Essays

What It Means for Pandemic Response Measures to Be Ethical

And why ethics matters as much as science

In the past weeks, we have addressed some of the ethically problematic aspects of pandemic response measures. These included unjustified infringements on individuals’ autonomy (paternalism), unfair treatment of certain populations (particularly young people), a narrow focus on merely protecting lives from COVID-19 to the detriment of quality and meaningfulness of lives, and so on.

But what does it mean to assess pandemic response measures ethically?

A few thoughts on this can help better navigate the ethical assessments we have been doing so far and the ones we will be making moving forward.

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How to assess ethics

An ethical assessment starts by identifying the principles and values at stake in the decisions we make. For example, saving lives, protecting the public good, treating individuals fairly, respecting their autonomy, and so on are all ethical values relevant to pandemic response measures. Unfortunately, as we have seen in the last year, there often is a trade-off required in pursuing each of them while giving due consideration to the others.

Thus, once we have identified what principles and values are at stake, the second step of an ethical assessment is to strike the right balance among them.  There will always be a certain degree of disagreement on how best to do this. People with different political, moral, and religious views will strike different balances between – for example – respect for individual freedom, fairness, and the collective good. But this does not mean that we should give up on asking questions about the ethical values guiding our decisions. On the contrary, asking questions is a critical part of the process that helps us understand each other better.  It also does not mean that our feelings, intuitions, and emotions should replace rational thinking in our efforts to make progress in ethical reflection.

In fact, the third step of an ethical assessment is to ensure that rationality prevails over the irrational tendencies we all have. Ethical decisions are often difficult because they often require us to overcome our intuitions, fears, instinctive selfishness, and received wisdom. And yet, ethics is the only method we have to justify decisions and policies to others. And while ethics is important to individual decision-making, it is also vital in liberal democracies, where the public is always owed a justification for the policies implemented.

Ethics requires us to engage in rational reflection and to be prepared to change our minds when presented with well-reasoned arguments. 

This is why it would be best if politics and ideology were kept separate from ethical assessments of pandemic response measures.  People are often unwilling to change their mind about matters relating to politics and ideology, even if there is a rational reason to do so. 

We cannot ‘follow the science’

Something is troubling in many of the slogans used to justify pandemic response measures. Policymakers often repeat that they “follow the science” or are “led by data, not dates”, and similar catchy soundbites. These phrases do not make sense. They contain a fundamental categorical mistake: science and data by themselves cannot lead anywhere if we don’t already know where we want to go and, ideally, why we want to go there.

This does not mean science and data don’t matter—quite the opposite. Science and data do matter. So much so that the more science and data we have, the more equipped we are to make decisions. They can tell us how best to go about and how likely we are to achieve certain goals – like COVID-19 eradication, for instance. However, what we want to achieve depends on what we want to prioritize, what we are prepared to sacrifice, and whom we want to enjoy the most benefits (and pay the highest cost) when trade-offs are inevitable.

These decisions are not about science; they are about values.  Science and data are descriptive, meaning they focus on what is or is likely to be the case. Conversely, choices and values are prescriptive and concern themselves with what we ought to do.  The philosopher David Hume famously demonstrated the discrepancy between is and ought

Ideally, we want the decisions we make at the policy level to be ethical. Of all the possible values that can ground decisions (political, religious, traditional, etc.), we should use ethical values. Ethical values are different from those derived from our whimsical preferences, our irrational fears, or from wanting to be perceived as virtuous.

We need to follow ethics

What does it mean, then, for decisions to be ‘ethical’? Despite the pervasive disagreement on ethical matters, some rational standards and objective conditions must be met for decisions to qualify as ethical — even when people disagree on how to make trade-offs between values.

One requirement of ethics is that decisions need to be impartial. For a decision or a policy to be ethical, it needs to assume that the interests of all the individuals involved deserve equal consideration. This does not necessarily mean that everyone ought to be treated equally. (In fact, most of the times, it does not). But it does mean that we need a compelling reason for why the interests of specific individuals or specific groups should be given more consideration than the interests of other individuals and other groups in a given circumstance.

For example, the interests of young people and those of older people should be assumed to count equally, and we should not assume that the interests of old population groups matter more unless we find some good reason to think so. But even when we do find such reasons, we should not forget that other people’s interests are at stake, too, and should always be given due consideration. Thus, for example, we discussed in week two how the interests of young generations have not been given due consideration throughout this pandemic.

We should then consider how to rank different interests in a way that can be rationally justified. This is where ethical disagreement is likely to arise.

Differing approaches

Criteria for ranking interests varies, and, indeed, a big part of moral philosophy as an academic discipline revolves around discussing them. Impartiality is the key, as mentioned above. So what does it mean to rank values and interests impartially?

According to a contractualist philosophy, impartial decisions reflect what rational people would choose if they did not know beforehand into what group they fell and, thus, how they might be personally affected by the decision.

For example, imagine a hypothetical pandemic scenario similar to COVID-19 where you did not know if, in that scenario, you were old or young, living in a wealthy or a developing country, healthy or sick, and so on. What policy would be rational for us to choose behind this ‘veil of ignorance’, as coined by political philosopher John Rawls?

According to utilitarianism, impartiality means maximizing the collective wellbeing of the whole community – ideally, the global community. This approach justifies imposing some sacrifices on certain individuals if the benefit that results for everyone else is significant enough to outweigh such costs. For example, in a pandemic context, it means that if the benefit to the collective of focussed protection strategies is so significant that it outweighs the cost to those who are temporarily shielded, then that policy is the ethically required one. In this case, the issue essentially comes down to empirical matters, i.e. an objective estimation of costs and benefits (for which science and data are indeed needed).

Per deontological approaches, ethical decisions comply with certain high-priority rules that are (almost) non-negotiable. For example, one rule might be that lives should be saved at all costs–even if the cost is very high for other people, and regardless of relevant variables such as the expected length and quality of the lives saved.

These are a few of the frameworks we might consider to construct policies that are as ethical as possible. What matters is not necessarily which approach to use but that the process of ethical reflection is made explicit. That way, when we discuss pandemic response policies, we can explain to ourselves and others why we prefer one approach over another.

Who decides?

Such ethical justification is not something that we can achieve by ‘following the science’.  Ethics is a more fundamental reflection that will guide what we do with science and data.

One important thing to remember is that when ‘experts’ are interviewed on mainstream media and asked for advice regarding lockdowns or other restrictions, we should wonder to what extent their expertise is relevant to making ethical decisions.

Have we thought about what it is we are trying to achieve and why? Or are we just waiting for some scientist to decide for us which ethical values matter the most?

Alberto Giubilini is a philosopher and Senior Research Fellow in practical ethics at the University of Oxford, specializing in public health ethics and the ethics of vaccination.

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