Anscombe Bioethics Centre: the Ethics of Pandemic Lockdown

 The Anscombe Bioethics Centre have commissioned, and published on their website, a series of  COVID-19 briefing papers. One of these papers addresses the ethics of imposed lockdowns to control the spread of the pandemic virus in different places. Written in mid-June 2020, it is able to draw on the experience of lockdowns in different parts of the world. It is able to discuss the part that has been played by lockdowns in relation to other steps aimed at keeping the spread of the pandemic under control, and the necessity of moving to a lockdown if those steps are not able to limit community spread.

The headings of the first three substantive sections of the paper are: "The Science of Pandemics", "The Logic of Pandemic Lockdowns" and "The Efficacy of Pandemic Lockdowns". These sections are clear that the virus responsible for COVID-19 represents a real and serious threat to the health of populations and to the well being of their communities. These sections provide properly academic analysis of the experience of different nations with respect to the implementation - or otherwise - of lockdowns. They are worth reading fully to provide a proper balance to coverage in the news media.

Before identifying the ethical principles that would underpin an evaluation of lockdowns, the fourth section, entitled "The Ethics of Pandemic Lockdowns", begins:

As we discussed above, lockdowns are the most potent weapon that public health officials can deploy to prevent or to limit a viral wildfire. They are used to bring an uncontrolled pandemic into control. From a public health perspective, this would ensure not only the health and well-being of a community but also the integrity and functioning of its healthcare system. However, a lockdown also has profound and often devastating impacts on the community’s economic and financial well-being. In April 2020, because of the Global Lockdown, the International Monetary Fund (IMF) predicted that global growth in this year of pandemic would fall to -3%. This is a downgrade of 6.3 percentage points from January 2020.

 Three ethical principles are then identified. The first is that there should be no differentiation in the duty of care between different members of society. Human dignity, and the regard for that dignity, attaches to each and every person regardless of their particular circumstances of physical health or social standing:

As a community, we have to try to protect them equally well during a pandemic even though we may not be able to protect everyone equally well. 

The second is a call to favour and protect the poor and the vulnerable:

Recalling the story of the Last Judgement (Mt. 25:31-46), we are called to put the needs of the poor and vulnerable first. This is especially important to remember during this pandemic because it is the poor who are bearing the brunt of the loss of health and the loss of wealth caused by COVID-19. 

 The third principle is that of protecting and preserving the common good of our communities:

The Catechism of the Catholic Church describes the common good as ‘the sum total of social conditions which allow people, either as groups or as individuals, to reach their fulfilment more fully and more easily.’ Within the commonweal, the government is given the authority to care for the common good. This is its primary responsibility. 

Pandemic lockdowns only make sense, from an ethical point of view, in their ability to protect and preserve the common good by reducing viral spread and, in particular, viral spread in the community. 

Lockdowns are ethically justifiable precisely because they protect both the individual good, especially the individual good of the poor and the vulnerable, and the common good. They ensure not only the health and well-being of a community but also the integrity and functioning of its healthcare system. 

The responsibility of government for the common good is what allows them to establish regulations with regard to the conduct of their lives during the pandemic that oblige the  population of their country. The citizen in their turn has an obligation to engage, as a subject of their own action, in favour of the common good and therefore in compliance with established regulations. Government is entitled, for example, to make self-isolation mandatory when a person is identified as a "contact" or tests positive for COVID-19. But the common good in its economic dimension also needs to be considered in determining the exact provisions of a lockdown. 

As we move forward, public health authorities should do what they can to avoid another global lockdown. The pandemic experience in several countries and locales including South Korea, Taiwan, and Hong Kong, show us how to do this: By building a robust testing, tracking, and tracing capacity that can identify clusters of infections and break chains of viral transmission before they trigger community spread and exponential growth of the pandemic. 

I would recommend Rev. Austriaco's briefing paper, particularly to those who are tempted by the inclination of some towards virus-sceptic or lockdown-sceptic positions.

Faith in Health Conference 2010: what makes a medical professional?

Though the question of what constitutes medical professionalism was not prominent in the titles of the sessions, it did nevertheless arise in more than one of the plenary lectures. The quality of the contributions on this point was, in my view, disappointing; but I should perhaps qualify that by recognising that those speakers who did touch on the question were not addressing it directly or fully.

Introducing one of the plenary lectures, Baroness Cumberlege referred to the report of a working party that she had chaired for the Royal College of Physicians in 2005, a report entitled Doctors in society: Medical professionalism in a changing world. The report can be downloaded in .pdf format from the website of the Royal College. Baroness Cumberlege cited its definition of medical professionalism, from chapter 5 of the report:

Medical professionalism signifies a set of values, behaviours, and relationships that underpins the trust the public has in doctors.

In itself, this didn't sound very useful (my notes taken at the time used the word "poor") because it does not define the "values, behaviours and relationships"; but it does need to be read with the description that follows immediately in the RCOP report:

Medicine is a vocation in which a doctor’s knowledge, clinical skills, and judgement are put in the service of protecting and restoring human well-being. This purpose is realised through a partnership between patient and doctor, one based on mutual respect, individual responsibility, and appropriate accountability.

In their day-to-day practice, doctors are committed to:

• integrity
• compassion
• altruism
• continuous improvement
• excellence
• working in partnership with members of the wider healthcare team.

These values, which underpin the science and practice of medicine, form the basis for a moral contract between the medical profession and society. Each party has a duty to work to strengthen the system of healthcare on which our collective human dignity depends.

In the same session of the conference, Sr Margaret Atkins talked about how Catholic health practitioners might preserve the sense of purpose which they had on entering the medical profession in a working environment that pressures them to move away from that purpose towards purposes driven by their employers or by government policy. Though not offering it as a definition of what medical professionalism is, Sister identified the healing vocation as having three elements: the making better of people who are sick (cure or healing), the provision of care and comfort, and the preventing of illness or keeping of health. The medical professional has responsibility for the patient in terms of their health, that is, in terms of these three elements.

At the beginning of her talk, Sr Margaret indicated that what she was going to talk about was, firstly, how those present as health care workers could keep their sense of purpose and secondly, and in my view quite significantly, how they might pass on that sense of purpose to others following them into the medical profession. This idea of "passing on" indicates that there is something that is permanent and unchanging in the idea of what it means to be a medical professional, and that that something is determinative of the nature of the profession. The implication of the RCOP working party report is quite the opposite. It suggests that the defining of medical professionalism needs to be responsive instead to the wishes of society around us.

I was a little disappointed that, in the discussion on professionalism in medicine, no reference was made to Luke Gormally's chapter "Medicine as a profession and the meaning of health as its goal" in the Linacre Centre publication Issues for a Catholic Bioethic. In that chapter, Luke Gormally is very critical of the World Health Organisation definition of health in terms of human well-being, the term that is adopted by the RCOP report. He argues instead that it is somatic health - the well-ordered organic functioning of the body - that is the proper goal of medicine as a profession. The purpose of the medical professional is then the restoration and maintenance of health defined in this way. It is this purpose that is the basis of the relationship of trust between the health professional and the patient. The professional is dedicated to the restoration and maintenance of health, and will not act in a way opposed to this, even if asked to do so by a patient; and the patient is deserving of courteous and just conduct from the professional out of respect for his dignity as a human being. The language of partnership and mutual respect in the RCOP description allows for something completely different.

World Day for the Sick: 11th February 2008

The theme for this year's World Day for the Sick is "The Eucharist, Lourdes and Care for the Sick". It therefore links two of the big international Catholic celebrations taking place in 2008 - the 150th anniversary year of the apparitions of the Virgin Mary at Lourdes and the International Eucharistic Congress taking place in Quebec, Canada in June. Pope Benedict XVIs message for the day can be found at the Vatican website. Another worthwhile read is the recent post of Catholic mom of 10 about her own illness.

The Vatican has its own "think tank" on matters relating to the world of healthcare. It is called the Pontifical Council for the Pastoral of Health (or variations upon, depending on how you translate from Italian into English!). The Council organises an annual conference on an issue related to healthcare and also leads on the World Day for the Sick. They publish an academic journal "Dolentium Hominum", which is published in several languages one of which is English. The conference ususally examines an issue very thoroughly, looking at clinical and epidemiological aspects, theological and spiritual aspects, practical and pastoral aspects, and the perspectives of other Christian denominations and religious faiths. The internet presence of the Pontifical Council is not as well organised as it might be. I know that the library of the Linacre Centre in London, UK, have a complete set of "Dolentium Hominum". We might keep the work of the Pontifical Council, and of all those involved in pastoral work with the sick and medical staff, in our prayers on 11th February.