ETHICS & COVID 19

Introduction

Man has emerged a loner in his quest for happiness and material advancement reducing the family and the society to being mere adjuncts and his confidence bordering on arrogance made him believe that he can live alone and all by himself, unmindful of the lives of others. However, the COVID-19 pandemic has shaken the fundamentals of living by oneself and highlighted the need for living in harmony with nature and fellow humans. The pandemic has raised questions about the meaning and purpose of life including the nature of relationships with fellow beings and moral issues connected with the current pathways of development given their impacts on nature and equity.

From resource allocation and priority-setting, physical distancing, public health surveillance, health-care worker's rights and obligations to conduct of clinical trials, the COVID-19 pandemic presents serious ethical challenges. These in turn are complicated by the diverse health systems and unique cultural and socio-economic contexts of countries. Consequently, there is a great need for guidance to ensure ethical conduct of research, decision making in clinical care, and public health policymaking at every level of the global COVID-19 response.

Global Ethics Response to COVID-19

The global ethics community is working together to address the ethical implications of the COVID-19 pandemic. WHO's Global Health Ethics team works to strengthen communication, collaboration and cooperation in these endeavors.

Global Network of WHO Collaborating Centers for Bioethics

In responding to COVID-19, the Global Health Ethics team is working together with the Global Network of WHO Collaborating Centers for Bioethics, a well-established network of institutions in diverse locations across the world. The expertise of these centers enriches the ethical support WHO is able to provide its Member States.

National Ethics Committees (NECs)

An increasing number of nations have created official bodies to provide advice to their executive and legislative branches, and often to the general public, about bioethics. Understandably, the demands on these bodies to provide ethical guidance have substantially grown in the urgent and rapidly changing context of the pandemic. The Global Health Ethics team seeks to support NECs by developing guidance in response to their needs and facilitating communication, collaboration and exchange between NECs from around the world to help countries respond to the ethical challenges presented by COVID-19.

Public Health Emergency Preparedness and Response Ethics Network (PHEPREN)

 Led by the World Health Organization and supported by key partners including the Fogarty International Center, Global Forum on Bioethics in Research, Global Health Network, Global Network of WHO Collaborating Centers and Welcome,  PHEPREN is a global community of bioethicists building on pre-existing expertise and resources to provide real-time, trusted, contextual support to communities, policymakers, researchers, and responders in relation to the ethical issues arising out of global health emergencies, with a current focus on the COVID-19 pandemic.

The philosophical and moral issues thrown by the Covid-19 pandemic:

• Our society is based on human relations, for everything we need people to justify our actions and this is going to change in future.
• Lockdown brought on by the Covid pandemic have struck people as a painfully long period of isolation. Social distancing seems to be hitting people even more than the scare of the deadly virus.
• People are getting highly restive and agitated in spite of social media connectivity.
• Cases of domestic violence have more than doubled in the country during this period.
• Humans have evolved to be social creatures and are wired to live in interactive groups. Being isolated from family, friends and colleagues can be unbalancing and traumatic for most people and can result in short or even long-term psychological and physical health problems.
• An increase in levels of anxiety, aggression, depression, forgetfulness and hallucinations are possible psychological effects of isolation.
• Mental conditions may be precipitated for those with underlying pre-existing susceptibilities and also show up in many others without any pre-condition. Personal relationships help us cope with stress, and if we lose this outlet for letting off steam, it results in a huge emotional void which, for an average person, is difficult to deal with.
• Just a few days of isolation can cause increased levels of anxiety and depression. Add to it the looming threat of a dreadful disease being repeatedly hammered in through the media and you have a recipe for many shades of mental and physical distress.
• Prisoners in solitary confinement and patients in isolated hospital units have often shown adverse psychological effects, including increased anxiety, panic attacks and increased levels of paranoia.
• Social isolation has been found to have a correlation with higher alcoholism.
• The Covid lockdown has brought forced isolation to many. There are youngsters living away from their families, trapped in small apartments with abysmal cooking skills. Many senior citizens living by themselves found companionship by meeting up with age mates in neighborhoods parks. They find themselves marooned, deprived of social interaction and also the occasional visits by their children.
• Lack of playtime with peers is making children irritable and edgy.
• It can be extremely oppressive and claustrophobic for large low-income families huddled together in small single-room houses. Children here are not lucky enough to have many board/electronic games or books to keep them occupied. Add to it the deep insecurity of running out of funds for food and basic necessities.
• On the other hand, there are people with dysfunctional family dynamics, such as domineering, abusive or alcoholic partners, siblings or parents which makes staying home a period of trial.
• Incidence of suicide and physical abuse against women has shown a worldwide increase.
• Heightened anxiety and depression also affect a person’s immune system, making them more susceptible to illness.
• Long-term lockdowns bring along a series of social, economic and religious upheavals in societies.
• Lower classes were worse off for living in closely packed, unhealthy environments. A large workforce had been destroyed; farms and factories were abandoned. Wages for labour shot up as did the cost of manufactured goods. There were some positive outcomes too, though at a huge price of death and destruction.

Ethical dilemmas due to the Covid-19 pandemic

The devastating pandemic that has stricken the worldwide population induced an unprecedented influx of patients in ICUs, raising ethical concerns not only surrounding triage and withdrawal of life support decisions, but also regarding family visits and quality of end-of-life support. These ingredients are liable to shake up our ethical principles, sharpen our ethical dilemmas, and lead to situations of major caregiver sufferings.

However, whatever the angle of approach, imbalance between utilitarian and individual ethics leads to unsolvable discomforts that caregivers will need to overcome.

There are three schools of ethics that we need to keep in mind while taking ethical positions on Covid-19-related ethical issues, or for that matter any ethical dilemmas:

• Virtue ethics is a philosophy developed by Aristotle and other ancient Greeks. It proposes that through virtuous behavior like being honest, brave, just, generous, and so on, a person develops an honorable and moral character.
• Deontology says that there are absolute rules for ethical behavior under all circumstances and they should be respected so that human dignity is protected. It is closely associated with German philosopher; ImmanuelKant. It does not allow treating a person as a means to an end. Every person is an end in himself.
• Utilitarianism is an ethical theory that determines right from wrong by focusing on outcomes. Utilitarianism holds that the most ethical choice is the one that will produce the greatest good for the greatest number.

What are the ethical issues and dilemmas posed by the current pandemic period?

• First are China’s wet markets. These are the places where live animals are often slaughtered and sold for human consumption — including, in some cases, wildlife like bats and pangolins. Market vendors cage animals of different species in close proximity, where the animals potentially bleed or salivate on other animals. That is why the markets create the perfect conditions for pathogens to jump between animal species and then to humans. This issue highlights the cruelty to animals and also causing zoonotic diseases.
• Second is the moral challenge of balancing life with livelihoods. Lock down is necessary for health and prevention of death. But unlocking is equally necessary for jobs, businesses, mental health, prevention of isolation, restoration of social life etc.
• Third is the ethical way of using the highly overburdened health infrastructure. The following are some of the ethical dilemmas witnessed currently:
  • Example: Let's suppose, there are three patients — a 16-year-old boy, a 25-year-old pregnant woman and a 75-year-old person. Only one ventilator is left. Who gets it?
  • Should we allocate intensive-care beds on a first-come, first-served basis?
  • Do we remove one patient with a limited chance of survival off a ventilator to give it to another with better chances?
  • If two patients have equal medical need and likelihood of recovery, should we choose the youngest? Or the one with the greatest number of dependents?
• Fourth is the ethics of social distancing. It is necessary to cut down transmission. But it needs lockdowns. We have a right to community and to travel, because doing so is deeply important for humans. Social distancing can limit our opportunities. The dilemma is about how far we should leave it to people to do so voluntarily as in Sweden.
• Fifth is the moral issue related to the development of vaccine. An effective vaccine could prevent millions of deaths. Some altruistic people volunteer to have the virus introduced into them to provide data for the development of vaccine. Some of them may die while some may develop side effects like disabilities. The dilemma relates to how to minimize the loss while allowing them to volunteer. It is called the human challenge.
• Sixth is about the rights and obligations of the health care workers. The dilemma is about declaring them to be an essential service and compelling them to work without proper health gear.

Seventh is about conducting clinical trials. The issue is the level of information that should be provided to the humans on whom the randomized control trials (RCT) are conducted. The dilemma is about whether the protocol can be diluted to conduct clinical trials on patients without giving them proper information about trials.

• Seventh ethical issue is also about pricing the vaccine as and when it is possible. Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) of the World Trade Organization allows monopoly pricing but it goes against public interest. It is necessary that safeguards should be allowed against expensive pricing.

Eighth ethical issue is the one related to privacy. There are two aspects to it. One is that the various contact tracing apps are seeking more information than required and thus violating privacy. The moral issue concerns the proper balance between public health and privacy. Another aspect is the confidentiality of the medical information of the patient which is vital for his social acceptability and dignity. It is the other side of the right to privacy.

Ninth ethical challenge is to ensure that centralization and technocracy of decision making during a pandemic does not make the state authoritarian. Therefore, people need to be taken into confidence at every turn.

Tenth ethical challenge relates to opting for the right tradeoff between dismissing employees and retaining them with limited benefits with the possibility of restoration of normalcy later.

Business Ethics in a Post COVID World

Business Ethics" - is that a contradiction in terms? Particularly in a developing economy where we struggle to feed millions is ethics a “luxury good"?

Actually, business ethics is a concept that makes eminent economic sense.Business and ethics are not opposite and business ethics makes economic sense. Business ethics promote trust in the stakeholders – customers, regulators, governments, suppliers and wider community. Tata is an example where the organization has earned the trust of many. On the other hand, lack of business ethics leads to deep mistrust as seen in private health care.

Purpose of business is not just about profit. It is about producing profitable solutions to problems of people and the planet and in the process earning profits. Trustworthiness and values must be the foundation for any business. Only through honesty, integrity and commitment to purpose, can trust be generated.

In times of crisis like COVID 19 pandemic, ethical behavior (Values and purpose) is a must to survive and thrive.

Dilemmas of business can be resolved through ethical values. Major dilemmas include:

• Lives vs revenues and livelihoods: Should economic activities involving physical activities restart to protect revenues? Doing so without concern for lives will be counterproductive. It can lead to outbreaks and longer closures. Hence a balance is needed.
• Pay cuts and layoffs to prevent short term losses: Layoffs result in loss of valuable skilled employees. This damages the trust of both laid off and remaining employees. Same is the case of pay cuts. Hence any layoffs and pay cuts to protect the financial health of the company must be deliberative and participative. Fairness, compassion and transparency are must to protect long term trust.

Social distancing is leading to increased digital use by businesses. Technology brings following ethical issues:

• Aarogyasetu and such contact tracing applications involve invasion into privacy of individuals which is a human right. Such applications must adhere to ethical standards such as – consent, just purpose and use; data minimization; eventual destruction of data after purpose is fulfilled. These will generate trust and hence increase participation which is a necessity for success of such applications.
• Exacerbating inequalities: Unequal access to technology can accentuate socio-economic inequalities. Digital education is an example where there is rural – urban and rich – poor divide in access to hardware (mobile, laptops, broadband etc.). Design of digital education policies must address all strata of population to ensure social justice to the most vulnerable.
• Enhanced automation: It results in loss of livelihoods and hence rises in poverty. Social justice must be factored in policies regarding the same to ensure a dignified life to all. Robot tax, universal basic income is some such measures.

Conclusion

Purpose, values and ethics need to be built into institutional design to build resilient businesses. By aspiring to contribute to society, employees will have a purpose in their daily work. This cultivates innovation and expands business models.