or oppressed, and so forth.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Special concern is also justified by the fact that many people in these vulnerable groups face more risks of harm throughout their lives and, indeed, suffer more harms such as diseases and injuries. These risks include health risks, <\/span><span style=\"font-weight: 400\">but also risks to their ability to provide for their families or to stay in their homes. <\/span><\/p>\n<p><span style=\"font-weight: 400\">Most people probably consider the pandemic a natural disaster. It is anything but. Collectively, we have failed to address the threat of pandemics and the problems that vulnerable people face, which are long standing, predictable, and extraordinary. While many governments have been grappling with national security risks, including biological threats, we have been very slow to think about the fairness of how we collectively create and distribute risks across individuals and groups within societies.\u00a0<\/span><\/p>\n<p><em><b>Jonathan Wolff<\/b><span style=\"font-weight: 400\"> is the Alfred Landecker professor of values and public policy at the Blavatnik School of Government, University of Oxford, and governing body fellow, Wolfson College, Oxford. Twitter <a href=\"https:\/\/twitter.com\/JoWolffBSG\">@jowolffbsg<\/a><\/span><\/em><\/p>\n<p><em><b>Sridhar Venkatapuram<\/b><span style=\"font-weight: 400\"> is an associate professor of global health &amp; philosophy at King&#8217;s College London. He is also acting deputy director of King&#8217;s Global Health Institute and director of King\u2019s Global Health Education &amp; Training. Twitter <\/span><a href=\"https:\/\/twitter.com\/sridhartweet\"><span class=\"css-901oao css-16my406 r-1qd0xha r-ad9z0x r-bcqeeo r-qvutc0\">@sridhartweet<\/span><\/a><\/em><\/p>\n<p><em><b>Nicole Hassoun <\/b>is a<span style=\"font-weight: 400\">\u00a0professor of philosophy at Binghamton University<\/span><span style=\"font-weight: 400\">. Twit<\/span><span style=\"font-weight: 400\">ter <\/span><a href=\"https:\/\/twitter.com\/kikseven2\"><span class=\"css-901oao css-16my406 r-1qd0xha r-ad9z0x r-bcqeeo r-qvutc0\">@kikseven2<\/span><\/a><\/em><\/p>\n<p><b>Competing interests<\/b><span style=\"font-weight: 400\">: none declared.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>How can we fairly distribute risks across individuals and groups within societies? Jonathan Wolff, Sridhar Venkatapuram, and Nicole Hassoun consider [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2020\/10\/22\/covid-19-and-the-ethics-of-risk\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":48891,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[223,5760],"tags":[],"class_list":["post-48876","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-guest-bloggers","category-medical-ethics-2"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Covid-19 and the ethics of risk - The BMJ<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmj\/2020\/10\/22\/covid-19-and-the-ethics-of-risk\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Covid-19 and the ethics of risk - The BMJ\" \/>\n<meta property=\"og:description\" content=\"How can we fairly distribute risks across individuals and groups within societies? 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In July the government announced a pay rise for public sector workers. But many nurses, health care assistants, porters, and cleaners who worked so hard, despite the risks, have been overlooked in the public sector pay rise. 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