Pandemic Ethics: Changing public expectations
Published on August 4th, 2022
Luca Savarino is Associate Professor of Moral Philosophy and Bioethics, Department of Translational Medicine, University of Eastern Piedmont. He is also Member of The Italian Committee for Bioethics. His research fields are: moral philosophy, medical ethics, public health, environmental ethics.
The Covid 19 pandemic has radically changed our everyday experience both in practical terms - that is affecting our health, legal and political spheres –and also symbolically & intellectually. As Martin Wolf pointed out in the Financial Times, the impact of this change was due to the virus, but also to the measures adopted to fight it. Covid was a medium sized epidemic compared to the Spanish Flu that caused between 50 and 100 million deaths worldwide in the early 20th century, not to mention the 14th century Black Death with a much higher death rate. The social upheaval and economic damage caused by Covid was the result of a transformation in our moral sense and material conditions over recent decades. “The response to the pandemic is a reflection of economic possibilities and social values today, at least in rich countries. We are prepared to pay a vast price to contain pandemics. And we can do so far better than before” (Wolf, 2020). Improved healthcare systems and overall higher living standards have made the risk of dying from an infectious disease unacceptable: until a hundred years ago it was considered natural and was met with a fatalistic resignation.
Commentary
Professor Luca Savarino
Pandemic Ethics: Changing Public Expectations
The Covid 19 pandemic has radically changed our everyday experience both in practical terms - that is affecting our health, legal and political spheres –and also symbolically & intellectually. As Martin Wolf pointed out in the Financial Times, the impact of this change was due to the virus, but also to the measures adopted to fight it. Covid was a medium-sized epidemic compared to the Spanish Flu that caused between 50 and 100 million deaths worldwide in the early 20th century, not to mention the 14th century Black Death with a much higher death rate. The social upheaval and economic damage caused by Covid was the result of a transformation in our moral sense and material conditions over recent decades. “The response to the pandemic is a reflection of economic possibilities and social values today, at least in rich countries. We are prepared to pay a vast price to contain pandemics. And we can do so far better than before” (Wolf, 2020). Improved healthcare systems and overall higher living standards have made the risk of dying from an infectious disease unacceptable: until a hundred years ago it was considered natural and was met with a fatalistic resignation.
In the past two years, European political leaders have generally legitimated restrictive measures presenting them as a necessity imposed by science: while understandable during the early stages of the pandemic, in the long run, this trend has proved counterproductive and can be understood as a deficit of the legitimacy of politics. To avoid reducing politics to a mere technical exercise, we have to become aware that containment measures can only be effectively justified from a normative point of view (Habermas, 2021). For instance, these measures have had costs that have impacted differently various strata of the population, and it is up to politics to justify the need to pay them. Costs are not limited to the restriction of key parts of citizens’ freedom in the name of public health but have entailed wider social and economic inequalities, as well as new forms of inequality such as the different impact that lockdowns have had according to age, work or gender. Recently we have been forced to make choices, between keeping schools or some businesses closed. In these cases, we cannot appeal exclusively to a scientific fact but we need a broad and shared assessment of the values and aims that inform the policies undertaken. Such an assessment has a political and moral content that cannot be reduced to scientific evidence, although the latter is necessary for making the appropriate decisions.
The past two years’ main ethical and political issues, including triage in ICUs, vaccination policies, and containment measures put security and individual autonomy, as well as justice and social solidarity into question, leading us to rethink the relationship between individual freedom and public health management. The pandemic has contributed to relativizing the “principle of autonomy”, developed by Western liberal bioethics. The pandemic emergency has thrust a new principle - solidarity – on the stage, and individual autonomy must find a way of fitting in with it. The duty of solidarity stems from an awareness of the interdependence between human beings, and the need to protect other people’s health and not just one's own health.
Effective and legitimate policies require us not just to rely on science or common sense: the ethical and philosophical foundations have to be made explicit, so it is possible to argue that the measures to contain the contagion were not just “necessary” but “right” (Vineis, Savarino, 2021). This is because they were aimed at maintaining a sense of social solidarity and defending the intergenerational pact, protecting the most fragile part of the population - essentially the elderly and the sick - at the expense of economic growth. This argument effectively counteracts those who claim that the pandemic emergency was simply a pretext to legitimize a new government organization where the management of the health emergency is an essential part of national and international bio-political and security political strategies.
Debates on the responsibilities of governments thrived, especially in Western countries, accused of failing to foresee an event that was largely predictable. As we now know, foreseeing a pandemic is related to human actions on the planet - increased deforestation, loss of biodiversity, a high number of intensive livestock farms - that over the past fifty years have exponentially increased zoonoses, i.e. the transmission of infectious diseases from animals to humans. Discussing what could and could not have been done is only useful if past mistakes can be used to draw lessons for the future.
One of the (few) merits of the pandemic was perhaps to remind everyone of the significance and importance of the National Health Services. Over the past two years, it has become clearer that, to effectively tackle the health crisis, a 'syndemic approach' [The Lancet, 2020] is required. The term refers to an approach that does not focus solely on a specific disease (in this case COVID), but turns its attention to the diseases that interact within a specific population and, above all, to the way in which social and economic inequalities impact on public health. Because of their universal nature, the National Health Services have proved to be a key tool not only in tackling the pandemic but in redressing the health inequalities the pandemic contributed to strengthen. Hence the need to improve them, after a season of severe cuts, and to take incisive action to strengthen community medicine and redress regional imbalances in access to care. The pandemic has made us aware of the importance of institutional action to protect individual and public health not only in times of crisis. More importantly, the need for preparedness in view of possible future health emergencies. Over the past two years, awareness of the importance of prevention in healthcare has grown. We have realized that health begins before the onset of disease and presumes the ability to prevent (and predict) the effects of the ecological crisis on our lives. The defense of public health is bound to environmental policies just as the lives of human beings are to the other life forms we share the planet with.
J. Habermas, Corona und der Schutz des Lebens. Zur Grundrechtsdebatte in der pandemischen Ausnahmesituation, in “Blätter für deutsche und internationale Politik”, 9/2021.
M. Wolf, What the world can learn from the Covid-19 pandemic, «Financial Times», 24 November 2020
R. Horton, COVID-19 is not a Pandemic, « The Lancet », September 26, 2020
P. Vineis, L. Savarino, La salute del mondo. Ambiente, società, pandemie, Milano, Feltrinelli, 2021.
