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Through the Shadows of the Pandemic: COVID-19, citizens and moral dilemmas

In these months of pandemic and lockdowns, governments and health authorities have imposed a series of unprecedented measures impacting citizens’ personal freedom and lifestyle. These measures often tend to be presented as decisions made just ‘on the basis of science’. Yet, with a virus that exists everywhere, countries that all claim to base their policies on the latest and best scientific evidence, have in fact adopted quite different measures. For example, while China and Italy went for a (near) total lockdown early on, the UK, the US, Brazil and The Netherlands waited several weeks before enforcing restrictive measures, or chose significantly milder containment strategies. As early as the 2nd of April, David Runciman, among others, reminded that ‘there is no such thing as doing what the science says’ and showed that governmental reactions to the pandemic appear to be significantly influenced by the political and ethical views of their cabinet members.

People question why theatres are closed, while churches remain open.

Debates have sparked in different countries on anti-COVID measures unevenly impacting different business sectors or categories of citizens. In this context, some have pointed out how such measures seem influenced by debatable (implicit) value choices and question why, in some countries, theatres are closed while churches remain open, or why people are forbidden to go to a restaurant but not to the gym, or they criticise governments for not putting in place more effective safeguards for children or women vulnerable to domestic abuse during total or partial lockdowns.

This value dimension emerges in all its drama when infection numbers reach the peak and, as it has happened in a number of countries, hospitals and ICU departments get overburdened. In such cases, the number of patients exceeds the available beds or ventilators and tough choices have to be made on who can be cured and who has to be left at the mercy of fate. National professional boards and ethical committees have elaborate triage protocols and criteria of choice which have been at the centre of much controversy, being accused of being discriminatory against certain categories such as the elderly or people with disabilities. For example, COVID-19 protocols by the Dutch Society of Intensive Care (NCIV) allow, in case of necessity, to exclude from care older individuals and persons completely dependent on others for personal care. The Italian College of Anaesthesia, Analgesia, Resuscitation and Intensive Care has advocated for the introduction of an age limit for patients’ access to ICUs.

Almost a year after the first appearance of COVID-19 these issues still tend not to be openly discussed in public.

Studying values and citizens’ opinions

What is striking in this situation is that both in relation to containment strategies and triage protocols, choices are made which have a huge impact on the fundamental rights of large parts of the population, largely without having organized consultations of stakeholders to find out what they think about them. This might be understandable when thinking of the first months of the pandemic, when decisions had to be made quickly and under a lot of uncertainty. However, almost a year after the first appearance of COVID-19 on the world stage these issues still tend not to be openly discussed in public. This has left governments and even unelected professional bodies to make choices with very little democratic scrutiny, in which the lives of entire demographic groups were jeopardized. This is problematic independently from the judgement on the content of the specific rules and guidelines. It has rather to do with the non-democratic character of the decision-making process leading to those choices, which rely on a too narrow evidence base and do not take adequately into account the complexity of the fundamental value conflicts at issue. Therefore, there is now the urgency to finally engage in these questions all the different categories of people forming the public opinion, collecting data which can form the basis of a serious debate on how the ethical implications of COVID-19 related measures are experienced and on what does this tell us about where we are going as a society.

For this reason, researchers at the Athena Institute have started a new research network on ethical issues in the COVID-19 crisis, grouping together academic partners from various countries within and outside Europe. Within this research network, multiple studies are either being done now, or in preparation:

COVID-19 Triage protocols around the world

A first study consists of a desk-based comparative research, analysing the different triage protocols and guidelines developed in national jurisdictions throughout the world. The study will allow to map the differences between the norms and criteria established in all countries which have adopted formal triage guidelines in relation to the COVID-19 crisis, and to point out the socio-legal and cultural factors influencing such choices. This project is financially supported by of the Amsterdam Centre for Law and Behaviour.

Citizens perceptions of Ethical Issues in COVID-19 in Kenya, The Netherlands, Indonesia and Italy

Another project focuses on citizens’ perceptions on moral issues in the COVID-19 crisis in Kenya. The study employs a mixed-methods approach, consisting of a document analysis of policy papers, protocols and news reports, scoping exploratory interviews to understand the main moral issues related to the COVID-19 crisis emerging in the country, and a survey focusing on the spectrum of opinions on this topic emerging in Kenya and how these opinions are split among the population. This project is funded by Amsterdam Public Health.

A similar project, but with a focus on The Netherlands and Indonesia, is also being performed, thanks to a grant by the World Health Organisation. In addition, a further analogous study consisting of document analysis, interviews and a survey has just started in Italy, funded by various local authorities.

All these studies have been preceded by a smaller pilot study comparing citizens’ perceptions of COVID-19-related moral issues in the Netherlands and in the US. We will report updates on the development of these projects and the insights emerging from the data collection in future posts on this blog, so stay tuned!

Written by Dr. Kevin De Sabbata

Research in collaboration with dr. Kevin De Sabbata, dr. Pim Klaassen, Nyambura Karumba, Alex Fehr, Rachel Brenner, Galoeh Noviar, Lizet Brenkman and Asiyah Tsabita (Athena Institute, VU), prof. Kees Blankman and prof. Masha Antokolskaja (VU Amsterdam School of Law), dr. Welcome Wami (Amsterdam Institute for Global Health and Development), prof. Dick Willems (Amsterdam Universitair Medisch Centrum – AMC), dr. Fajar Perdhana, dr. Lucky Andrianto, dr. Regitta Agusni and Annisa Ika Putri (Soetomo General Hospital and Airlangga University, Surabaya, Indonesia), dr. Maurizio Balistreri and mr. Steve Umbrello (University of Turin) and the African Population and Health Research Centre in Nairobi.

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