What does Covid-19 reveal about ethical decision-making on a macro and micro level?

Introduction

The global coronavirus pandemic has resulted in an unprecedented crisis affecting every aspect of society. The economy, industry, education, leisure and most of all health, have all encountered considerable and in some cases overwhelming impacts as a result of the pandemic. A crisis is defined as a time of intense difficulty or danger (Oxford English Dictionary) that interrupts the normal routine. At a time of global crisis can we expect normal ethical reasoning to apply? Should individuals be expected to make different ethical decisions in times of crisis? What ethical philosophies should governments use to underpin the decisions they make? Should decisions with long-term uncertain outcomes be prioritised over short-term decisions with more certain outcomes? 

The challenge of ethics in a global crisis is that macro and micro ethics interact with each other as, for example, in how decisions made by individuals about how they conduct themselves affect decisions made by governments in how they direct limited resources, and all in a changing and uncertain situation with imperfect information and limited applicable experience.

A different kind of crisis

Although pandemics have occurred before (Jarus, 2020), and an outbreak of the nature of coronavirus had been predicted (University of Cambridge, 2018), the world was not ready for a pandemic powered by the transmission mechanisms of globalization (Saker et al, 2004), including international air travel and just-in-time manufacturing and logistics.

In making ethical decisions about health, western society has spent the preceding decades being trained in linear cause-and-effect thinking. ‘If you smoke, you’ll get lung cancer”, and “If you don’t immunise your child, they’ll get measles”, have been the messages that our nations have been communicating and our peoples have been consuming.

But pandemics play by different rules. No longer is the cause-and-effect thinking of individuals making decisions that affect solely themselves applicable. A different kind of thinking is required, one that utilises an understanding of exponential growth (Dalton, 2020. Baldwin, 2020. Diamandis, 2020) and applies very different ethical reasoning.

The micro ethics of individuals during crisis

Micro ethics are those that apply at the level of individuals. People making decisions about what they consider to be right and wrong behaviour for themselves rather than explicit rational argument (Komesaroff, 1995). Micro ethics are context-specific and involves decisions often made as a result of historic aversions and habitual behaviour rather than any ethical considerations.

In times of crisis an individual’s ability to make clearly ethical choices, especially based on historic ethical choices and behaviours, becomes severely impacted. Choosing right from wrong is not an easy task.

Social distancing

Social distancing practices have a very clear objective; reduce the R nought of coronavirus. R nought, the measure of the maximum epidemic potential and effective reproduction rate depending on a population’s susceptibility (Eisenberg, 2020), explains how many people are likely to be infected by each person carrying coronavirus. It is this transmissibility that makes an understanding of exponential growth so important. When an individual chooses to adhere to the social distancing guidance they may do so for a number of reasons; social pressures to conform, self-protection from infection, and a social conscience of not spreading coronavirus further, but equally they can choose not to adhere. They are making a free choice.

The Rights Approach offers a view on an individual’s free choice in decision-making. Kant’s ideas centred around the individual’s right to choose, affording them a fundamental moral right to have their choices respected. The choices a person makes can only be judged by the degree to which they violate the right of other individuals. Action’s from an individual that take away the rights of other individuals can therefore be thought of as unethical actions. “People are not objects to be manipulated; it is a violation of human dignity to use people in ways they do not freely choose.” (Velasquez et al. 2015). 

Is it right then, for the government to ‘use’ people as a mechanism to reduce the spread of coronavirus, especially when other mechanisms exist, for example increasing the funding and capacity of the health service to deal with those who become ill? And is it right for an individual to act in ways that may decrease the choices others have by not choosing to socially distance themselves, when they are given the right to choose? Can a person who chooses not to socially distance themselves be considered to be making an unethical choice if they are exercising their right to choose and don’t affect others right to choose?

Misinformation

Misinformation about coronavirus has spread more quickly and more widely than the virus itself. “Over the last couple of months, posts from the World Health Organization (WHO) and the US Center of Disease Control (CDC) have cumulatively only achieved several hundred thousand engagements, considerably eclipsed by hoax and conspiracy theory sites, which have amassed over 52 million.” (Mian & Khan, 2020). State-sponsored misinformation campaigns, cyber-espionage and hacking attacks targeting the World Health Organisation and US National Institutes of Health with the “twofold aim of undermining the EU and its crisis response, and to sow confusion about the origins and health implications of Covid-19/coronavirus” continue to take place (Beaumont, Borger & Boffey, 2020). A real-time analysis of tweets identified as unreliable, misleading or meant as clickbait showed 54% were biased or politically motivated and 34% were from an unreliable source (USC Melody Lab). Against such a backdrop, what micro ethical decisions could we reliably expect of anyone? Would sharing misinformation unknowingly but with positive intentions be considered ethical?

Kant’s non-consequentialist “categorical imperative” suggests that an action could be taken as ethical if it could be considered to be choosing to obey a universal moral law (Velasquez et al. 2015), such as in the case of sharing information that you believe to be helpful. Kant’s argument that behaving with ‘right’ intentions is morally correct regardless of the consequences of our actions. I wonder if Kant would have thought the same had he witnessed 21st century social media and the crisis of misinformation that spread inaccurate and harmful information about which actions to take and not take during the pandemic? Many people will have, and will continue, to spread misinformation with generally good intentions of passing on helpful advice, and unwittingly pass on misleading, untrue and potentially harmful information. Would Kant argue that they have acted ethically, or that they had not reduced the question of whether to pass on information that they could not verify to a universal law? 

The complex, internet-connected world full of bad actors with nefarious intentions, along with the fallout of a postmodern state of no single source of truth, places an insurmountable burden on any individual to be able to accept the duty of behaving as Kant’s ‘rational creature’.

The macro ethics of nations in crisis

Macroethics tends to emphasise principles, seeking a more universal application of ethical choices that can be exercised on a large scale, for example across an entire society. 

A nation’s leaders have to apply different ethics to individuals in a time of crisis. The ethics that are effective for decision making at a micro level are not appropriate guides for decisions that take place at a national level and affect large populations, the national economy and infrastructures ability to cope and recover from crisis.

Herd immunity

Between the 10th and 13th March more than a quarter of a million people attended the Cheltenham Festival (Ostlere, 2020). Despite the 4th March seeing the biggest one-day increase in cases of Covid-19 in the UK to date, and the WHO declaring a pandemic on the 11th (Holmes, 2020), the advice from Public Health England at time was that large gatherings need not be avoided. One month later the Gloucestershire Hospitals NHS Foundation Trust reported 107 deaths (Lane, 2020), more than double the next highest count from NHS Trusts. 

At the time, the UK government claimed to believe that herd immunity offered the best chance of helping the greatest number of people survive the coronavirus outbreak in the long run. “The strategy of the British government in minimising the impact of Covid-19 is to allow the virus to pass through the entire population so that we acquire herd immunity, but at a much delayed speed so that those who suffer the most acute symptoms are able to receive the medical support they need, and such that the health service is not overwhelmed and crushed by the sheer number of cases it has to treat at any one time.” (Preston, 2020). Approximately five days later the UK government revised its strategy, abandoning the idea of herd immunity (Matthews, 2020).

Utilitarianism was conceived in the 19th century to help legislators determine which laws were morally best (Velasquez et al. 2015) and could easily have informed the UK government’s thinking on how to deal with the coronovirus outbreak. Based on the idea that ethical actions are those that provide the greatest balance of good over evil, the method of thinking asks which courses of action are available, who will be affected by each action and what benefits or harms will be derived from each. From answering these the ethical action is considered to be the one that provides the greatest good for the greatest number. 

The greater good argument comes with an inherent question about the inequalities of sacrifice; which groups in society will be expected to lay down their lives for the greater good? The answer, most often, is the weak, under-represented, poor, minorities. If we think that the role of a society is for the strong to protect the weak (Schneider, 2005), then the greater good argument is revealed as a mechanism of privilege rather than a means making an ethical choice that “provides the greatest good for the greatest number” (Velasquez et al. 2015). 

Building on the ideas of utilitarianism, the ethicist John Rawls defined the common good as “certain general conditions that are…equally to everyone’s advantage.”, a definition that herd immunity could not be said to meet as not everyone survives. From this point of view it’s difficult to see how the UK government could be said to have made a marco-ethical choice in its herd immunity strategy or in applying utilitarianist thinking to the situation.

NHS volunteering

“The NHS is “rallying the troops” for the war on coronavirus, with volunteers being called up to help vulnerable people stay safe and well at home. The nation is looking for up to 250,000 volunteers to help up to 1.5 million people who have been asked to shield themselves from coronavirus because of underlying health conditions.” (NHS website). 

The volunteer scheme has taken longer than hoped to become fully operational and assign tasks to the 750,000 volunteers but demonstrates the “extraordinary willingness” (Marsh & Sabbagh 2020) of the British people to help in a time of crisis. But why? Why would so many ordinary people (three times what was asked for) answer the call to potentially put themselves at risk? Perhaps those that responded were applying the virtue approach.

“The virtue approach to ethics assumes that there are certain ideals toward which we should strive. These ideals provide for the full development of our humanity, and are discovered through thoughtful reflection on what kind of people we have the potential to become.” (Velasquez et al. 2015). Volunteering is an inherently altruistic activity, embodying ideals of compassion, sacrifice, and generosity on the part of the individual but utilised at scale and affected by macro ethical considerations as volunteers perform acts of good across the nation in support of a society-wide goal of helping the 2.5 million people considered at risk (BBC, 2020).

Applying the virtue approach further to macro ethics and the volunteer action in support of the NHS at a time of crisis, the virtues of volunteering become the characteristics of society, making us more predisposed to act in ways consistent with our moral principles and enable us to pursue higher ideals. 

Conclusion

Crisis causes us to question our ethics. What seems like easy decisions in more stable times become more difficult in times of uncertainty and disruption to the normal routine of life.

COVID-19 has revealed a need to be able to quickly adjust our ethical thinking, change our moral standpoints, and adopt a new approach to what can be considered right and wrong for individuals, groups, nations and the entire world. Just as very many other parts of society have had no choice but to adjust to meet this new challenge, ethical decision-making on a macro and micro level must be changed too.

References

Jones, Thomas M. (1991). Ethical Decision Making by Individuals in Organizations: An Issue-Contingent Model. The Academy of Management Review. Vol. 16, No. 2 (Apr., 1991), pp. 366-395 (30 pages)

Jarus, O. 2020. 20 of the worst epidemics and pandemics in history. livescience.com.

University of Cambridge. (2018). Citizen science experiment predicts massive toll of flu pandemic on the UK. University of Cambridge website. 

Dalton, C. (2020). I’m an ER doctor. Please take coronavirus seriously. theguardian.com.

Baldwin, R. (2020). Coronavirus: An economist’s view of the epidemiological curve. World Economic Forum.

Diamandis, P. (2020). Exponential implications: Coronavirus. Diamandis.com

Saker, L., Lee, K. Cannito, B., Gilmore, A. & Campbell-Lendrum, D. (2004). Globalisation and infectious diseases: A review of the linkages. UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases. World Health Organization.

Komesaroff, P. A. (1995). Troubled Bodies : Critical Perspectives On Postmodernism, Medical Ethics, and the Body. Durham (N.C.): Duke university press.

Basu, A. (2020). The ‘herd immunity’ route to fighting coronavirus is unethical and potentially dangerous. Theconversation.com

Eisenberg, J. (2020). How Scientists Quantify the Intensity of an Outbreak Like COVID-19. University of Michigan.

Velasquez, M., Andre, C., Shanks, T.S.J., & Meyer, M.J. (2015). Thinking Ethically. Markkula Center for Applied Ethics.

Mian, A., Khan, S. (2020). Coronavirus: the spread of misinformation. BMC Med 18, 89.

Beaumont, P., Borger, J. & Boffey, D. (2020). Malicious forces creating ‘perfect storm’ of coronavirus disinformation. theguardian.com

Ostlere, L. (2020). Coronavirus: Cheltenham defends decision to go ahead with Festival. Independent.co.uk

Holmes, F. (2020). COVID-19 Timeline. British Foreign Policy Group.

Lane, E. (2020). Coronavirus deaths in Gloucestershire reach 107 as nine more people die. Gloucestershirelive.co.uk

Peston, R. (2020). British government wants UK to acquire coronavirus ‘herd immunity’. itv.com

Matthews, O. Britain Drops Its Go-It-Alone Approach to Coronavirus. Foreignpolicy.com

Schneider, W. (2005). The Strong and the Weak. theatlantic.com

‘Your NHS Needs You’ – NHS call for volunteer army. (2020).

Marsh, S. & Sabbagh, D. (2020). NHS says coronavirus volunteer scheme taking time to get up to speed. theguardian.com

Coronavirus: NHS volunteers to start receiving tasks. (2020). bbc.co.uk