Science for Troubled Times - How Does Ethical Science Change When Faced with a Global Pandemic?

For the past couple of months, Covid-19 has brought the world to a standstill. Flights have been cancelled, visits have been postponed and people have kept themselves shut indoors. But with lockdown beginning to lift here in the UK, now is the time to reflect on the ethical strains that have been weighing on recent scientific and medical practices.

Difficult Decisions.

Imagine you are a doctor caring for two patients. They are both severely infected with Covid-19, developing pneumonia and need the assistance of a ventilator but, tragically, there is only enough medical equipment to save one. One patient is a middle-aged man who is otherwise healthy and has no family dependant on him. The other is a woman whose immune system is weakened by underlying health conditions and has two small children in her care. Who do you choose?

It’s a difficult decision yet, according to the World Health Organisation, around 1 in 5 of those who are infected with Covid-19 require hospital care. At its peak, 3099* patients were admitted on the 1^st April in the UK putting immense strain on our NHS and its health workers.

With such limited resources, how are patients selected to be treated?

In 2017 the government issued guidelines to aide people in making decisions during a pandemic. The principles follow a strong theme of fairness and ‘equal respect’ where ‘everyone matters, and everyone matters equally’ but in such strange times fairness needs to take a different form. The guidelines state that ‘[equal respect] does not mean that everyone will be treated the same’ therefore a triage (grading patients according to the urgency of their needs to decide the order of treatment) is required.

This almost god-like judgement of who must live or die sits uncomfortably with most of us - especially with the medical practitioners. The British Medical Association (BMA) in its Ethical Issues Guidance cites that ‘it is both lawful and ethical for a doctor […] to refuse someone potentially life saving treatment where someone else is expected to benefit more’. However, this gives little comfort as many health care workers have seen a decline in mental health due to the moral dilemmas and traumas experienced daily in caring and treating those worst affected by the virus.

It’s not as fair as it seems.

Sadly, the pandemic has shown that fairness and ‘equal respect’ haven’t been so easily achieved. Instead, Covid-19 may have exacerbated existing inequalities since Black males are 4.2 times more likely to die from Covid and Black females are 4.3 times more likely than their White peers (according to the Office of National Statistics, ONS). Despite only making 13% of the UK population, 34% of Covid intensive care patients were of ethnic minorities. These figures are the result of the economic and social inequalities that are still present in our society today, highlighting the need for more social reforms post Covid.

Following the death of George Floyd on the 25^th May in the US, thousands of protesters took to the streets in America and here in the UK. This was in support of the Black Lives Matter Campaign and aimed to bring awareness to the racism that many members of our community still face. Despite the discouragement from the government, these mass gatherings haven’t been found to have caused a spike in coronavirus cases. This is due to the fact that these were open air events with crowds wearing facemasks and not standing in one place. Thus it is left to be a moral choice as to whether the risk of infection outweighs the moral indignation felt against the treatment of Black people.

The Next Steps.

Now, hospital admissions have reduced to 275* on the 23^rd June and we seem to be experiencing the end of the worst. Lockdown is lifting and people are venturing outside again. Through the pandemic we all tested our moral consciences: questioning the impact on ourselves and our loved ones through every action we make. It’s uplifting to hear that businesses and pubs are opening again but we mustn’t let ourselves forget the cause of all this disruption.

We still need to be mindful of social distancing and good hygiene. The virus is yet to disappear, and the threat of a second wave is still present. Between the 25^th and 28^th June, the ONS said that 69% of adults were worried about the effect of coronavirus. Like the doctors and nurses in our hospitals, we need to conduct ‘equal respect’ in our new way of life by safely following government guidelines. Until the virus is defeated, we must be aware of the affects of our needs and actions have on others and ‘triage’ our wants to prevent unnecessary strain on the people around us. It’s tempting to forget the advice but in doing so, we put others at risk.

"Between the 25^th and 28^th June, the ONS said that 69% of adults were worried about the effect of coronavirus."

A Fairer Future

Unwittingly, the pandemic has taught us to become more compassionate and aware of the larger community around us. So many of us have pulled together by volunteering for foodbanks, the NHS or delivering supplies to vulnerable neighbours. We have shown immense gratitude towards our NHS and all the other valuable key workers. Hence, with the greater need for social interaction and human kindness, lets carry forward an ethical and moral compassion into our new way of life and integrate it into our science, medicine, and society post Covid-19.

*Figures from the Centre for Evidence-Based Medicine (CEBM).