Abstract
Follow the science, but what about the ethics?
Follow the science has been one of the mantras of our political leaders, propelled centre stage to deal with COVID-19. And much of the science has been breathtakingly brilliant, as I and countless others lined up for our jabs with a vaccine developed in what must be record-breaking time.
Rather than view COVID-19 with that most excellent gift of 20:20 hindsight, let me take you back some 13 years or so. It is easy to proclaim ‘follow the science’, but there are a range of views about ‘the science’ and no one simple answer. The same is true of ethics. I know. I learned this the hard way. I chaired the UK Government Committee to look at ethical aspects of pandemic influenza and devise a framework to enable ministers to take ethically robust decisions in the event of a pandemic. The Committee on Ethical Aspects of Pandemic Influenza (CEAPI) attempted precisely that.
If the framework were to be genuinely useful and cross boundaries and offer an inter- and multi-disciplinary approach, then disparate voices from disparate disciplines and the four nations had to be included, and heard, and committed to the direction of travel. Remember the high court judge taking a stroll down Edinburgh’s Royal Mile who observed two old pals in their respective top flats having a real ding-dong of an argument across the street: as the judge wryly noted, ‘I see they are arguing from different premises.’ My committee argued for sure, not from different premises, but for one fundamental premise—equal concern and respect. Our seven main principles, not ranked in any order, orbited the fundamental premise, challenging the decision taker to take all into account: minimising harm; fairness; working together; reciprocity; keeping things in proportion; flexibility; voice and choice. It was a framework and not guidance, because there may be no one correct answer to many of the dilemmas decision takers will have to take when pandemic strikes.
So what about the ethics? During the swine flu pandemic questions from UK ministers ranged from compulsory post-mortems to provision of antivirals. Working assumptions had to be drastically revised: pigs and Mexico rather than avian and SE Asia. In ‘The 2009 Influenza Pandemic: An independent review of the UK response to the 2009 influenza pandemic’ Dame Deirdre Hine stated: ‘The production of an ethical framework—drawn up by an independent body, CEAPI—was a vitally important step, given the potential pressures on critical care which would therefore have necessitated prioritisation decisions.’
Doubtless in 2020 many wrestled with the ethical dilemmas of who needed PPE most or how to stop hospitals being overwhelmed. Was the NHS protected at the height of the pandemic at the expense of the elderly and frail? How does that square with ‘equal concern and respect’ or everybody matters equally? When a review is undertaken of how COVID-19 was managed, it will be fascinating to hear both about the science and the ethics.