'Ethical Theories: Part 3'

CAERS SUBSTACK ARTICLE #67

‘Ethical Theories: Part 3’

CAERS Substack Article #67

It would be nice to think that during the pandemic everyone, including the authorities, carefully weighed all of the various perspectives using the many different ethical theories to derive their best moral stance with respect to the many issues that arose. Sadly, I suspect that such was not the case. From where I sat it appeared that raw fear, and blind obedience to whatever protocols seemed to mitigate that fear, were the driving forces behind the thoughts and behaviours of most Canadians.

Perhaps if there had been more awareness of ethical principles and theories it might have helped. Humility is perhaps the most important starting point. Does one feel that they alone have the intelligence and correct moral compass necessary for the task, or do they recognize that others have them too? Can one accept that despite how strongly one may feel about their perspective that others with different perspectives might have something worthwhile to contribute as well? And that maybe that they are deserving of respect, and maybe even serious consideration?

I’m not sure I witnessed much in the way of humility or tolerance or open-mindedness. There wasn’t much in the way of critical thinking either; binary reacting, based in emotions especially fear, seemed to rule the day and to a large degree still does. There did not appear to be a culture of respectful dialogue; those who did not agree with the ‘experts’ were shut down, and often demonized in the process. There was a definite hierarchy when it came to who could speak and who could not, who could make decisions and who could not. The average Canadian was to be seen and not heard; and they were to follow rules without question. Much was secretive; transparency became a lost art. And there was only one source of information allowed, only one narrative was deemed to be acceptable.

There is certainly merit to minimizing harm from SARS-CoV-2; from the Consequentialist perspective the greatest good for the greatest number seems like a laudable goal. But the means for doing so left a lot to be desired. All other illnesses and diseases were put on the backburner, if they were left on the stove at all. No doubt many suffered and died waiting for treatments that were deferred because of COVID, and that backlog has likely still not been cleared. And there was little admission, let alone monitoring, of the potential harm of the many measures implemented to reduce morbidity and mortality from COVID. Social isolation, financial loss, lack of exercise and so many other repercussions of the mandates did harm but that harm was not allowed to be acknowledged. Transparency seemed to have vanished from the moral landscape.

Although it is admirable that Canadians agreed to sacrifice for each other, particularly the most vulnerable, using mandates to accomplish this essentially eliminated the need for informed consent (capacity, disclosure, voluntariness). Doing so essentially quashed the autonomy of Principilism that has characterized modern medical ethics, and historically such an approach has resulted in great harm. The Nuremberg Code was developed in the mid-twentieth Century in response to those types of harms.

Additionally, as a result of the consequentialist paradigm used to justify so much of the pandemic, the sanctity of the patient-physician relationship was compromised. Exemptions to so many of the measures used at a population level were rarely, if ever, allowed; individuals ceased to matter, be they patients or physicians. There was one rule for everyone and no allowances were granted for any exceptions regardless of circumstances, pregnancy included; one size had to fit all. No sacrifice by any patient was too great for the community’s protection from COVID.

It was Communitarianism taken to a dangerous extreme, almost a communism. It is one thing to respect and value our social nature. It is quite another to steamroll over individual human rights in the process by suppressing free speech, ignoring informed consent and demonizing those who asked legitimate questions.

Working diligently to protect us from COVID, especially those at high risk, would seem to display an Ethics of Care. Unfortunately, those at highest risks in nursing homes or living alone were isolated from family and had other medical conditions left untreated, hardly in keeping with a model of deep caring. Dying alone without good palliative care does not embody the ethos that such a theory promotes. Nor does the divisiveness that seemed to characterize so much of the pandemic.

How virtuous was our collective behaviour during the pandemic? Were the noble virtues of compassion, discernment, trustworthiness, integrity and conscientiousness well demonstrated by the authorities who managed the pandemic? Bribery, heavy-handed mandates and other forms of coercion are seldom elements of any Virtue Ethics. It is likely becoming clear at this point that the promises of efficacy and safety of the experimental vaccines have not been realized. Truth-telling and humility, critical ethical principles, could have been in much greater supply.

But maybe I have much of this wrong. What do you think? In retrospect, are you satisfied with the ethics that underpinned the pandemic management? What, if anything, would you like to have seen done differently, or be done differently in the future? You have the right to do your own ethical analysis, and the right to speak up about it. In fact, in a democracy, you have the duty and therefore should have the right to do so openly and without fear. Do you feel that you do? But more importantly, will you?

J. Barry Engelhardt MD (retired) MHSc (bioethics)

CAERS Health Intake Facilitator