ETHICS IN THE TIME OF CORONAVIRUS

The Coronavirus (COVID-19) pandemic is running rampant across the globe. It started in December 2019 in China and has grown into a worldwide problem, unlike anything any of us have ever seen before. 

The Covid-19 emergency is severely challenging the whole world, unprepared for an unexpected and rapidly spreading epidemic. Our habits are changing, by virtue of an appeal to responsibility that is limiting many of our daily activities and relationships. This unexpected situation demands from Ethicists to offer answers to certain relevant questions or at least to start opening discussions in the face of this emergency situation. Here we try to discuss ‘how to behave in the time of the Coronavirus emergency?’ and to offer some moral norms to be observed with a sense of responsibility.

Relevant Ethical Principles

Ethics involves judgements about the way we ought to live our lives, including our actions, intentions, and our habitual behaviour. The process of ethical analysis involves identifying relevant principles, applying them to a particular situation, and making judgements. Here we propose a variety of ethical principles, which are relevant at the time of the alarming spread of the pandemic Covid-19. These themes are taken from Guidance for Managing Ethical Issues in Infectious Disease Outbreaks, published by the World Health Organization. 

Justice, or fairness, encompasses two different concepts. The first is equity, which refers to fairness in the distribution of resources, opportunities and outcomes. Key elements of equity include treating like cases alike, avoiding discrimination and exploitation, and being sensitive to persons who are especially vulnerable to harm or injustice. The second aspect of justice is procedural justice, which refers to a fair process for making important decisions. Elements of procedural justice include due process (providing notice to interested persons and an opportunity to be heard), transparency (providing clear and accurate information about the basis for decisions and the process by which they are made), inclusiveness/community engagement (ensuring all relevant stakeholders are able to participate in decisions), accountability (allocating and enforcing responsibility for decisions), and oversight (ensuring appropriate mechanisms for monitoring and review). 

Beneficence refers to acts that are done for the benefit of others, such as efforts to relieve individuals’ pain and suffering. In the public health context, the principle of beneficence underlies society’s obligation to meet the basic needs of individuals and communities, particularly humanitarian needs such as nourishment, shelter, good health, and security. 

Utility: The principle of utility states that actions are right insofar as they promote the well-being of individuals or communities. Efforts to maximize utility require consideration of proportionality (balancing the potential benefits of an activity against any risks of harm) and efficiency (achieving the greatest benefits at the lowest possible cost). 

Respect for persons refers to treating individuals in ways that are fitting to and informed by recognition of our common humanity, dignity and inherent rights. A central aspect of respect for persons is respect for autonomy, which requires letting individuals make their own choices based on their values and preferences. Informed consent, a process in which a competent individual authorizes a course of action based on sufficient relevant information, without coercion or undue inducement, is one way to operationalize this concept. Where individuals lack decision making capacity, it may be necessary for others to be charged with protecting their interests. Respect for persons also includes paying attention to values such as privacy and confidentiality, as well as social, religious and cultural beliefs and important relationships, including family bonds. Finally, respect for persons requires transparency and truth telling in the context of carrying out public health and research activities.

Liberty: Broadly speaking, liberty is the ability to do as one pleases. In contemporary terms, liberty is the state of being free within society from oppressive restrictions imposed by authority on one's way of life, behaviour, or religious, cultural or political views. It involves free will as contrasted with determinism. Liberty is to be differentiated from freedom, as ‘freedom' primarily, if not exclusively, means the ability to do as one wills and what one has the power to do; and ‘liberty’ means the absence of arbitrary restraints, taking into account the rights of all involved.

In this sense, the exercise of liberty is subject to capability and limited by the rights of others. Thus liberty entails the responsible use of freedom under the rule of law without depriving anyone else of their freedom. Thus liberty includes a broad range of social, religious and political freedoms, such as freedom of movement, freedom of peaceful assembly, and freedom of speech. Many aspects of liberty are protected as fundamental human rights. 

Reciprocity consists of making a ‘fitting and proportional return’ for contributions that people have made. Policies that encourage reciprocity can be an important means of promoting the principle of justice, as they can correct unfair disparities in the distribution of the benefits and burdens of epidemic response efforts.

Solidarity is a social relation in which a group, community, nation or, potentially, global community stands together. The principle of solidarity justifies collective action in the face of common threats. It also supports efforts to overcome inequalities that undermine the welfare of minorities and groups that suffer from discrimination.

Specific Issues
Having seen some general ethical principles, we will now try to address some specific issues related to the present day pandemic Covid-19.

Transmission of Information 

One of the fundamental requirements at the spread of a new epidemic is that of clear, unambiguous and scientifically founded information, offered by authoritative sources. This helps to avoid hasty panic reactions, instilling awareness, reasonableness and moderation in public opinion, which is generally in emotional and irrational terms in such situations. 

The information must constantly accompany the preventive or restrictive measures taken by public authorities to motivate compliance with the provisions and motivate citizens on the effectiveness of the sacrifices requested. A collaboration of the media is required in view of the common good, putting sensationalism and the search for the scoop aside, to contribute to a climate in which people are aware of the risks, but they stay serene and confident. This does not mean cancelling the right to information, but modulating its exercise in the forms that prudence imposes in situations of danger and emergency. 

The role of those who govern public affairs is fundamental and requires maximum transparency towards citizens, together with collaboration and convergence between the various bodies and levels of administration. 

Mass media have long been recognized as powerful force shaping how we experience the world and ourselves. This recognition is accompanied by a growing volume of research, that closely follows the footsteps of technological transformations (e.g. radio, movies, television, the internet, mobiles, smartphones) and the zeitgeist (e.g. cold war, 9/11, climate change, flood in Kerala) in an attempt to map the major impacts of mass media on how we perceive ourselves, both as individuals and citizens. Are media still able to convey a sense of unity reaching the large audience, or are they making meaningless noise and self-promotion? Do social media provide solace and support or grounds for misinformation, dehumanization, and discrimination? Can we harness the flexibility and ubiquity of media technologies to increase the public’s adherence to the safety measures suggested by global health organizations to combat the spread of COVID-19? How can different media industries and channels for mass communication promote adaptive responses to foster positive health attitudes and adherence to preventive measures? How media impact the dynamics in the private domain in this self-imposed lockdown, like strengthening family bonds, using creatively the free time people get during these days etc.?

Within this ample framework of complexity, the media may address their impact and their role during the COVID-19 pandemic, keeping in mind the following topics: Effective health communication for the adoption of sustainable preventive measures and curtailing misinformation; Public health communication to increase psychological resources and resilience in distinct age groups and socioeconomic conditions; Effective strategies for helping individuals in dealing with social and physical distancing; Reduction of stigma, prejudice, discrimination, and inequalities. 

Social media is one of the best ways to share news nowadays for most of the people, especially if we are trying to alert people of something serious in a very, very quick manner. They have made people aware of the situation constantly, educated them about the symptoms and encouraged them to make every possible step to avoid the spread of this pandemic. But, unfortunately and in many instances, social media is used by people irresponsibly, spreading misinformation, fake news and hatred. We should do a little research to see if what we are reading is actually factual before forwarding it to anybody else. Otherwise, you may be inclined to share the misinformation and fuel the fear of something that isn’t necessarily true. We should also refrain from posting anything that makes fun of, ridicules, or minimizes the seriousness of the situation. If we are planning to post or forward anything, make sure that it is informative and it corresponds to the facts. Cross check any information you get in the social media with the official information platforms. 

Confidentiality 

It is also important to keep confidentiality of the details of the affected people. Revealing their details to the public may constitute a serious violation of the privacy of the subjects concerned in terms of sensitive data such as those concerning health. In times of emergency, requests to identify the infected are likely to arise in the illusion that this allows to fight the pandemic, while often it only contributes to reinforcing false safety and marginalization of patients exposed to the public as ‘plagued’ and (possible ) spreaders. 

It is quite instinctive that in situations of social alarm like Covid-19, the compromise of fundamental rights is easier and it is more difficult for different voices to arise in defence of their protection. Instead, it must be reiterated that fundamental rights may never be revoked in the name of any cause; their exercise may be regulated and - in extreme cases - suspended only if it is evident that this actually contributes to protecting the common good. It may be implemented only for limited period of time, in order to avoid that urgency and fear, avoiding the sliding towards forms of injustice and abuse. 

Criteria for Accessing Limited Medical Resources 

It is quite natural that in situations of the spread of epidemics and social alarm like Covid-19, there may arise the possibility of limited access to medical resources. There is the possibility of a change in the forms of triage to define patients’ access to the intensive care unit (ICU) if the places are extremely scarce compared to patients who need such support. 

It should be remembered that this contingency, foreseen for exceptional situations of catastrophe, war or epidemics, demands the need to save the greatest number of people in the face of limited resources that cannot be offered to everyone, as in the ordinary situations. This must be considered only when a limit level is truly reached and the use of a ‘rationing of resources’ really corresponds to the only possible good that can be achieved in a serious situation that cannot be faced otherwise. 

Before taking this step, all the alternatives available, including those reserved for natural disasters, must be exhausted, according to the logic of solidarity and sharing of resources. It is demanded by distributive and social justice. In this case, timely and non-alarmist information must be provided to the public, ensuring the criteria and criteria adopted to select patients justly and impartially. These criteria must be predominantly medical and objective as far as possible in order not to leave room for discrimination and injustice. However, anticipating the information before the described circumstances occur appears to be a reckless and inappropriate alarmist communication, at least at the present moment. 

Hoarding and Price Gouging 

Hoarding is the practice of obtaining and holding resources in quantities greater than needed for one’s immediate use. It may include the practice of obtaining and holding resources to create artificial scarcity, thus reducing the supply, to increase the price, so that they can be sold to customers for profit. In an emergency situation like Covid-19 this behaviour can be considered as an instinctive response to fear of a shortage of necessary good. It leads people to collect foodstuffs, water, and other essentials which they believe, rightly or wrongly, may soon be in short supply. Hoarding occurs also because people think that the market will operate efficiently in current or expected conditions. Price gouging occurs when a seller increases the prices of goods, services or commodities to a level much higher than is considered reasonable or fair. This also is a common behaviour at the time of civil emergency. Price gouging may be considered exploitative and unethical. When these happen, it is the duty of the government primarily to interfere and bring things into control. It also requires all citizens to be responsible in their buying and selling. 

Safety and Protection to Healthcare and Emergency Workers 

Protecting the health and safety of health-care workers and other emergency responders is crucial to maintaining an adequate and functional workforce and ensuring the continuity of the emergency response and essential health services. In an emergency situation like Covid-19, the, the government and the employers need to be prepared to adapt their usual practice in consultation with workers and technical experts in order to achieve a reasonable balance of safety versus obligation to work. 

In dealing with the risks during management of outbreaks and emergencies, the following general rights, duties and responsibilities of employers are specified in the International Labour Organization (ILO) Occupational Safety and Health Convention of 1981, article 155.

Employers have overall responsibility to ensure that all practicable preventive and protective measures are taken to minimize occupational risks. Employers are responsible for providing adequate information, comprehensive instruction, guidelines and necessary training. Employers are required to provide workers with adequate protective clothing and protective equipment and appropriate training on their use, to prevent, so far as is reasonably practicable, the risk of adverse effects on health. They also have to provide appropriate psychological support, as well as implement measures to promote healthy practices and provide adequate compensation for the services provided by these workers, in the form of risk premiums and insurance for them and their families and disability benefits for those who contract the infection. Systematic monitoring and evaluation of the effectiveness of the service they provide also is important.

Workers are required to report immediately to their supervisor any situation that they have reasonable justification to believe presents an imminent and serious danger to their lives or health.

Until the employer has taken remedial action, if necessary, the employer cannot require workers to return to a work situation where there is a continuing imminent and serious danger to life or health; Workers have the right to remove themselves from a work situation that they have reasonable justification to believe presents an imminent and serious danger to their lives or health. When a worker exercises this right, he or she shall be protected from any undue consequences; Workers are responsible for following established protocols and procedures, avoiding the exposure of others to health and safety risks, and participating in training provided by the government and the employer. Infections and post-traumatic stress disorder, if acquired through occupational exposure, are considered occupational diseases, and that affected workers have the right to compensation, rehabilitation and curative services. 

The Christian Community 

The believers are supposed to be well aware about the situation and to behave as collaborative citizens, assuming their responsibilities in accordance with the directions of the authorities, both civil and ecclesiastical. If the preventive measures directed by the authorities require avoiding meetings with people, the suspension of people’s participation in the liturgical and other celebrations, which is legitimate and appropriate, comply with them wholeheartedly. The local ordinaries are called to pronounce directions clearly on the matter, to avoid discrepancies of behaviour among the faithful, including priests! And believers have a serious moral obligation to behave fairly and respect the directions given by the authorities, avoiding subterfuge. 

Certainly, the renunciation of participation in the Eucharistic celebration (especially on Sundays, in this Lenten season) is a sacrifice for Christians. But the good of public health may require the restriction of forms of public worship in exceptional situations. In such cases, the media can offer alternative forms of participation in the liturgical celebrations, contact with the community and support for prayer. 

The ‘forced Eucharistic fasting’ - like other forms of renunciation imposed by the emergency - may also help us recover the value and appreciation for what we often take for granted: Eucharist, community, relationships, interactions..., which in this time of ‘special lent’ constitute effective forms of fasting and sharing.