Ethics and COVID-19: What’s Old and What’s New

It is scarcely imaginable that a pandemic is actually upon us, killing hundreds of thousands and potentially many more. Those of us who are not in the healthcare field seem to have been led to believe that, given the current advance in medical technology and knowledge in public health, especially as we have defeated the two previous potentially destructive epidemics, SARS and the MERS, this one should be the same, a local epidemic that can be contained in a short time, endangering thousands only.

However, as we all know by now, things are not the same this time. Instead of a local epidemic whose spread is confined to a certain geographical area, the new disease, dubbed COVID-19 by the World Health Organization, is now officially a pandemic, and all countries in the world now contain at least some who are infected. As of this writing, as many as 3 million people have been infected, and more than 200,000 are now dead. This is a staggering number. In comparison, the 2004 tsunami, which took place on December 26, 2004 in the Indian Ocean, took around 230,000 lives. But that was a one shot event. What is very serious is that the COVID-19 pandemic seemed to have only started. Since it is an entirely new disease caused by a previously unknown virus, now called SARS-CoV-2, there is no vaccine, and there is no cure. There is thus a distinct possibility that the number of deaths will rise higher. After all, it has only been a little more than four months since the first case was reported. Four months is a very short time, and within this short span of time, the disease has caused untold damages not only to human health but also to the world’s economy. Many fear that after the pandemic has subsided, a much more serious economic problem awaits. Many remember that economic hardships almost always precede political upheavals and wholesale structural changes in human society. Right now we can only speculate and wait to see what kind of changes the pandemic will bring about.

Now the world is paying its full attention and is marshaling vast amount of resources to fight the virus and to stop its spread. Since it’s a new virus and since the spread has been deeply global, there are a number of new elements that we should learn in order not to repeat the same mistakes again in the future. Nonetheless, there are also some elements which are old — some are as old as human nature itself.

Let us focus on the old first. What is now happening across the globe is that various countries are developing ways to fight the virus in their own way. I don’t think this is surprising, given that countries reflect the mindset and the culture of the people. At first China tried to suppress the information about the new virus; this is totally explainable in terms of the Communist state’s near paranoid about secrecy and control of information. When the new virus was first recognized — when it became known to medical professionals that this was not the same virus that they had encountered, the duty was to give out warnings as soon as possible. But the Chinese authorities at first silenced some of the first people who gave out the warnings. Dr. Li Wenliang was among the first who recognized the new virus and tried to warn his colleagues, but he was accused of spreading “false rumors” by the authorities. This is a very old way of handling things. No matter the content, appearance rules. Furthermore, this is not only unique to China. Other countries in Asia, especially those that are more traditional, share the same secretive culture and “face-saving” culture too. Thailand is one clear example. We will certainly have more to say about Thailand and its responses to the pandemic later on. What is rather sad about the Chinese attempt to cover up the early spread of the virus is that the world could have acted on it earlier than it did, leading to early containment and isolation regulations. The death toll could have been now much lower.

And what about the new? Apart from the fact that the virus and its disease are new to science, the pandemic situation has shown that there are many things that have not been experienced before. First of all, the global scope of the pandemic is unprecedented in the past century. The last time there was a pandemic of this scale was in 1918, when the Spanish influenza spread all over the world, causing as many as 50 million dead. In any case, however, what is truly new in the case of this epidemic is the sheer scale of economic disruptions that it has caused. This situation is closely connected with the global situation of the early twenty-first century, where globalization is very tight. What is happening and is clearly visible is that, when people are ordered to stay home, a very large number, especially the poorer people, do suffer because they cannot go out to do their daily jobs. The situation is particularly acute in the developing economies because the poorer section simply fall out of the safety net and directly face immediate hardships as soon as they are out of work. I don’t know what the situation was like with the Spanish flu epidemic in 1918, but the world’s economy did not appear to collapse as a result. Literature on the economic impact of the 1918 pandemic was scant, but a study on the effect on the Swedish economy shows that the influenza did not have a strongly adverse impact on the Swedish economy as much as previously predicted. It is too early to assess the economic impact on the 2020 pandemic, but many signs appear to show that the impact is going to be quite severe. This may be due to the fact that the global economy in 2020 is much more tightly knit and interdependent than in 1918.

Another new scenario is the use of the Internet, mostly as a means for many workers to work from their home. This is entirely new because the Internet obviously was not available in 1918. The global lockdown has seen a rapid rise in videoconferencing apps such as Zoom and others. This also brings about a number of ethical challenges, such as security and privacy issues. Furthermore, mobile apps are being developed that help fight the epidemic. Some apps report the location of their user, and those found wandering from their homes are then quickly arrested. This gives rise to a debate on personal rights and public health measures. Some apps tell their user whether someone with the infection is nearby or not. These apps do pose ethical challenges because the user would know who has the disease, but in this unusual time perhaps they are necessary for slowing the spread and saving lives. The ideal, of course, is to find a way to balance the two so that personal rights are also saved while public health measures followed.

The global condition of COVID-19, its virulence, and the use of the Internet mentioned above are some of the impetuses for perhaps a new way of ethical thinking. However, as is always the case in philosophy, new situation gives way to a new way of thinking, but that new way is still founded upon age-old theories and can refer back to past precedents. Recently Peter Singer and Richard Yetter Chappell have proposed that the usual restriction in research ethics be lifted in order to expedite the process of developing and manufacturing vaccine for the disease. In normal times the trial process in vaccine manufacturing is time-consuming because of the restrictions placed upon researchers so that they don’t violate the norms of research ethics on human subjects. Singer and Chappell, on the contrary, propose that volunteer human subjects be recruited so that they can, for example, receive a smaller and weaker dose of the virus, and if they develop immunity, the process of manufacturing the vaccine can be sped up. This obvious would violate the rights of the volunteer, but, being utilitarians, Singer and Chappell propose that the benefits to be gained by the proposal outweighs the risks borne by the volunteer. So we see both the old and the new. The situation is new, but the proposal, utilitarianism, is more than two hundred years old.

The traditional debate between utilitarian and Kantianism is still also alive and well, especially around the triage problem. As there are more and more COVID-19 patients flooding the hospitals, there arise the necessary problem of how to choose. In Thailand, this has not visibly arisen much yet as the number of patients is not too high yet. But there is a potential for such a scenario to happen any time soon. As of now, to my knowledge, there is no official directive to Thai doctors on how to make a triage decision. An official guideline based on sound ethical principles needs to be done very soon, however, before the real triage situation actually arrives.

The use of the apps and the Internet also give rise to new problems, or a reemergence of older ones. In 2020, one would expect that the digital divide problem is all but gone, given the fact that practically everybody has a smart phone and is connected constantly. However, the pandemic has exposed the old problem in a brutal way. Not only is the problem one among groups of people, but corporations also experience it too. When the work from home order was given, no one perhaps expected that there could be all these problems. For example, when universities around Thailand announced that they would start to teach online, many problems were exposed. Many students did not have a smart phone; the university did not know this before because these students were able to use the computers on campus for their study and other business. However, when everyone was forced to stay home, these students were at a disadvantage and as a result lagged behind their friends. Thai universities responded by giving these students free SIM cards, but that did not help them much because some did not have a smart phone to begin with.

Apart from the digital divide problem, the very traditional problem of economic inequality and discrimination can still be found due to the new pandemic. Some workers, for example, found it that they simply could not work online at all. Taxi drivers, for example, still have to go out on the street, exposing themselves to the virus in order to make a living. The Thai government has announced a scheme where those who are affected by the shutdown and who do not belong to other groups specified by the government are given 5,000 Baht (around 167 US dollars) for three months. But there are many problems related to how the scheme is implemented. Some who were qualified did not get the money, whereas some who were not qualified did in fact get it. Moreover, the Thai government has been accused of wavering on the key decisions that could have either saved or endangered the lives and livelihood of a very large number of population. This wavering could have an explanation based on the specific details of Thai culture, in the same way as responses in other countries are based on their own cultures too.

So in conclusion, what is happening is that the new situation, the new virus and the new kind of pandemic, has given rise to new dimensions of ethical problems. Nonetheless, the latter are still founded upon traditional theories. No one has come up with a really new ethical theory, one that could replace either utilitarianism, Kantianism, virtue ethics, or any other existing theory. Surely the pandemic has given rise to a need for a new way of thinking, for example, on what to do when people are forced to work from home. But the principles that underlie the decisions to be made are still founded upon the old theories, and we also have seen that the new situation has resulted in some old debates being brought back again, such as the one on the digital divide.

Does this, then, mean that ethicists and philosophers are always stuck in the past, unable to innovate really new ways of thinking that would help us solve these new problems? I don’t think so. The claim that we ethicists and philosophers are stuck in the past is only an appearance, and this appearance stems from the fact that after all we are human beings. The same kind of human beings that existed in Plato’s, Augustine’s and Kant’s times. We reflect on the best course of action when these new problems arise, but then, as human beings, we cannot escape the fact that our values, desires and goals do not change much after these centuries. The best course of action here still need to be founded upon these goals and values. There can be no other way. Human beings still want to get happiness, avoid pain and suffering and they want to flourish in whatever way they conceive. This has been around for quite a long time.

So does this imply that ethics does not offer anything new at all in this pandemic time? I don’t think so either. Perhaps the change that we are experiencing right now is not drastic enough to merit an entirely new way of thinking ethically, an entirely new form of ethical theory. That would be world changing. That would mean that our goals and values do indeed change. However, we have not arrived at that situation, and I doubt that we will ever do that. Nonetheless, we can also think of less drastic forms of change. The rapid flow of information across the globe and the ever increasing use of the Internet has resulted in an awareness of how many countries are responding to the COVID-19 challenge. We have seen earlier how China responded with their iron-fist policy, and how Thailand wavers rather indecisively in their responses. The awareness that many countries and many cultures are responding to the challenge in various ways perhaps gives rise to a recognition that what we have assumed to be true might not be that way all the time. What some may have believed to be true universally, such as Kant’s style of doing ethics, might not even be recognized by those in other parts of the world. This does not mean that those in other parts do not share the aspiration for truth or true morality; it is just that for them what makes for true morality differs from that conceived by Kantians. Perhaps what Kant is after, a universal rule for morality, is only a way of talk, a language couched in vocabulary that is suited for one time and place, but not every time and every place. There might still be true morality — after all we are all human beings — but the way that true morality is expressed, the vocabulary used, could be different from one culture to another.

When we see how countries such as South Korea and Taiwan rise up to the challenge of the pandemic, and some of attributed their successes to their intellectual traditions. While that may or may not entirely be the case, the point is that the ethics that underlies the decisions made by leaders in these countries are hardly Kantian. What I mean is, the decision makers do not have the vocabulary of Kantian ethics in mind when they make their decisions. What they have in mind may be only the desire the stop the virus and to help save the lives of their people. It is only philosophers, like Kant, who try to analyze these decisions and to base them on a secure foundation. But this foundation does not have to be couched in the language of ethical theory that sounds Kantian, or Rawlsian, or utilitarian, for that matter.

Hence, it is entirely possible for there to be a single morality based on a single nature (we are all Homo Sapiens and all that the fact entails), but expressed in different details. This is to look at the matter from a very high level of abstraction, however. In real life there are always debates and trade offs to be made. The triage situation is a clear case in point. The normal response to a triage in Thailand is that those who suffer more should get the treatment, but that is not always set in stone. There can always be situations where those who suffer more yield to somebody else if that would bring about more benefits. Negotiations and discussions will always be made. I think that would be the same throughout all cultures. It is only Kantians and utilitarians who prefer to set up hard and fast rules due to their overall intention to change ethics to be a science. But throughout all of the world’s cultures, ethics is not a science, and is not supposed to be. It is more like an art, something that one learns through practice. In this way the ancient Greek theory of virtue ethics is more akin to the theory found in other ancient cultures.

Let us return to the point I am trying to make, which is that the opening up of how various cultures respond to the coronavirus pandemic show us that there are many ways to solve the problem, and that these various ways do vary according to different mindsets, historical traditions, cultural beliefs, and a host of others. This, to be sure, is not new at all as far as ethics or ethical theory is concerned. But at least it points to a more empirical outlook for ethics. This does not mean that ethics can, or should, be reduced to sociobiology in the way proposed by Sam Harris. Rather it means that there is a wider scope for different languages and vocabularies to express what we take to be the most valuable and desirable goal of being a human. Facing the pandemic, our most valuable goal is to survive as well as saving means for us to continue to flourish when the pandemic is gone. Being aware that there are many ways to express the fundamental values does not preclude our ability, or even our duty, to criticize our fellow human beings when they practice what we believe to be in the wrong. For example, the cover up attempt by the Chinese government, or the recommendation by the American President that ingesting disinfectant might help kill the virus inside, must be directly and clearly criticized. Here the fundamental value is one of survival as well as healthy living. This is the same for everyone. The difference lies in the fact that the way the criticism is delivered and how it is expressed might be different in one locality to another.