With the worst of the pandemic behind us, even as our country starts to return to normal life, challenging ethical questions remain. How should we evaluate the decisions that were made in the first waves of the covid-19 pandemic? What decisions should we make now? And how should we respond to future pandemic threats?
For example, can there ever be an ethically acceptable level of deaths from an infectious threat, and how could such a thing be determined? Do we need to learn to live with covid-19? Do we need to change our ways of living to minimise future infections? These are challenging and controversial questions that cannot be avoided.
World-leading researchers from the UK Pandemic Ethics Accelerator collaborative – which has received £1.4M funding from the Arts and Humanities Research Council (AHRC) as part of the UK Research and Innovation rapid response to covid – have started to consider these difficult questions from five different perspectives in a series of new thought-provoking pieces.
The pandemic has seen not only the tragic deaths caused directly by the virus – 130,000 in the UK and the 3 million worldwide – but also the illness caused by long-covid.
There have been indirect impacts on health too, due to postponed treatments, and to people avoiding health and care systems, leading to delayed diagnosis and treatment. There have also been mental health impacts, resulting from anxiety, loneliness and isolation. We are going to be living with the wider impacts of covid for a long time and we need to consider what priorities and values should guide us through this next phase and into the future.
The Ethics Accelerator’s Principal Investigator, Ilina Singh, Professor of Neuroscience & Society in the Department of Psychiatry and Co-Director of the Wellcome Centre for Ethics & Humanities at the University of Oxford said: “We are going to have to learn how to live with covid-19. The work of the Ethics Accelerator facilitates grappling with the hard decisions through clear-sighted analysis of what is gained and lost in decisions and choices made individually and collectively.
“As a society, we all will still need to make trade-offs to suppress the virus in the long term. Those decisions will affect us all. For example, the measures to reduce deaths and protect health services have created risks and impacts elsewhere, including increased waiting list times and people becoming reluctant to seek medical help, as well as impacts on mental health, child development and education.
“In terms of mortality, the pandemic is now forcing us to consider what sorts of deaths, and whose deaths should we be most concerned about, as well as the values that underpin such judgments. Untimely or unexpected deaths are something to be avoided – but at what cost?
“In considering many of these issues, the approach by government has often been top-down. At the heart of future policies informing the covid-19 recovery must lie serious and genuine attempts to engage a range of perspectives, including the wider public in identifying what is important to them. Understanding how publics judge and respond to risks, and the diverse values that influence these judgments, is crucial in shaping effective and ethical pandemic policy.”
Notes to Editors
The five thought pieces published today are:
Living and dying with covid: The tough choices ahead
Dr Jonathan Pugh, Professor Dominic Wilkinson, Professor Julian Savulescu, University of Oxford.
- The UK is currently aiming to suppress the virus to acceptable levels, rather than to eliminate it completely.
- The suppression strategy means that we must make a societal decision about the harms we are and are not willing to accept to suppress the virus.
- This decision means that we will have to make trade-offs between three key values: reducing covid mortality, liberty, and equality. This is a trilemma.
- To make a decision about what is acceptable in suppressing the virus, we cannot simply appeal to comparisons between covid-19 and harms caused by other infectious diseases – we have to confront the fundamental conflict between values in the covid trilemma.
Living and dying with covid: Not all deaths are equal
Dr Sarah Chan, University of Edinburgh.
- The covid-19 pandemic has been tracked largely in terms of numbers of deaths, but death is not the only harm we should take into account: other negative consequences such as non-covid health impacts and social costs need to be considered.
- We also need to explore the ethical values that underlie judgments about these harms, both of different sorts of deaths, and of the other consequences of the pandemic.
- Effective pandemic policy-making requires us to understand the values of diverse publics that influence how people judge and respond to risks.
Living and dying with covid: Ethical complexity and health/health trade-offs
Professor John Coggon, University of Bristol.
- The prominence of health protection rationales to justify regulatory and policy measures during the covid-19 pandemic has logically drawn attention to health harms, including collateral harms, that have also been created;
- ‘Health/health trade-offs’ present complex ethical challenges that apply across sectors, and which cannot be well resolved through a single measure or standard of evaluation;
- Public debate is needed to evaluate health impacts across government policy, with attention to the sources, natures, and distribution of health costs across society.
Living and dying with covid: An ethics of counting for living with covid-19 deaths
Dr Cian O’Donovan, Professor Melanie Smallman and Professor James Wilson, University College London.
- Counts of covid-19 deaths will continue to influence government responses for some time to come
- Infrastructures for counting deaths must be adapted to fit evolving circumstances
- As we adapt to living with covid-19 data that report how people die and in what numbers should be augmented by information on how they lived and what they valued
- A critical question for decision makers and society is: what does a sustainable approach to the collection and use of data on covid deaths for public health purposes look like?
Living and dying with covid: Resolving the hard questions of living with covid-19 – the need for public deliberation
Jamie Webb, University of Edinburgh and Hugh Whittall, Nuffield Council on Bioethics
- UK public engagement during the pandemic so far has focused on measurement: of the public’s beliefs, intentions and opinions.
- Navigating our covid future will require making difficult, value-laden policy choices that affect us all. The public should be involved in these decisions.
- Future UK public engagement needs to place deliberative democracy – engaging ordinary citizens in making policy recommendations – at the heart of the Covid recovery.
About the UK Pandemic Ethics Accelerator
The Accelerator’s Principal Investigator is Professor Ilina Singh from the University of Oxford. Its Co-Investigators are:
- University of Bristol: Professor John Coggon
- University of Edinburgh: Dr Sarah Chan and Professor Sarah Cunningham-Burley
- University of Oxford: Professors Dominic Wilkinson and Julian Savulescu
- University College London: Dr Melanie Smallman and Professor James Wilson
- Nuffield Council on Bioethics: Hugh Whittall
The Accelerator is initially addressing five key themes:
- Data use: ethical challenges arising from large-scale data collection, access, and use, such as those arising from the NHS tracking app and vaccine certification.
- Foresight: ethical challenges arising from the current pandemic such as vaccine passports, and preparedness for future pandemic crises.
- Prioritisation: the values informing access to resources, such as vaccine distribution and treatment triaging policies, the deployment of mass testing, and the use of public health interventions such as quarantine.
- Public health and health inequalities: identifying values and ethical challenges to inform equitable policy and practice, given that the direct and indirect impacts of covid-19 have both underscored and exacerbated structural health inequalities.
- Public values, transparency and governance: ensuring public attitudes and engagements inform policy-making when individuals’ and societies’ core interests and values, including health, well-being, equity, social justice and liberty, are at stake.
The Accelerator’s work is supported by the Arts and Humanities Research Council (AHRC) as part of the UK Research and Innovation rapid response to Covid-19, grant number AH/V013947/1.
Other Accelerator outputs
- Accelerator collaborative partners have produced a number of Rapid Ethics Reviews including:
- Government Healthy Weight Strategies: Ethical Considerations. Professor John Coggon, University of Bristol.
- Ethical Considerations in Unfairness and Mitigating Social Disparities in Covid-19 Vaccine Distribution and Uptake in the UK. Dr Alex McKeown, University of Oxford.
- They have also delivered a variety of papers on key issues, such as vaccine prioritisation and passporting; have engaged with the Government’s review of immunity certification; and have given a number of media interviews. Their work will also help develop a platform for ensuring that ethical considerations are built into UK preparedness for its response to future pandemics.
- More information is on the Accelerator’s website. New content will be added regularly: www.ukpandemicethics.org
- Twitter: https://twitter.com/pandemicethics_ (please note underscore)
Head of Communications and Public Affairs, UK Pandemic Ethics Accelerator
Mobile: 07710 307059