An Example of an Ethical Dilemma

Covid-19 (vaccination and treatment)

The coronavirus pandemic that started sweeping the world in 2020 is stress testing the world in many ways, ie

"...beyond challenging human fortitude, national health services and international rivalry, it is has forced a series of moral choices..."

John Authers, 2020

Some of these choices revolve around

- the role of government in determining public good as against individual rights and freedoms (civil liberties), eg

    a) forced closure of businesses, schools, towns, regions, countries, etc

    b) restricted activities of different community groups, eg places of religious worship, sporting, entertainment, families, etc

    c) restricted travel and people's movement, eg closing borders (international, internal, etc), etc

    d) forcing people into quarantine, self-isolation, etc

    e) restricting public attendance, eg at sporting events, protests, gatherings (social, religious, community, etc), etc

    f) no termination or 'sunset clauses' on losses of civil liberties, etc

- preferential treatment for different socio-economic groups in society, like elderly

- mask-wearing and social distancing impact on civil liberties, etc

However, the toughest moral dilemma is expected to be around development and distribution of effective treatment and/or suitable vaccination. These represent the best chances to end the pandemic.

There are contrasting views from different stakeholders, eg scientists/researchers, doctors, commentators, academics, religious/ethnic communities, etc. Some issues being wrestled with include

- risks associated with deliberate speeding up, or taking shortcuts, in the accepted procedures in developing treatment(s) and/or vaccine(s). In addition to being effective, they must be safe.

"...a failed Covid-19 vaccine could even compromise confidence in other vaccinations, threatening a return of measles, polio and other plagues..."

John Authers, 2020

One possibility to speed up the process is to skip animal testing and test humans as appropriate.

However, the benefits must outweigh the risks.

- how much risk of harming humans can be justified?

The medical profession takes the Hippocratic oath, ie 'do no harm'

"...virtuous ends do not justify unethical means..."

John Authers, 2020

Linked with this are the 'human challenge trials'. This process has been used to test cholera and dengue vaccines

"...volunteers are injected with a vaccine and then deliberately infected with the germ the researchers are hoping to neutralise. The subjects are tightly monitored, and results are available within weeks..."

John Authers, 2020

An alternative is a real-world approach which is to reveal how the vaccine/treatment behaves with different groups of people and in different regions. This is different from the 'human challenge' as it is held in laboratory conditions.

- doctors are morally obliged to tell volunteers how to avoid getting infected!!!!!

- selecting volunteers is based on their being informed about the health issues (including risks, etc), willingness to participate, in a low-risk group, etc. Using volunteers should only be contemplated when life-saving treatments are available for anyone who gets sick.

- building morality around individual freedom, ie volunteers must provide consent. As with Covid-19, there is a general lack of knowledge and understanding of the long-term implications of Covid-19, so to give 'informed consent' is not easy.

- compulsion

 As vaccines work best when everybody receives them, there is a strong case for compulsion. However,

"...libertarians have a problem with forcing a potentially harmful vaccine on someone without the 'informed consent'..."

John Authers, 2020

It is very hard to reach a critical mass to maximise benefits from mass vaccination without compulsion.

One suggestion is to leave compulsion to private entities, ie

"...An employee might demand vaccination as a condition of reporting for work. A university might impose the same requirement on a faculty and students. A vaccine might be dangled as a golden ticket to return to theatres, nightclubs, sporting events. Governments and foundations could even pay people to receive a shot..."

Arthur Caplan as quoted by John Authers, 2020

 - affordability of vaccines/treatments, ie

There is a potential conflict as most pharmaceutical companies, who are in the research, development and production of vaccines/treatments, have a responsibility to their shareholders, ie maximise profit. Yet most of the world that needs the vaccines/treatments lacks the financial resources to produce, distribute and/or finance them.

Additionally, significant government money is being invested in the research, including universities, for developing suitable vaccines/treatments

"...should private companies be free to set prices for public good developed with government aid..."

John Authers, 2020

Should the vaccine or treatment be free to the public?

In countries that have a nationalised health system, it most likely will be free or very cheap.

- 'vaccine nationalism', ie This is epitomised by the attitude 'every country for itself', with wealthy countries having little incentive to collaborate with poor ones. Initially, there is insufficient vaccines and treatments to immediately handle the entire global population of around 8 b.. Thus rationing is inevitable. But who makes these decisions and with what criteria? A possible criterion could be to protect those most likely to be harmed/vulnerable, eg prioritise people according to risk, eg

    i) medical professionals, workers, etc who are in the front line of the pandemic

    ii) less privileged groups in society who are at most risk like prisoners; susceptible minority groups who are living in poverty and crowded conditions (ideal conditions for virus spread)

    iii) people who cannot work from home, like emergency services personnel, etc


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