The COVID-19 pandemic has forced us to ask difficult questions about the economy, our health and the value of life itself. Pandemic Ethics, a new book by Dr Ben Bramble from the ANU School of Philosophy shows us how a philosophy can help us to make sense of these questions and find the best answers writes Adam Spence.
2020 has been a uniquely challenging year. First came the fires and the smoke, on a scale and intensity unlike any other in recent history. Then, before we could properly make sense of the summer that had been, the summer unlike any other, a new cloud descended on us. Unlike those clouds of smoke that stained the normally blue skies of the Australian summer, the cloud of unease and uncertainty brought by COVID-19 was notable for what was absent to the eye. The sight of people crowding cafes and bars, children in the playground and workers crowding lobbies in the morning, giving way instead to social distancing, and working and learning from home.
It seemed as if life as normal had paused, replaced by a new reality in which we continue to face uneasy questions about the economy, our health and the value of life itself.
“The pandemic is clearly one of the worst things to have happened to humanity in the last hundred years,” says Dr Ben Bramble, a lecturer in Philosophy at The Australian National University. Dr Bramble is the author of the new book Pandemic Ethics, a thought-provoking work that considers informed answers to some of the significant questions posed by this once in a century pandemic.
As scientists and policy makers work to understand the virus and identify options to control and treat it, Dr Bramble sees a vital role for philosophical thinking in helping to guide decision making.
“Philosophical thinking is needed to help us work out which options we should choose. Policymakers are engaging in philosophy in this sense whenever they make and enact policies,” says Dr Bramble.
Some of these questions are relatively simple, like how we as a community should use masks to control the spread of COVID? At first, the answer wasn’t so simple. Health authorities in Australia as in some other countries dissuaded the use of masks, both to preserve supplies of protective masks for workers most at risk, and owing to the then scarce research about the efficacy of general mask use. Benefiting now though from more research and the experiences of countries where mask use is culturally widespread, there’s a clear lesson says Dr Bramble.
“When the virus is circulating, a culture of wearing cloth and surgical masks, in order to protect, not oneself, but others, is invaluable. It is highly effective in suppressing the virus, and comes at a very small cost. The question is: how do you convince enough people to wear masks in this circumstance?”
The summer’s bushfires demonstrated that when a risk like thick smoke in the air exists, Australians certainly aren’t averse to wearing masks. As Dr Bramble explains though, to encourage mask use in a pandemic requires a different way of thinking, to recognise that we ourselves might be the risk and we have a duty to protect others.
“You’ve really got to drive home the effectiveness of it and the low cost of it, and emphasise the fact that many people who have the virus don’t know it. So, if you don’t wear a mask, then you’re putting others’ lives at risk.”
Some of the questions in this pandemic are harder, like when and for how long to lockdown parts of society to control the spread of the COVID-19. Controlling that spread is vital because left unabated, the disease threatens to overwhelm health systems, cause a significant number of deaths, and inflict ongoing health effects that are only now starting to be recognised.
Governments around Australia and the world are grappling with this issue, balancing the immediate need to protect lives against the economic costs. The choice is made harder by the uncertainty about when a vaccine will become available, and what kind of immunity can be expected in the community both with and without a vaccine. Some advocate opening up, either in the belief that letting the virus spread will create herd immunity, or that the cost of locking down is far greater that the cost the virus would otherwise inflict. For Dr Bramble the potentially great cost COVID would inflict can’t be justified, he concludes that lockdowns of varying degrees are the only sensible course until the virus is controlled.
“To reach herd immunity without a vaccine, even if this were possible, would involve a huge number of deaths, and a great deal of severe illness, among not just older and vulnerable people, but many younger and healthy ones as well. It is simply not worth it given that a vaccine is likely coming within the next year,” says Dr Bramble. “Prematurely relaxing lockdowns does not result in economies surging back. While the virus is still ripping through populations, few people want to go shopping, travelling, and so on. To get back to a thriving economy, we need to deal with the virus.”
Good government policy that supports those affected by lockdowns can greatly reduce the negative effects argues Dr Bramble, while measures such as mask wearing, contact tracing and testing can support the relaxation of measures and bring back normality sooner.
Perhaps the most difficult question this pandemic forces us to consider is how we should value life? Australia has been fortunate, despite the setbacks in Victoria, early prevention measures flattened the curve and avoided health services being overburdened. That hasn’t been the case everywhere. When hospitals reach capacity, when there aren’t enough ventilators and other treatment resources, society faces the seemingly impossible task of choosing who receives those now scarce resources and who doesn’t. In essence, who lives, and who dies. What is the moral way of doing this? How do we avoid placing an implicit pressure on those who are older or more vulnerable or more altruistic to turn down treatment so that others may receive it instead? A point-based system for triage offers a better solution argues Dr Bramble, who in his book explores various potential algorithms.
“I propose a points-based algorithm for allocating ventilators and other life-saving resources during COVID-19, to try to reduce the tragedy that results when hospitals are overburdened. We should give extra priority to the young and healthy, parents of dependant children, essential workers, and the socio-economically disadvantaged,” says Dr Bramble. “The idea is explicitly not that these people are somehow more important or have greater value. It is rather to reduce tragedy in the extraordinarily rare situation where hospital resources run out.”
Dr Bramble cautions against such a system though being used more widely in a healthcare system outside of extraordinary times, stating emphatically that healthcare must be resourced so that everyone has proper access to it. “The health of our citizens is the bedrock of our society.”
From bushfires to pandemics, we respond to disastrous events in different ways. Some of us look for a greater meaning, a purpose to be taken from it that can help us to move forward. Some look for someone or something to blame, leading sometimes to unfortunate consequences exemplified by racism and conspiracy theories. “It is natural, when things go bad, to look for someone to blame. And there certainly are blameworthy parties,” says Dr Bramble.
Who and what is to blame for the COVID-19 pandemic? Is it the wet markets in which conditions allowed the virus to make the jump from animals to humans? Is it the policy makers who failed to prepare for the prospect of a pandemic despite the warnings of scientists? It’s both these things and more according to Dr Bramble. “The worst effects of the pandemic are ‘on us’, which makes it deeply morally troubling,”
Like any disaster it’s rarely one thing responsible, rather it’s a series of events and decisions. For those looking for that greater meaning in all this, that optimism with which to move forward, that too exists. Though this pandemic has made 2020 turbulent, and its effects will be felt for some time to come, it has afforded us an opportunity to look at ourselves and what we value, and to prepare better for future challenges.
“We are incredibly lucky that this virus is not worse than it is,” says Dr Bramble. “As bad as COVID-19 is, it is important to think of it as a wake-up call for even worse possible pandemics, not to mention other catastrophic events, like climate change.”
There are many lessons to take forward from this pandemic according to Dr Bramble, including the need to respect scientific advice, provide all citizens access to healthcare and support that enables them to flourish. And though the challenges of COVID-19 are great, there are similar challenges in the world that have existed far longer like world poverty and exploitation of low-paid workers, the pandemic highlighting further the need to address these issues.
“There is much that we can learn from a catastrophe like this about ourselves—for example, what we care about, our moral character, and so on,” says Dr Bramble. “Philosophers are needed to help to bring out what the pandemic reveals to us about ourselves.”
Pandemic Ethics is available now as an open access book online. You can reach Dr Bramble via his website and Twitter.