By Gabriela Arguedas Ramírez
Pandemics are threshold situations that put our individual and collective convictions, priorities and capacities to the test. They test state institutions, the ethical principles that have guided the formation of public policy and the strengths and weaknesses of our social fabric.
Pandemics are ethical-political issues and not simply medical or biological ones. Already, we have seen several news reports about the saturation of intensive care units in hospitals around the world, and the subsequent and unavoidable need to choose which patient will be intubated because they can no longer breathe on their own, and which patient will not, and will die. There are various theoretical frameworks in bioethics that model how such decisions can be made. Some base decision making on the principle of “first come, first served,” while others utilize specific criteria, such as the probability of success of the medical intervention versus the futility of the therapeutic effort.
If these dreadful scenarios are presented by the media without a critical reflection that go along with them, the news coverage can become reduced to clickbait. In effect, such headlines can push the public to become more aware of the gravity of a pandemic like COVID19, but they do so by making a spectacle out of death. So far, in many countries, neither the mass media nor governments are engaging with society in an honest and detailed explanation as to why it has come to this extreme, and whether or not it could have been avoided if international organizations and governments had made other decisions in the past.
When governments and public health institutions sidestep ethical principles and the framework of human rights, sooner or later, a tragedy will come. The negligence of so many governments regarding the COVID19 pandemic is a powerful demonstration of what I am arguing. Now many politicians and leaders are trying to wash their hands by saying that this crisis has taken the entire world by surprise and that there was no way to predict or prepare in time, and thus, to avoid so many deaths and the ongoing economic disaster.
This is far from true. States, and in particular those of wealthier nations, have sophisticated epidemiological surveillance systems and strong scientific sectors. In addition, intergovernmental agencies such as World Health Organization (WHO), have accumulated experience in attending to pandemics and other global health emergencies. The amount of specialized reports aimed at orienting governments on their public health and prevention policies and on disaster management is abundant. What is more, there is a vast amount of scientific literature that has been available for years and which demonstrates the need to take sanitary measures to prevent a pandemic like this one.
But the implementation of such policies, which requires public institutions capable of putting them to action, costs money. And for the last three decades most countries around the world have been dealing with a strong lobby advocating for the privatization of public services, such as health care. Add to this the fact that the regulatory and preventative role of public health departments has diminished over time because certain financial and business sectors consider that health and environmental controls slow economic growth.
The underfunding of health care systems and the dismantling of public institutions related to the protection of the environment are characteristic actions taken by governments that bet on applying market logics as public policy. From this ideological position of minimal or zero state intervention, the principles of justice and nondiscrimination are often received with hostility and sanitary measures are seen as threats to individual liberties.
Fear of the economic costs of taking radical and early actions to face this pandemic has led many governments to opt for doing nothing or the bare minimum. Let the virus come, let the virus pass… Let the strongest survive. Let those who get sick fight for their lives if they can’t find room in hospitals. However, as weeks passed various governments accepted what they had already been told by many specialists: doing nothing to avoid disrupting the economy is both ethically unacceptable and, ludicrous from an economic perspective.
But if preventative measures are not timely put in place, a catastrophe occurs. Hospitals are overwhelmed, even in wealthy countries. The shocking moral burden of deciding how to distribute scarce resources faced with hundreds of sick people falls on the shoulders of healthcare workers. In the end, the chain of political irresponsibility leads to the death of patients who might have been saved. And the consequences for healthcare workers can even reach the severity of post-traumatic stress disorder (PTSD) and death.
For that, governmental officials who made those decisions should be held accountable. They could have contributed to avoid much of the suffering. But they choose not to do it.
Author: Gabriela Arguedas Ramírez
Affiliation: University of Costa Rica
Competing interests: None declared