For the last six months, in every country, on every continent, politicians, policymakers and scientists have been convulsed by trying to locate and then do the ‘right thing’ in the face of COVID-19 – and very often, apparently, they have been failing.
For the first time, in a very long time, philosophical considerations have become the stuff of political debate and everyday conversation. Is it right to deprive people of their liberty or not; to dictate personal behaviour or not; to close borders or not; to protect life or the health service or the economy, or not?
The world seems stymied by ethical considerations: is there a right thing and, if so, what is it? These are not everyday questions, for most people and many politicians in particular stand accused of having done the wrong thing, taken the wrong decisions. But the Oxford Professor of Medical Ethics, (Dr) Dominic Wilkinson, is someone for whom these are everyday questions and he does not rush to judgement. He says, ‘Philosophy can help inform what we ought to do, given what we know.’
The trouble is, Professor Wilkinson says, the ‘facts’ appear to have changed in terms of our understanding of COVID-19 as time has progressed. What we know now, compared with what we knew even three months ago, is vastly different. And, says Professor Wilkinson, ‘You couldn’t make decisions based on what you didn’t know. You can only make decisions [and be judged] on what it was reasonable to do at a particular point in time....You can look back in two, five or ten years and see how things turned out. But even if a decision turns out badly – that doesn’t make it the wrong decision to have made at the time.’
‘Consequentialism’, as it is known in philosophy, commends considering what will follow (the consequences) when you make a decision. You consider what will (or may) happen if you take certain actions. And because of the imperfections of our understanding, Professor Wilkinson says, ‘Sometimes you have to make a decision in good faith.’
Clearly, from the multiplicity of approaches around the world to the pandemic, different governments and policymakers have come to different conclusions – both about the ‘right thing’ to do and the right thing to consider when making those decisions. Most, if not all, will have sought to preserve life. But whose life? A COVID-sufferer’s, a cancer patient’s, a person who loses their job? And mixed in with the question have been other considerations: should we prioritise saving the NHS and flattening the curve over individual liberty – and would this, anyway, achieve the over-arching aim of preserving life?
One canard which has dropped into the debate has been the notion that politicians are merely ‘following the science’. Although beloved by policymakers, Professor Wilkinson insists that science cannot make policy decisions, ‘In some limited instances, it may be ethically obvious what conclusion should follow from ‘following the science’. But with a novel virus, this is not the case....’
He adds, ‘Decisions involve values....There may be an obvious ethical answer to a straightforward question. But when you’re making an ethical and political decision, all sorts of different values are at stake – how to protect the well-being of people with COVID or of the unemployed or someone with cancer.
‘Science cannot tell us what values we should put weight on. These are ethical decisions – not scientific ones...What is more, science is messy and complicated and very often says different things and science will evolve over time.’
So how do we make sense of countries’ attempts to tackle the pandemic? Is anyone doing the right thing? According to Professor Wilkinson, ‘There isn’t a single right answer, it depends how you weigh up your choices. You need to distinguish between a number of things.’
Does this mean, then, that all decisions are equally valid – another philosophical standpoint: ‘relativism’? No, says Professor Wilkinson, ‘Context matters, what might be the right thing in the UK or the US may not be the right thing somewhere else. But that doesn’t mean it is just a matter of opinion. Philosophers, justifiably reject the idea of ethical relativism. It might be difficult to work out the reasonable, right approach but there are definitely wrong choices.’
For example, Professor Wilkinson, who is also a qualified doctor, says that ‘recommending non-evidenced based’ interventions such as chloroquine, or bleach could be seen as ‘morally wrong’ choices. But he says, ‘We will all make mistakes. There are some things, however, which are not just a matter of someone’s opinion.’
At some point in the future, when the pandemic and the policy decisions are reviewed and blame is apportioned, it may be possible to look back and say that some decisions were made in good faith, given the knowledge at the time, even though they cost lives – meanwhile, others will look wrong.
Consistency, says Professor Wilkinson, is key to ethical decision-making. Where governments and politicians have failed to show consistency, it becomes difficult to justify decisions. But does that mean, henceforth, that the entire purpose of society should be given to preserving life – our national income should be entirely directed towards curing cancer?
‘No,’ says Professor Wilkinson. ‘We knew COVID was different from influenza [and needed to be approached differently]. But this is a novel epidemic rather than an endemic condition (such as malaria or TB) and so it is justified to treat it in a different way to the way we treat other healthcare threats.’
Key to the treatment of COVID-19, he says, was the fact that many people were going to be unwell at the same time, whereas cancer is a long-standing threat that is not going to go away. But, with fears of a second wave coming, Professor Wilkinson says, policymakers will soon have a different set of decisions, since it ‘may not be possible’ politically to take the same actions again in the face of a renewed virus. With concerns mounting about the impact on the economy and the reluctance of many younger people to be contained, the priority, he says, must be to ‘save lives’. But the mere number of lives saved is not the only thing that matters. ‘You need to consider the length of life and how the lives of the population are diminished [by intervention measures].’
These are hard questions for anyone, politicians included. It is not just a question of ‘following the science’, ‘this is about making an ethical decision about what might happen. And ethical decisions can be wrong’. There has been little time or opportunity for reflection, but says Professor Wilkinson, ‘Politicians have to balance a range of priorities, think seriously about how to act.’
Whether modern politicians are equipped for such considerations, is not something on which a good philosopher will venture an opinion. But trust is essential, Professor Wilkinson says, ‘Issues of credibility arise when there is inconsistency. We demand of our politicians a high standard.’
Since the beginning of the crisis there have been frequent comparisons with wartime embattlement. From a philosophical point of view, it raises similar questions, ‘You have to balance costs and face ethical questions in much the same way...There are lots of parallels with the profound and difficult questions that countries face when they are at war.’
When all this is over, will there be the new world, the new normal of which so much is heard? As a doctor, Professor Wilkinson, believes there could be, ‘Many people who have faced serious illness reflect on their priorities...it helps to put their life into perspective.’
But, he says, ‘The trickiest time is still ahead. We could be facing something worse than the first wave and we will need to take decisions on things such as who gets the vaccine first...there are many more ethical decisions than just the lockdown. We don’t know yet what people will tolerate – what they will do.’
The blame game has a long way to run – particular for those whose decisions do not stand up to scrutiny.