There are hundreds, perhaps thousands, of ethical issues when a country is hit by a pandemic of monumental proportions at a time when little thought has been given to the science, much less the politics.
The nationwide blast we know as COVID-19 is the latest in a long line of novel coronavirus pandemics that caught policymakers, medical institutions and the public flatfooted. Much has been done to identify, satisfy and explain the array of scientific, medical, political and practical consequences.
A major effort was also undertaken to deal with the novel ethical challenges in this year’s pandemic. The virus itself spread like a wildfire, driven by a hurricane, and seemingly ignited by something barely short of an atomic bomb. Before most of us knew it, we had tens of thousands either diagnosed, in treatment or infected, but not symptomatic.
The political conundrum was whether to tell anyone or just hope it would evaporate before the upcoming election. The ethical dilemma was how and how fast the scientific and medical communities could decipher and detect new ethical challenges acceptable to the political powers in the nation’s capital.
Our government responded, as fast as light rail would allow. Its progress can be reassessed in the 230-page government report titled, Ethical and Legal Considerations in Mitigating Pandemic Disease: Workshop Summary. It was accomplished under the auspices of the National Academies of Science, Medicine and Engineering, fondly known as The National Academies Press.
While this massive assessment is about the science, not the politics, it’s virtually impossible to separate these two worlds because what one side would proclaim, the other would disdain. What is good science, with morally sound ethical constructs, is not always what politicians want to hear. When they don’t like what they hear they duck, weave and dodge because of the political risk inherent in letting science and morality lead a nation.
The report’s “Summary and Assessment” lays out some of the Academy’s concerns regarding the lack of clear authority for decision-making in public health emergencies. It partially addresses the “History and consequences of the longstanding conflict between federal and state claims to public health authority. It suggests a potential resolution through a system of ‘cooperative federalism’ in which the federal government establishes standards for pandemic measures that are subsequently administered by state government and implemented at the local level. . . This model argues that ‘from an ethical standpoint, federal health agencies should play a more directive role in establishing standards and critical requirements for state and local jurisdictions in order to ensure equal levels of preparedness for all citizens.’” That strategy might “protect all U.S. citizens equally and, in much the same way that the federal government ensures that each state meets certain minimal environmental standards, will enforce basic requirements for public health in pandemic preparations and response.”
Whether that happened is a political question. The ethical questions were part of the study but may not have been part of the solution, at least at the federal level. By citing just seven of the several hundred questions the report deals with, a sliver of ethical assessment emerges.
- “What are the implications of pandemic influenza on human rights, access to health care, obligations of and to health-care workers, and obligations of countries and intergovernmental organizations?”
- “Are there ethical principles that can be applied in policy making to address dilemmas faced by pandemic planners given the classic struggle between individual and group?”
- “What limitations are there on the freedom of action or the imposition of a duty to act in the pursuit of the continued existence of life and order?”
- “At the national level what advanced planning, communication, and public involvement in will realize an ethically responsible and appropriate response?”
- “The greatest moral challenge posed by a pandemic is how to respect commitments to social justice in the face of the overwhelming and entrenched inequalities.”
- “There is a need for clear authority for decision-making in public health emergencies. There is a longstanding conflict between federal and state claims to public health authority. A potential resolution [might be] a system of ‘cooperative federalism’ in which the federal government establishes standards for pandemic measures that are subsequently administered by state government and implemented at the local level.”
- “At the clinical level, there is the need for specific criteria to triage patients with respiratory failure in the likely event of a shortage of respirators during a pandemic as well as the need for guidelines and procedures to address the practical problems that will arise when such policies are implemented. [Without federal and state cooperation] public participation in the crafting of such guidelines and procedures will be important in creating popular acceptance of the difficult choices that must be made during a pandemic.”
This blog cannot reach the substantive issues or the ethical applications of mitigating the ongoing pandemic disease called COVID-19. This blog is limited to the ethics of writing about migrating pandemic disease. The seven ethical questions above frame some of the ethical norms for those writing about America’s ongoing effort to mitigate the disease. Simplified, the ethical message is that everyone writing about mitigation should treat the ethical questions with the same vigor used to advance or slow the politics of the pandemic. Tell the truth. Trust the science. Establish policies that are as ethical as they are fair and non-discriminatory.
I am an author and a part-time lawyer with a focus on ethics and professional discipline. I teach creative writing and ethics to law students at Arizona State University. Read my bio.
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