Conference on Value Judgments in Public Health Emergencies

On 23rd May 2022 the UK Pandemic Ethics Accelerator hosted an event bringing together experts from a range of fields and sectors to discuss how value judgments did, can, and should feature in public decision-making and policy.

The aim of the event was to evaluate the place and visibility of value judgements in the COVID-19 pandemic, and what this might teach us for future planning and practice. It was organised by Professor John Coggon and Dr Beth Kamunge-Kpodo, both from the Centre for Health, Law, and Society, at the University of Bristol Law School.

Panel 1 – Chaired by Professor John Coggon, with Professor Martin McKee, London School of Hygiene and Tropical Medicine and a member and former acting chair of Independent SAGE; Dr Kamran Abbassi, Editor-in-Chief of The BMJ; and Dr Mehrunisha Suleman, Director of Medical Ethics and Law Education at the University of Oxford.

The first panel considered questions of openness and transparency in decision making during the Covid-19 pandemic. Panellists discussed the over-reliance on the idea of “following the science” and unpicked the need for greater transparency in the value judgements which were being made. They highlighted examples of government decisions, such as around the distribution of personal protective equipment (PPE), the use of data from previous pandemics and economic crises, and the role of notions that are not backed by evidence, such as ‘public fatigue’. Critically, the panel highlighted differences across the devolved nations in the relative transparency of their value judgements.

Panel 2 – Chaired by Dr Beth Kamunge-Kpodo, with Professor Sir Jonathan Montgomery, University College, London and Co-chair of the UK Moral and Ethical Advisory Group; Professor Michael Parker, Co-Director of the Wellcome Centre for Ethics and Humanities, University of Oxford and Participant in SAGE; Dr Heather Payne, Chair of the COVID-19 Moral and Ethical Guidance for Wales Advisory Group.

The second panel explored how ethical expertise, and discussions of values, and value trade-offs should be handled in public decision-making. Our panellists brought their own experiences of providing ethical advice to the Government. This included insights into social and political context, setting out how they had sought to navigate the political environment in which decisions were being made. One suggestion was that rather than advising on policy decisions, ethicists’ primary contribution could be to raise awareness of ethical tensions, map ‘moral landscapes’, and provide tools to navigate moral judgements.

Panel 3 – Chaired by Professor James Wilson, Professor of Philosophy at UCL and Co-Director of the Health Humanities Centre, with Professor Ilina Singh, Co-Director of the Wellcome Centre for Ethics and Humanities and Principal Investigator of the UK Pandemic Ethics Accelerator at the University of Oxford; Dr Anjana Ahuja, Science Columnist for the Financial Times; Victoria Butler-Cole QC, Barrister in health and social care law; and Dr Julian Sheather, Special Adviser in Ethics and Human Rights for the British Medical Association.

The final panel discussed what mechanisms we might create in future to bring ethics expertise to bear in policy and public decision-making. This session brought to the fore the role of public institutions, such as universities, the media, the law, and professional societies in supporting policy makers to make value judgements and in holding them to account for these. Experts recognised that there would be benefits to greater pooling of expertise and thinking across sectors. Panellists argued that we need to move to a long-term mainstreaming of ethics into policy-making, to ensure we are prepared before public health emergencies arise. Development and application of rigorous methods of public engagement and involvement were seen as critical dimensions of an approach that could amplify voices of different groups and communities before, during and after public health emergencies. 

Participants reflected that it had been productive to review the multiple and distinct role of ethicists and value judgements in the pandemic.

“This event looked both at the sorts of ethical decisions and tensions that have arisen in the context of covid-19, and the ways in which ethics featured in decision-making. The place of value judgements is undeniable. The questions that arise concern the best ways to be rigorous and transparent when making value judgements, how meaningfully to engage with different communities, and how to harness ethical expertise in planning, creating, implementing, and scrutinising policy. Our speakers’ distinct perspectives and experiences have provided an outstanding basis to develop our understanding and future planning and practice in relation to these matters.”

Professor John Coggon