Michael Parker: The challenges of ‘real-time public ethics’: incorporating ethics expertise in public decision-making

The following is an edited version of Michael Parker’s remarks at a UK Pandemic Ethics Accelerator event on 23rd May 2022, discussing the place of values in public policy during a pandemic

Professor Michael Parker is Professor of Bioethics and Director of the Ethox Centre at the University of Oxford. One of his main areas of research interest is in global health bioethics, with a particular emphasis on infectious disease ethics. During the COVID-19 pandemic, he participated in the UK’s Scientific Advisory Group on Emergencies (SAGE), the World Health Organisation’s COVID-19 Ethics & Governance Working Group, and the UK Department of Health and Social Care’s Moral and Ethics Advisory Group (MEAG).

I’m going to organise my thoughts under three headings: ethics advice during COVID; the role of the ethicist in these kind of situations; and the ethics of advisory committee membership.

I think it’s important that we reflect on the roles through which, and the ways in which, more attention can be brought to bear on the ethical dimensions of policy. It is important for policy-makers to recognise that many of the decisions they need to be made are, or have as a key part of them, value judgements. To say that one can “follow the science” or “follow the data” is to fail to acknowledge that the making of value judgements about what matters morally is an unavoidable step in any policy-making process. This step is, however, often, implicit and unnoticed.

I think this reflection is important and these aspects are often unacknowledged parts of the problematic policy-making process.

Ethics advice during COVID

It is important to note that the amount of direct ethics input into UK policy during COVID-19 has been very significant and many ethicists and social scientists with an interest in ethics have been involved.

In my own case, over more than two years throughout the pandemic I’ve attended more than 100 main SAGE meetings, and an equal number, at least, of meetings of various SAGE subgroups, including on vaccines, on the events research programme, on children in education, on mass gatherings, and on the Scientific Pandemic Insights Group on Behaviours (SPI-B) and so on. My guess is that I have put in more than a thousand hours over those two years, over and above the day job, and I know that I am not alone in this.

It is interesting, I think, that government has seen the need for ethics input to its various advisory groups and those subgroups. I think it is without precedent, except perhaps in the work of Mary Warnock on ethics and reproductive medicine. It is likely to be one of the most sustained and intensive periods over which a government has had access to timely ethics advice on policy evolving in real time.

Against that background I think it is important to ask ourselves why, at this particular time, through my involvement in SAGE, the forming of MEAG, and the work that the Nuffield Council on Bioethics has been asked to undertake, has ethics has been seen as important and relevant by policy-makers? There are a range of ways in which it could have been better, and there could have been more of it. But I do think it is important to ask ourselves the question why did this happen, why was ethics input seen as important and how can we build on it for the future?

As you can see, I would want to challenge the narrative that ethics has not been central through COVID. I think it has been in many interesting and novel ways.

The role of the ethicist

If we all agree that value judgements are central, it raises a question around what is the role of the ethicist in this kind of setting, and in the context of an advisory committee. Here are a few thoughts on this.

I think it is clear that, as a member of an advisory group of this type, it’s not the job of the ethicist to tell elected governments what they should do. That’s not the job of the scientific advisors either. I think there are some exceptions, which I’ll come to. But in general this is the case.

If that is true, then what is the role? – I think there are three things:

  • I think it was my role to ensure that decision-makers were aware that policy-making has an ethical dimension and to encourage them to see the importance of paying careful attention to this and to the making of value judgements;
  • Second bringing the moral significance of specific decisions to their attention – the fact that there is a moral dimension. I call this mapping the moral landscape – setting out the ethical and moral implications of different available courses of action, and setting out the arguments in favour of and against pursuing them;
  • Finally, emphasising the need for justification, and providing tools for navigating these dilemmas – i.e. concepts, arguments, reasons and so on – the kinds of tools that are needed to make moral judgements about different courses of action. It is about providing the tools to make and justify decisions, rather than telling decision-makers what to do.

The ethics of committee membership

I think the ethics of committee membership and advisory roles is an unexplored topic in the bioethics literature. It’s important, but not enough work – if any – has been done on it.

When you’re in this kind of situation there is, to some extent, a degree of collective responsibility for advice. As a member of SAGE, I have some responsibility for the advice that emerged from those meetings. Not all of it will have reflected my argued positions within the context of the meetings. This is the nature of committee work. Clearly, it is possible to imagine situations and conditions under which it would be appropriate for an ethicist to resign or speak out publicly. But that can’t be the default every time there is a disagreement, or something you do every week. The default position has to be to argue the case, to make the tools available, and to do the best job you can. There is then an important ethical question about what are the limits of that, what changes the expected into the exceptional?

Secondly, I think you have to recognise that the role of senior adviser comes with some responsibilities. I think it’s important to ask ourselves what the nature, scope and the limits of those responsibilities are. I don’t think that’s had as much attention as it ought to do. Some of the most influential ethicists and moral philosophers in the UK have played these kinds of roles – such as Mary Warnock and Bernard Williams, and many of our currently active friends and colleagues in bioethics – and have struggled with these kinds of problems. I think that we need to do more work on this.

Then there is a difficult balance as an individual. Before I joined SAGE, I had written papers on ethical issues in the pandemic around resource allocations in intensive care units for example – a fairly controversial paper. I also wrote a paper on the contact tracing app and argued about ethical aspects of that. When I joined SAGE I decided to stop writing papers that were personal positions on this particular issue. However, I’d be interested to think more about what is the appropriate balance in these kinds of roles between being an advisory group member and an active member of the bioethics community.