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Bioethics for the Pandemic

Our existing ethical frameworks for health-care decisions were not devised for a pandemic – and it shows. The principles that have been enshrined, while important, do not address the difficult question of what to do when medical resources are suddenly in short supply, as they are now.

BUDAPEST – Since the SARS-CoV-2 virus spread from China to most of the world in February and March, we have all gradually become participants in textbook ethical dilemmas. Above all, the COVID-19 pandemic has presented overloaded health systems with the huge question of how to continue caring for patients in a secure, fair, and effective way. And, worryingly, the crisis has highlighted not only the unpreparedness of politicians and health-care systems, but also our failure to develop relevant ethical norms.

As the pandemic spread, many governments hastily implemented medical and social-distancing protocols that mirrored the Chinese authorities’ draconian response. Until early this year, richer countries had been discussing access to new health-care tools such as robotics and artificial intelligence, or how the state might finance artificial reproductive technologies. But in the blink of an eye, their health systems surprisingly and unhesitatingly accepted utilitarian ethics – not only by performing drastic triage in intensive-care units (ICUs), but also by refusing to offer a range of other much-needed medical services.

Ethics textbooks contain numerous philosophical dilemmas that call into question the morality of always applying a utilitarian calculus to human lives. One of the most widely known was devised by the British philosopher Philippa Foot, and involves a runaway trolley rushing toward five people tied to a train track. By pulling a switch, you can divert the trolley to another track and save those five lives, but the trolley will then kill one person on that track. What should you do?