By Louise Campbell

The COVID-19 pandemic has catapulted ethics into the spotlight.  Questions previously deliberated about by small numbers of people interested in or affected by particular issues are now being posed with an unprecedented urgency right across the public domain.  One of the interesting facets of this development is the way in which the questions we are asking now draw attention, not just to the importance of ethics in public life, but to the very nature of ethics as practice, namely ethics as it is applied to specific societal and environmental concerns.

Some of these questions which have captured the public imagination were originally debated specifically within healthcare circles and at the level of health policy: what measures must be taken to prevent hospitals from becoming overwhelmed if there is a surge in the number of people requiring hospitalisation?  How will critical care resources such as ventilators be prioritised if need outstrips supply?  In a crisis situation, will older people or people with disabilities have the same opportunities to access scarce resources, even though they may have less chance of survival than people without age-related conditions or disabilities?  What level of risk should healthcare workers be expected to assume when treating patients in situations in which personal protective equipment may be inadequate or unavailable?   Have the rights of patients with chronic conditions been traded off against the need to prepare the health service to meet a demand which to date has not arisen?  Will the response to COVID-19 based on current evidence compromise the capacity of the health system to provide routine outpatient and non-emergency care to patients in the near future?

Other questions relate more broadly to the intersection between health and society: how do we calculate the harms of compelling entire populations to isolate themselves from loved ones and from their communities?  How do we balance these harms against the risks of giving people more autonomy to act responsibly?  What consideration is given to the fact that, in an unequal society, restrictions on liberty will affect certain social groups in disproportionate ways?  What does the catastrophic impact of COVID-19 on residents of nursing homes say about our priorities as a society and to what extent is their plight our collective responsibility?  What steps have been taken to protect marginalised communities who are at greater risk from an outbreak of infectious disease: for example, people who have no choice but to coexist in close proximity with one another in direct provision centres, in prison settings and on halting sites?

The broadest set of questions flirts with the idea of a common societal good: what justification can be provided for such unprecedented interference with the liberty of individual citizens?  How are the ‘public interest’ considerations which underlie decisions to restrict liberty defined, and how transparent are they?  By what consensus are public health goals reached?  What level of social cohesion is required to maximise the effectiveness of measures taken to address the crisis?  How will the longitudinal effects of these restrictions on the well-being of the population be measured?  How should governmental structures be redesigned to address the increased poverty, deepening social inequity, educational inequality and loss of opportunity which will be the spiralling consequences of our attempts to contain the pandemic?

All of these questions are ethical questions because of three features that they share: first, they invite an evaluative response.  Their currency is the language of right and wrong, better and worse, should and shouldn’t.  As such, finding answers is not merely a matter of describing solutions to the particular problems raised.  Reflection on the adequacy of these solutions is required, and this entails a process of identifying the harms and benefits – defined broadly or narrowly – which are associated with specific courses of action.  Weighing these harms and benefits against one another is necessary if what is being proposed as an ethically-appropriate solution to a problem which has a societal impact is to be justified.  Justification is a second important feature of ethics and the robustness of the justification provided will depend on the quality of the process by which it is reached.  Whereas justification in the field of theoretical ethics involves scrutinising the reasoning leading to a conclusion – conceptual coherence, freedom from contradiction – justification in the domain of applied ethics involves examining, not just the quality of the reasoning involved or the appropriateness of the principles applied, but also the impartiality, transparency, fairness and inclusivity of the process by which the conclusion is reached.   This reliance on principles which are publicly defensible emphasises the time-bound and historically contingent nature of applied ethics, but it is also linked to a third defining feature of ethics as practice: the ineliminable role played by values[i].  Our value systems as individuals and as members of society are deeply implicated in the questions we ask, the ethical issues we identify, the way we frame these issues, how we define what count as harms and benefits, the solutions we construct.  Ethics as practice involves examining these values and the influence they have on our decisions and actions.  In pluralist societies, it is implicitly accepted that individuals will disagree with one another about the merits or otherwise of certain states of affairs and that their private ethical values are a matter of personal choice.  What is interesting is how ‘deep disagreements’ – inability to reach a consensus because of a clash between values which are fundamental but irreconcilable – play out in the public domain, where solutions must be found to complex problems which affect everyone in society.

How we justify the measures we have employed to contain the spread of COVID-19, how we will emerge from our current situation, how we will reimagine society after the pandemic has ended, what kinds of changes need to be made to our existing way of life – all of these issues will give rise to deep disagreements.   But deep disagreements are a necessary prerequisite of reflection on how we might better integrate the values of liberty, solidarity, compassion, belonging, identity and well-being in future versions of our society.   Ethics has never been more relevant.

[i] Ethical theory does not escape this: ethical norms for Plato, Aristotle, Kant and Mill were deeply rooted in their own historically-conditioned value-systems and social biases.

Author: Louise Campbell

Affiliation: School of Medicine, National University of Ireland, Galway

Competing interests: The author has no competing interests.