A clear and provocative introduction to the ethics of COVID-19, suitable for university-level students, academics, and policymakers, as well as the general reader. It is also an original contribution to the emerging literature on this important topic. The author has made it available Open Access, so that it can be downloaded and read for free by all those who are interested in these issues. Key features include: A neat organisation of the ethical issues raised by the pandemic. An exploration (...) of the many complex interconnections between these issues. A succinct case for a continued lockdown until we develop a vaccine. An original account of the Deep Moral Problem of the Pandemic, and a Revolutionary Argument for how we should change society post-pandemic. References to, and engagement with, many of the best writings on the pandemic so far (both in popular media and academic journals). ISBN: 978-0-6489016-0-0. (shrink)

Conservative assumptions in medical ethics risk immense harms during a pandemic. Public health institutions and public discourse alike have repeatedly privileged inaction over aggressive medical interventions to address the pandemic, perversely increasing population-wide risks while claiming to be guided by ‘caution’. This puzzling disconnect between rhetoric and reality is suggestive of an underlying philosophical confusion. In this paper, I argue that we have been misled by status quo bias—exaggerating the moral significance of the risks inherent in medical interventions, (...) while systematically neglecting the (objectively greater) risks inherent in the status quo prospect of an out-of-control pandemic. By coming to appreciate the possibility and significance of status quo risk, we will be better prepared to respond appropriately when the next pandemic strikes. (shrink)

Models not only represent but may also influence their targets in important ways. While models’ abilities to influence outcomes has been studied in the context of economic models, often under the label ‘performativity’, we argue that this phenomenon also pertains to epidemiological models, such as those used for forecasting the trajectory of the Covid-19 pandemic. After identifying three ways in which a model by the Covid-19 Response Team at Imperial College London may have influenced scientific advice, policy, and individual (...) responses, we consider the implications of epidemiological models’ performative capacities. We argue, first, that performativity may impair models’ ability to successfully predict the course of an epidemic; but second, that it may provide an additional sense in which these models can be successful, namely by changing the course of an epidemic. (shrink)

The COVID-19 pandemic has caused a global societal, economic, and social upheaval unseen in living memory. There have been substantial cross-national differences in the kinds of policies implemented by political decision-makers to prevent the spread of the virus, to test the population, and to manage infected patients. Among other factors, these policies vary with politicians’ sex: early findings indicate that, on average, female leaders seem more focused on minimizing direct human suffering caused by the SARS-CoV-2 virus, while male leaders (...) implement riskier short-term decisions, possibly aiming to minimize economic disruptions. These sex differences are consistent with broader findings in psychology, reflecting women’s stronger empathy, higher pathogen disgust, health concern, care-taking orientation, and dislike for the suffering of other people—as well as men’s higher risk-taking, Machiavellianism, psychopathy, narcissism, and focus on financial indicators of success and status. This review article contextualizes sex differences in pandemic leadership in an evolutionary framework. Evolution by natural selection is the only known process in nature that organizes organisms into higher degrees of functional order, or counteracts the unavoidable disorder that would otherwise ensue, and is therefore essential for explaining the origins of human sex differences. Differential sexual selection and parental investment between males and females, together with the sexual differentiation of the mammalian brain, drive sex differences in cognition and behavioral dispositions, underlying men’s and women’s leadership styles and decision-making during a global pandemic. According to thesexually dimorphic leadership specialization hypothesis, general psychobehavioral sex differences have been exapted during human evolution to create sexually dimorphic leadership styles. They may be facultatively co-opted by societies and/or followers when facing different kinds of ecological and/or sociopolitical threats, such as disease outbreaks or intergroup aggression. Early evidence indicates that against the invisible viral foe that can bring nations to their knees, the strategic circumspection of empathic feminine health “worriers” may bring more effective and humanitarian outcomes than the devil-may-care incaution of masculine risk-taking “warriors”. (shrink)

The current global COVID-19 pandemic has led to a deep and multidimensional crisis across all sectors of society. As countries contemplate their mobility and social-distancing policy restrictions, we have a unique opportunity to re-imagine the deliberative frameworks and value priorities in our food systems. Pre-pandemic food systems at global, national, regional and local scales already needed revision to chart a common vision for sustainable and ethical food futures. Re-orientation is also needed by the relevant sciences, traditionally siloed in (...) their disciplines and without adequate attention paid to how the food system problem is variously framed by diverse stakeholders according to their values. From the transdisciplinary perspective of food ethics, we argue that a post-pandemic scheme focused on bottom-up, regional, cross-sectoral and non-partisan deliberation may provide the re-orientation and benchmarks needed for not only more sustainable, but also more ethical food futures. (shrink)

This paper analyzes the ethical breakdowns witnessed during the COVID-19 pandemic through the structural lens of Judgemental Philosophy. We argue that many high-stakes decisions—lockdowns, vaccine mandates, contact tracing—were made in contexts where one or more axes of the Judgemental Triad (Constructivity, Coherence, Resonance) collapsed, rendering individual moral judgement impossible. In response, governments often appealed to public acceptability as a functional substitute. We explore when such substitution is structurally justifiable, and when it merely masks ethical voids. This framework reframes (...) class='Hi'>pandemic-era ethics not as failed choices, but as decisions made in structurally unjudgeable fields. (shrink)

Seasonal influenza kills many hundreds of thousands of people every year. We argue that the current pandemic has lessons we should learn concerning how we should respond to it. Our response to the COVID-19 not only provides us with tools for confronting influenza; it also changes our sense of what is possible. The recognition of how dramatic policy responses to COVID-19 were and how widespread their general acceptance has been allowed us to imagine new and more sweeping responses to (...) influenza. In fact, we not only can grasp how we can reduce its toll; this new knowledge entails new responsibilities to do so. We outline a range of potential interventions to alter social norms and to change structures to reduce influenza transmission, and consider ethical objections to our proposals. (shrink)

This paper uses the example of the COVID-19 pandemic to analyse the danger associated with insufficient epistemic pluralism in evidence-based public health policy. Drawing on certain elements in Paul Feyerabend’s political philosophy of science, it discusses reasons for implementing more pluralism as well as challenges to be tackled on the way forward.

The COVID-19 pandemic has affected every human being on the planet and forced us all to reflect on the bioethical issues it raises. In this timely book, Gregory Pence examines a number of relevant issues, including the fair allocation of scarce medical resources, immunity passports, tradeoffs between protecting senior citizens and allowing children to flourish, discrimination against minorities and the disabled, and the myriad issues raised by vaccines.

The COVID-19 pandemic has coincided with the proliferation of ethical guidance documents to assist public health authorities, health care providers, practitioners and staff with responding to ethical challenges posed by the pandemic. Like ethical guidelines relating to infectious disease that have preceded them, what unites many COVID-19 guidance documents is their dependency on an under-developed approach to bioethical principlism, a normative framework that attempts to guide actions based on a list of prima facie, unranked ethical principles. By situating (...) them in relation to the key philosophical debates concerning bioethical principlism, we aim to explore the limits and limitations of pandemic ethical guidance documents as, specifically, ethics documents – documents that fulfil the functions of ethics as a fundamentally normative discipline. This means not only determining whether such ethical guidance documents can, in principle, provide adequate action guidance and action justification, but also, more importantly where pandemics are concerned, determining whether they support consistent decision making and transparent processes of justification. Having highlighted the problems with merely furnishing ethical guidelines with substantive ethical content in terms of principles and values, we argue that organizations that develop these documents should, instead, focus on the procedural dimensions of action guidance and action justification, which extend to questions regarding the make-up of the committees, panels and groups that develop such guidelines, the public transparency of justifications for specific pandemic-related advice or interventions and the development of explicit procedures for transparent and consistent decision making. (shrink)

There is too much that we do not know about COVID-19. The longer we take to find it out, the more lives will be lost. In this paper, we will defend a principle of risk parity: if it is permissible to expose some members of society (e.g. health workers or the economically vulnerable) to a certain level of ex ante risk in order to minimize overall harm from the virus, then it is permissible to expose fully informed volunteers to a (...) comparable level of risk in the context of promising research into the virus. We apply this principle to three examples of risky research: skipping animal trials for promising treatments, human challenge trials to speed up vaccine development, and low-dose controlled infection or “variolation.” We conclude that if volunteers, fully informed about the risks, are willing to help fight the pandemic by aiding promising research, there are strong moral reasons to gratefully accept their help. To refuse it would implicitly subject others to still graver risks. (shrink)

The crisis of pandemics such as Covid-19 reveals the reality of a crisis-ridden world fraught by devastation of nature and distortion of human life simultaneously. This article tries to bring to light that pandemics actually move from one ‘region’ of human Lifeworld to another. The phenomenological notion of ‘Lifeworld’ can enable one to see ‘natural life’ and ‘civil life’ as two different but related ‘regions of life’ related to each other in the context of an ontological unity. As such, the (...) ‘coming’ of pandemic viruses into human life-sphere is seen as one step in a process which had already begun with the disruptive human interference in the natural environment. These are in fact practical implications of the mastery of the modern ‘ego cogito’ and its use of technological warfare. (shrink)

Early pandemic supply chain disruptions posed unprecedented challenges for logisticians and logistical systems. This article investigates the loss prevention strategies pursued by supply chain operators in the face of these blockages. Focusing on the legal doctrine of force majeure, the redesign of supply chain models and financial risk management, I show how the adjustment of logistical rationalities to pandemic conditions involves their entanglement with legal, ecological and epidemiological logics. Far from being temporary modifications, these intersections register wider mutations (...) of capitalism that both exceed the pandemic and have been hastened by it. (shrink)

Inserting the discourse within an existentialist framework, this paper examines our existence of interrupted realities through the lens of Kierkegaardian thoughts and also draws on Simone de Beauvoir’s “Qu’est-ce que l’existentialisme?” (1947). As we navigate a surrealist time of COVID-19 (ab)normal, the lingering pandemic has left an impact on a both societal and psychosocial level. With societies across the globe facing continuous restrictions, what happens to free will? De Beauvoir defines our raison d’être as the individual having reality “only (...) through his engagement in the world”. In this period of limited individual freedom, can we still talk of free will and how shall we engage with this all-pervasive, rule-changing pandemic ‘New Normal’? (shrink)

The COVID‐19 pandemic highlighted the tension between protecting public health and safeguarding individual rights, particularly the right to privacy. In South Africa (SA), privacy is both a constitutional right and a statutory obligation under the Protection of Personal Information Act (POPIA). However, during public health crises, this right may be limited by legal measures such as surveillance, mandatory reporting and data processing under POPIA, the National Health Act and the Disaster Management Act. These instruments collectively define the conditions under (...) which the right to privacy may be limited in the interest of public health. This article examines whether SA’s legal framework allows for the lawful, necessary and proportionate limitation of privacy during disease outbreaks, drawing on key legislation and case law. To assess SA’s compliance with international human rights standards, a benchmarking of domestic provisions against the International Covenant on Civil and Political Rights and the Siracusa Principles is also undertaken. These instruments offer guidance on how states may justifiably limit rights during public health emergencies. The article further briefly examines whether adhering to constitutional and statutory requirements translates into public trust during pandemics. Lastly, it also provides recommended requirements to guide future limitations on privacy that uphold constitutional values while enabling effective public health responses. (shrink)

When central authority fails in socially crucial tasks, mutual aid, solidarity, and grassroots organization frequently arise as people take up slack on the basis of informal networks and civil society organizations. We can learn something important about the possibility of horizontal organization by studying such experiments. In this paper we focus on the rationality, care, and effectiveness of grassroots measures to respond to the pandemic and show how they illustrate core elements of anarchist thought. We do not argue for (...) the correctness of any version of anarchist politics, nor claim that the bulk of this grassroots work was done with anarchist ideas explicitly in mind. Nonetheless, the current pandemic, like many social crises before it, serves as a sort experiment in political implementation. -/- Two things have been striking in the US response to the COVID-19 pandemic: the chaos, incompetence, irrationality, and often cruel misguidedness of the centralized government response; and the rationality, care, and effectiveness of grassroots measures in many parts of the country. In this paper we focus on the latter—especially the case of Washington, DC—to illustrate core features of anarchist politics. We do not argue for the correctness of any version of anarchist politics here, but merely illustrate guiding ideas that have been a part of anarchist theory and practice for well over a century. We also do not claim that the bulk of this grassroots work was done with anarchist ideas in mind, or explicitly out of a commitment to anarchist politics. Some was, and some arises out of related ideological commitments, but most simply functions out of no more than a desire to support one another. -/- The current pandemic, like many social crises before it, rather than providing a stand-alone argument or functioning as an implementation of any political theory, serves as a sort of laboratory experiment. When central authority fails in socially crucial tasks, mutual aid, solidarity, and grassroots organization frequently arise as people take up slack on the basis of informal networks and civil society organizations. We can learn something important about the possibility of horizontal organization by studying such experiments, including how it arises through spontaneous action. If political thought is best illustrated through its implementation in practice, the functioning of grassroots individuals and organizations in a time of crisis is one way to understand the political mechanisms core to anarchist thought. (shrink)

The UK has been ‘following the science’ in response to the COVID-19 pandemic in line with the national framework for the use of scientific advice in assessment of risk. We argue that the way in which it does so is unsatisfactory in two important respects. Firstly, pandemic policy making is not based on a comprehensive assessment of policy impacts. And secondly, the focus on reasonable worst-case scenarios as a way of managing uncertainty results in a loss of decision-relevant (...) information and does not provide a coherent basis for policy making. (shrink)

The background paper provides an introduction to the concept of pandemics and to the ethical and political issues related with pandemic preparedness.

There are no egalitarians in a pandemic. The scale of the challenge for health systems and public policy means that there is an ineluctable need to prioritize the needs of the many. It is impossible to treat all citizens equally, and a failure to carefully consider the consequences of actions could lead to massive preventable loss of life. In a pandemic there is a strong ethical need to consider how to do most good overall. Utilitarianism is an influential (...) moral theory that states that the right action is the action that is expected to produce the greatest good. It offers clear operationalizable principles. In this paper we provide a summary of how utilitarianism could inform two challenging questions that have been important in the early phase of the pandemic: (a) Triage: which patients should receive access to a ventilator if there is overwhelming demand outstripping supply? (b) Lockdown: how should countries decide when to implement stringent social restrictions, balancing preventing deaths from COVID‐19 with causing deaths and reductions in well‐being from other causes? Our aim is not to argue that utilitarianism is the only relevant ethical theory, or in favour of a purely utilitarian approach. However, clearly considering which options will do the most good overall will help societies identify and consider the necessary cost of other values. Societies may choose either to embrace or not to embrace the utilitarian course, but with a clear understanding of the values involved and the price they are willing to pay. (shrink)

This article aims to approach the COVID-19 health crisis through the category of precarity in two senses. On the one hand, in the face of power, a state of exception has been configured as the new form of political handling of the new normality. On the other hand, the loss of public space has meant that community ties have been broken, fostering greater atomisation and loneliness. Both processes were already present in modernity and post-modernity and foster an increasing uprooting of (...) the individual through the loss of the symbolic axes of socialisation, as well as more intense social control. In short, the defining characteristic of the pandemic is the precarity of life. (shrink)

Background Planning for the next pandemic influenza outbreak is underway in hospitals across the world. The global SARS experience has taught us that ethical frameworks to guide decision-making may help to reduce collateral damage and increase trust and solidarity within and between health care organisations. Good pandemic planning requires reflection on values because science alone cannot tell us how to prepare for a public health crisis. Discussion In this paper, we present an ethical framework for pandemic influenza (...) planning. The ethical framework was developed with expertise from clinical, organisational and public health ethics and validated through a stakeholder engagement process. The ethical framework includes both substantive and procedural elements for ethical pandemic influenza planning. The incorporation of ethics into pandemic planning can be helped by senior hospital administrators sponsoring its use, by having stakeholders vet the framework, and by designing or identifying decision review processes. We discuss the merits and limits of an applied ethical framework for hospital decision-making, as well as the robustness of the framework. Summary The need for reflection on the ethical issues raised by the spectre of a pandemic influenza outbreak is great. Our efforts to address the normative aspects of pandemic planning in hospitals have generated interest from other hospitals and from the governmental sector. The framework will require re-evaluation and refinement and we hope that this paper will generate feedback on how to make it even more robust. (shrink)

Prioritarianism pertains to the generic idea that it matters more to benefit people, the worse off they are, and while prioritarianism is not uncontroversial, it is considered a generally plausible and widely shared distributive principle often applied to healthcare prioritisation. In this paper, I identify social justice prioritarianism, severity prioritarianism and age-weighted prioritarianism as three different interpretations of the general prioritarian idea and discuss them in light of the effect of pandemic consequences on healthcare priority setting. On this analysis, (...) the paper arrives at the following three conclusions: that we have strong prioritarian reasons for special concern about the vulnerable and socially disadvantaged in reference to pandemic effects, that severity of illness is an important factor in identifying the worse off in priority setting but that this must not over-ride the special priority to the socially disadvantaged and that the maximisation rationale of the age-weighted view runs against the core prioritarian idea, and the age-weighted prioritarianism is thus unfitting as a prioritarian response to the COVID-19 case. (shrink)

Many democratic countries have failed to stand up to the challenge presented by the COVID-19 pandemic. I argue that the collective response to the pandemic has been incapacitated by an ‘epistemic crisis’, (i.e., a breakdown in the social division of epistemic labor) that led to a failure of citizens’ beliefs to converge towards a shared perception of the situation. Neither a paucity of relevant expert knowledge nor democratic citizens’ irrationality is required for the crisis to emerge. In particular, (...) I highlight three obstacles capable of preventing relevant expert testimony from gaining democratic legitimacy necessary for an effective policy response: 1) the proper domain of expertise is uncertain; 2) regular citizens’ meta-expertise – (i.e., ability to discriminate among the putative experts based on their relative epistemic merit) – is not efficacious enough to trigger truth-convergence of the public opinion; 3) the prominent sources of third-party meta-expertise lack credibility due to their conflicts of interest. Since the first two problems appear irresolvable, I propose that the search for a path towards preclusion of future epistemic crises concentrates on upgrading the institutional fundament for meta-expertise provision. Social epistemology plays a vital role in this search, but its close cooperation with other disciplines is a must. (shrink)

This research aims to examine access to medical treatment during the COVID-19 pandemic for people living with disabilities. During the COVID-19 pandemic, the practical and ethical problems of allocating limited medical resources such as intensive care unit beds and ventilators became critical. Although different countries have proposed different guidelines to manage this emergency, these proposed criteria do not sufficiently consider people living with disabilities. People living with disabilities are therefore at a higher risk of exclusion from medical treatments (...) as physicians tend to assume they have poor quality of life, whereas access to medical treatment should be based on several parameters, including clinical data and prognosis. However, the COVID-19 pandemic shifts the medical paradigm from person-centred medicine to community-centred medicine, challenging the main ethical theories. We reviewed the main guidelines and recommendations for resources allocation and examined their position toward persons with disabilities. Based on our findings, we propose criteria for not discriminating against people with disabilities in allocating resources. The shift from person-centred to community-centred medicine offers opportunities but also risks sacrificing the most vulnerable people. The principle of reasonable accommodation must always be considered to guarantee the rights of persons with disabilities. (shrink)

While the unprecedented lockdown measures were at the heart of the debate in the first year of the pandemic, the focus since then has shifted to vaccination issues. The reason, of course, is that vaccines and vaccinations have become available by now. All experts agree: If mankind had failed to develop vaccines against SARS-CoV-2, the death toll would have been much higher. This issue seeks to explore what could be described as a “generational approach to vaccinations”. The question “What (...) can we do to avoid future pandemics?” is related to different aspects of the failures and successes of humanity’s vaccination strategy against SARS-CoV-2. Pathogens are among the existential risks to humanity that could potentially kill a large part of it in a very short time. For all the tragedy and horror it has brought upon the world, the Corona virus has not been lethal on such a large, all-encompassing scale. But it could serve as a wake-up call for more and better prevention in the future, put differently: as a call to build a “preventive society”. When people look back to the year 2022 from the year 2200, will they think of the absence of mandatory vaccination as a dangerous anachronism? And will the unequal global distribution of vaccines be seen as an unbearable vice of our epoch? And will “human infection studies” still be dismissed as unethical if a dangerous new virus boards human bodies? If intergenerational justice means improving the life chances and living conditions of future generations to the largest possible extent, then its link to (the avoidance) of infectious diseases is obvious. We should protect future generations from foreseeable damage if we have the power to do so. “We” is humankind in its entirety. Politically, humanity is divided into many single nations. But biologically, as members of the same species, we share the same vulnerability regardless of ethnicity. The regular reader of this journal might wonder why this issue of IGJR has a different structure. An unprecedented pandemic calls for an unprecedented reaction and therefore IGJR 1/2021 and 2/2021 are special issues that deal with this disruptive event. We have invited several health experts, politicians and scholars alike to share their perspectives in short opinion pieces (instead of regular peer-reviewed articles). And we are exploring something new: the publication of a FRFG policy paper. This policy paper starts off with a historical overview on how pandemics have afflicted humanity in the past. It separates moral from legal duties and formulates “epidemiological imperatives” – the way of thinking of a responsible and solidary individual facing the task of preventing an outbreak of epidemics in a community. With the discovery of vaccines, and their availability, the catalogue of duties is increased by one more: to get the jabs as an act of solidarity with others, including future generations. This would prevent states from being forced to take disease control measures that bring about drastic collateral damage. During the first two years of the Corona pandemic, states have imposed lockdowns. The closure of schools has put a special burden on the youngest members of society. This could have been prevented during the second and the further waves. The policy paper also calls for more government funding for prophylactic vaccine research and for the designation of vaccines as “global public goods”. The issue then moves on to a section dedicated to opinion papers by various different authors. The first paper, written by Agnes Binagwaho and Kedest Mathewos (both from University of Global Health Equity, Rwanda), focuses on the issue of health inequity, a concern which has gained more and more traction during the Covid-19 pandemic. The paper examines how vaccine distribution during the pandemic was mainly focused on the global north and how such actions might affect future generations’ perception of what is just, fair and morally correct. The second paper, by Samantha Vanderslott (University of Oxford), focuses on the right and wrongdoings connected to pandemic preparedness and response. The third paper, authored by Rajeev Sadanandan (Health Systems Transformation Platform, India), talks about the lessons that can and should be drawn from child immunisations. The fourth paper, by Adriano Mannino (LMU and Parmenides Foundation, Munich), delves into the question how future generations will assess our actions and our response to the current pandemic. The fifth and final paper, written by Jörg Tremmel (FRFG and University Tübingen), is centered around the question whether human infection studies could have been implemented during the early stages of the pandemic to minimise deaths and severe infections. The issue concludes with two reviews on recent books by Alberto Giubilini and Katie Wright. In his review of Giubilini’s The Ethics of Vaccination, Marius Kunte notes that it contains a “thought-provoking plea” for individual, collective and institutional obligations to reach high vaccination rates. Judith Kausch-Zongo concludes her review of Wright’s Gender, Migration and the Intergenerational Transfer of Human Wellbeing with a special emphasis on the book’s empirical findings, and praises it in its entirety as “undoubtedly important”. Both books serve as poignant reminders of how sustainable societies can only emerge once the challenges revolving around its most vulnerable members have been properly addressed. (shrink)

COVID-19 deeply affects many spheres of life. Lockdown measures implemented worldwide have accentuated mental wellbeing changes in the population from the perspectives of space and social relations. These changes leave lasting imprints on individuals and communities. This article draws upon solidarity and care ethics in exploring their role in rebuilding mental wellbeing in the light of constraints arising from lockdown. The diversity of responses to physical and social isolation during the pandemic illuminates the distinctly relational nature of human beings, (...) offering the opportunity for care and solidarity to respond to mental wellbeing challenges in an inclusive and context-sensitive way. (shrink)

The SARS-CoV-2 pandemic has transgressed biomedical categories. According to Horton, it turned out to be a 'syndrome' that infected virtually all spheres of social life. The pandemic has created toxic social atmosphere highly unfavorable to clinical and clinic-ethical decision making. Constraints and pressures related to micro-, meso-, exo- and macro-environments framing doctors, nurses, and medical students in training were identified. These factors exacerbated moral distress (moral injury) amongst clinicians. In a joint Polish-Lithuanian project (IDUB 2020-2022) we examined predictors (...) of moral distress in pandemic clinical contexts. A survey-based, real-time, correlational and comparative study was conducted in Poland and Lithuania after the first year of pandemic with N=227 participants. Unexpected differences on regular and pandemic-type moral distress levels were found between the two national samples. Polish participants showed significantly higher moral distress levels than their Lithuanian counterparts. The following article discusses these findings and recommends the reinforcement of resilient medical decision making. (shrink)

After the viral outbreak that hit populations across the planet in the first half of 2020, it has been argued that the coronavirus pandemic can be described as a quintessential phenomenon of the Anthropocene, i.e. the result of a particular stage of socionatural relations in which wild habitats are invaded and anthropogenic climate change creates the conditions for the emergence of more frequent viral pathogens. Likewise, it has also been argued that the pandemic is an event that shares (...) structural features with climate change itself and, consequently, offers some lessons about how best to fight the latter. I will consider these arguments, offering an alternative view of the relationship between the pandemic and the Anthropocene. I will argue that although the pandemic should not be primarily seen as an event of the Anthropocene, it can end up reinforcing the Anthropocene frame for several reasons. (shrink)

This contribution attempts to shed a light from a phenomenological point of view on the ecological crises that have affected our planet and our surrounding lifeworld in the twentieth century, and particularly on the devastating 2020 global pandemic. I first address some historical-critical aspects that precede the 2020 pandemic that are related to the modern mechanistic view in sciences and culture. I then deal, within the natural attitude, with this current eco-crisis as a “guiding thread” for a retrospective (...) questioning toward the experiential roots of every human sense and validity from the first-person perspective, contrasting it as well with aspects of a new, unified, systems view of life. In what follows, retrieving the paradox of the subject-in-the world and the subject-for-the world, I examine the lifeworld’s structure as the way (path) to the transcendental field of experience—that of the correlation between human life (embodied, intersubjective, and historical-temporal) and the world, namely, the noetic-noematic structure, in order to show how it is not reducible to a mere passive self-affection, but is the original source of a spiritual virtue and transformational capacity: that of responsibility. (shrink)

Humans have been using fire for hundreds of millennia, creating an ancestral expansion toward the nocturnal niche. The new adaptive challenges faced at night were recurrent enough to amplify existing psychological variation in our species. Night-time is dangerous and mysterious, so it selects for individuals with higher tendencies for paranoia, risk-taking, and sociability. During night-time, individuals are generally tired and show decreased self-control and increased impulsive behaviors. The lower visibility during night-time favors the partial concealment of identity and opens more (...) opportunities for disinhibition of self-interested behaviors. Indeed, individuals with an evening-oriented chronotype are more paranoid, risk-taking, extraverted, impulsive, promiscuous, and have higher antisocial personality traits. However, under some circumstances, such as respiratory pandemics, the psychobehavioral traits favored by the nocturnal niche might be counter-productive, increasing contagion rates of a disease that can evade the behavioral immune system because its disease cues are often nonexistent or mild. The eveningness epidemiological liability hypothesis presented here suggests that during the COVID-19 pandemic, the evening-oriented psychobehavioral profile can have collectively harmful consequences: there is a clash of core tendencies between the nocturnal chronotype and the recent viral transmission-mitigating safety guidelines and rules. The pandemic safety protocols disrupt much normal social activity, particularly at night when making new social contacts is desired. The SARS-CoV-2 virus is contagious even in presymptomatic and asymptomatic individuals, which enables it to mostly evade our evolved contagious disease avoidance mechanisms. A growing body of research has indirectly shown that individual traits interfering with social distancing and anti-contagion measures are related to those of the nocturnal chronotype. Indeed, some of the social contexts that have been identified as superspreading events occur at night, such as in restaurants, bars, and nightclubs. Furthermore, nocturnal environmental conditions favor the survival of the SARS-CoV-2 virus much longer than daytime conditions. We compare the eveningness epidemiological liability hypothesis with other factors related to non-compliance with pandemic safety protocols, namely sex, age, and life history. Although there is not yet a direct link between the nocturnal chronotype and non-compliance with pandemic safety protocols, security measures and future empirical research should take this crucial evolutionary mismatch and adaptive metaproblem into account, and focus on how to avoid nocturnal individuals becoming superspreaders, offering secure alternatives for nocturnal social activities. (shrink)

Numerous grounds have been offered for the view that healthcare workers have a duty to treat, including expressed consent, implied consent, special training, reciprocity (also called the social contract view), and professional oaths and codes. Quite often, however, these grounds are simply asserted without being adequately defended or without the defenses being critically evaluated. This essay aims to help remedy that problem by providing a critical examination of the strengths and weaknesses of each of these five grounds for asserting that (...) healthcare workers have a duty to treat, especially as that duty would arise in the context of an infectious disease pandemic. Ultimately, it argues that none of the defenses is currently sufficient to ground the kind of duty that would be needed in a pandemic. It concludes by sketching some practical recommendations in that regard. (shrink)

The paper discusses the reactions of different political and constitutional systems reactions to the pandemic and also the impact of COVID to populism, constitutionalism, and autocracy. Beyond the choice between economic and health considerations also applied in liberal democratic countries, which have lead either to “under-” or “overreaction” to the pandemic, certain illiberal regimes used the crisis situation as a pretext to strengthen the autocratic character of their systems. In some cases, this needed an “underreach,” like in Poland (...) to insist on the presidential election, which has been important to entrench the power of the governing party’s incumbent, elsewhere “overreach,” like in Hungary, where an unlimited emergency power of government has been introduced after the very first cases of contagion. These autocratic “overreactions” have breached the formerly used authoritarian legalistic approaches by openly violating their own illiberal constitutions. New “conservative” theories on “common good constitutionalism” emerged to legitimize the necessity of authoritative rule by the executive power. The paper concludes that one possibility to overcome authoritarian populism and restore constitutionalism in crisis situation such as the COVID-19 pandemic would be to rely on the involvement of the well informed public, one that is capable to understand and assess the advice of the meritocratic elite. This kind of participation would also help build up a constitutional culture necessary to preserve the values of constitutionalism. (shrink)

In a severe influenza pandemic, hospitals will likely experience serious and widespread shortages of patient pulmonary ventilators and of staff qualified to operate them. Deciding who will receive access to mechanical ventilation will often determine who lives and who dies. This prospect raises an important question whether pandemic preparedness plans should include some process by which individuals affected by ventilator rationing would have the opportunity to appeal adverse decisions. However, the issue of appeals processes to ventilator rationing decisions (...) has been largely neglected in state pandemic planning efforts. If we are to devise just and effective plans for coping with a severe influenza pandemic, more attention to the issue of appeals processes for pandemic ventilator rationing decisions is needed. Arguments for and against appeals processes are considered, and some suggestions are offered to help efforts at devising more rational pandemic preparedness plans. (shrink)

For last couple of years, the subcontinent of India has witnessed a number of influenza epidemic outbreaks. History reveals influenza epidemic to be a constant but neglected companion of India. Considering the repeated occurrences of the event on Indian soil, including influenza A H1N1 after 2009-10 pandemic event, a check to the planning measures has been done at national level. A literature survey on the initiative measures, planning accomplishments etc. reveals that it is only after the emergence of A (...) H5N1, national health authorities have began planning efforts to mitigate and respond to influenza outbreaks. This paper outlines the evolution of Indian pandemic planning that can be traced in the research literature, summarize the accomplishments, and explain the importance of pandemic planning in India. Pandemic influenza, as it is commonly known, emerges, evolves, attacks, and sways a large part of world declaring public health emergency in a short span. Several outbreak events such as SARS, Avian influenza A H5N1, and H1N1 have demonstrated the need of international concern for public health emergency and had established the value of planning in advance. Preparedness planning in India is found to be at its nascent stage and it needs further improvement at multiple aspects to tackle the future public health crises, to rectify ethical failures. (shrink)

This article examines the impact of a pandemic on democratic societies. The central research question is the extent to which a pandemic can alter the trajectory of social and ethical democratic development nationally and internationally. Therefore, the article examines contemporary controversies in democratic society in the aftermath of a pandemic. The leading hypothesis is that the pandemic should reinforce the need for social solidarity, but it is unclear what political form this need will take: populism or (...) deliberative/nonconsensual democracy. (shrink)

We analyse insufficient epistemic pluralism and associated problems in science-based policy advice during the COVID-19 pandemic drawing on specific arguments in Paul Feyerabend’s philosophy. Our goal is twofold: to deepen our understanding of the epistemic shortcomings in science-based policy during the pandemic, and to assess the merits and problems of Feyerabend’s arguments for epistemic pluralism as well as their relevance for policy-making. We discuss opportunities and challenges of integrating a plurality of viewpoints from within and outside science into (...) policy advice thus contributing to discussions about normative issues concerning evidence and expertise in policy-making. (shrink)

This open-access issue aims to highlight views about justice in a pandemic context from Latin American countries and to contribute to the dialogue between them as well as with the global scientific community. It explores the global challenges of the COVID-19 pandemic, relevant differences between public health measures and their impact on high-income countries versus low- or middle-income countries, and how global injustice deepened because of the COVID-19 pandemic. It also draws attention to experiences, outcomes, and responses (...) to the pandemic from the global north regarding vulnerable populations and exposure paths that are also present in Latin America. (shrink)

Background Planning for the next pandemic influenza outbreak is underway in hospitals across the world. The global SARS experience has taught us that ethical frameworks to guide decision-making may help to reduce collateral damage and increase trust and solidarity within and between health care organisations. Good pandemic planning requires reflection on values because science alone cannot tell us how to prepare for a public health crisis. Discussion In this paper, we present an ethical framework for pandemic influenza (...) planning. The ethical framework was developed with expertise from clinical, organisational and public health ethics and validated through a stakeholder engagement process. The ethical framework includes both substantive and procedural elements for ethical pandemic influenza planning. The incorporation of ethics into pandemic planning can be helped by senior hospital administrators sponsoring its use, by having stakeholders vet the framework, and by designing or identifying decision review processes. We discuss the merits and limits of an applied ethical framework for hospital decision-making, as well as the robustness of the framework. Summary The need for reflection on the ethical issues raised by the spectre of a pandemic influenza outbreak is great. Our efforts to address the normative aspects of pandemic planning in hospitals have generated interest from other hospitals and from the governmental sector. The framework will require re-evaluation and refinement and we hope that this paper will generate feedback on how to make it even more robust. (shrink)

Like COVID-19, new infectious disease outbreaks emerge almost annually, and studies predict that this trend will continue due to a variety of factors, including an aging population, ease of travel, and globalization of the economy. In response to episodic public health crises, governments and organizations develop, implement, and enforce policies, procedures, protocols, and programs. The epidemiological triad is both a model of disease causation and fundamentally used to design and deploy such control measures. Here we adapt this model to the (...) workplace setting and use the epidemiological triad to characterize the related ethical challenges in implementing the control measures employers face as a guide for a workplace intervention framework. Through this approach, our aim is to show how an integrated ethical framework, grounded in epidemiological principles, has important implications for how we categorize, understand, and resolve the difficult decisions that emerge in the workplace under pandemic conditions. (shrink)

What kind of epidemiological modeling works well? This is determined by the nature of the target: the relevant causal relations are unstable across contexts. I look at two influential examples of modeling from the Covid pandemic. The first is the paper from Imperial College London, which, in March 2020, was influential in persuading the UK government to impose a lockdown. Because it assumes stability, this first example of modeling fails. A different modeling strategy is required, one less ambitious but (...) more effective. This is illustrated by a second paper from Imperial College London, which, in December 2020, first estimated the transmissibility of the Alpha variant. (shrink)

In response to the COVID‐19 pandemic philosophers and governments have proposed scarce resource allocation guidelines. Their purpose is to advise healthcare professionals on how to ethically allocate scarce medical resources. One challenging feature of the pandemic has been the large numbers of patients needing mechanical ventilatory support. Guidelines have paradigmatically focused on the question of what doctors should do if they have fewer ventilators than patients who need respiratory support: which patient should get the ventilator? There is, however, (...) an important higher level allocation problem. Namely, how are we to ethically distribute newly obtained ventilators across hospitals: which hospital should get the ventilator(s)? In this paper, we identify a set of principles for allocating newly obtained ventilators across hospitals. We focus particularly on low and middle income countries, who frequently have limited pre‐existing intensive care capacity, and have needed to source additional ventilators. We first provide some background. Second, we argue that the main population healthcare aim during the COVID‐19 pandemic should be to save the most lives. Next, we assess a series of potential heuristics or principles that could be used to guide allocation: allocation to the most densely populated cities, random allocation, allocation based on the ratio of patients to ICU personnel, prioritisation in terms of intrahospital mortality, prioritisation of younger populations, and prioritisation in terms of population mortality. We conclude by providing a plausible ranking of the principles, while noting a number of epistemological challenges, in terms of how they best further the aim of increasing the probability of saving the most lives. (shrink)

A comprehensive understanding of the ethics of the COVID-19 pandemic priorities must be sensitive to the influence of social inequality. We distinguish between ex-ante and ex-post relevance of social inequality for COVID-19 disadvantage. Ex-ante relevance refers to the distribution of risks of exposure. Ex-post relevance refers to the effect of inequality on how patients respond to infection. In the case of COVID-19, both ex-ante and ex-post effects suggest a distribution which is sensitive to the prevalence social inequality. On this (...) basis, we provide a generic fairness argument for the claim that welfare states ought to favour a healthcare priority scheme that gives particular weight to protecting the socially disadvantaged. (shrink)

Purpose: This systematic review aimed to analyze the impact that the COVID-19 lockdown had on the amount of physical activity performed by university students.Materials and Methods: A systematic electronic search for studies providing information regarding physical activity levels pre and during COVID-19 pandemic in university students was performed up to 20th October 2020 in the databases Cochrane Library, PubMed, SPORTDiscus, and Web of Science. The risk of bias of external validity quality of included studies was assessed by means of (...) those the Newcastle-Ottawa Scale. The quality of the evidence for main outcomes was graded using the Grading of Recommendations Assessment, Development and Evaluation approach.Results and Conclusions: A total of 10 studies were selected. Physical activity levels were assessed by means of questionnaires and accelerometer. Risk of bias was regarded as low and high in six and four investigations, respectively. The quality of evidence was downgraded to low. A significant reduction of physical activity levels were observed in 9 studies. Compared to pre-lockdown values, five studies showed a reduction of light/mild physical activity between 32.5 and 365.5%, while seven studies revealed a reduction of high/vigorous physical activity between 2.9 and 52.8%. Walking, moderate, vigorous, and total physical activity levels have been reduced during the COVID-19 pandemic confinements in university students of different countries. Despite of the reductions, those who met the current minimum PA recommendations before the lockdown generally met the recommendations also during the confinements. (shrink)

This essay identifies three insights about global equity and justice in light of the COVID pandemic. It discusses the need for greater recognition of the role of the global order in the distributio...

This paper examines the case of a recent H5N1virus (avian influenza) outbreak in West Bengal, an eastern state of India, and argues that poorly executed pandemic management may be viewed as a moral lapse. It further argues that pandemic management initiatives are intimately related to the concept of health as a social 'good' and to the moral responsibility of protection from foreseeable social harm from an infectious disease. The initiatives, therefore, have to be guided by special moral obligations (...) towards biorisk reduction, obligations which remain unfulfilled when a public body entrusted with the responsibility fails to manage satisfactorily the prevention and control of the infection. The overall conclusion is that pandemic management has a moral dimension. The gravity of the threat that fatal infectious diseases pose for public health creates special moral obligations for public bodies in pandemic situations. However, the paper views the West Bengal case as a learning opportunity, and considers the lapses cited as challenges that better, more effectively conducted pandemic management can prepare for. It is hoped that this paper will provoke constructive bioethical deliberations, particularly pertinent to the developing world, on how to ensure that the obligations towards health are fulfilled ethically and more effectively. (shrink)

A common early narrative that arose as people struggled to cope with their new lives under COVID-19 centered on a platitude about the pandemic being “the great leveler.” But the pretense that we are equally vulnerable—or that we’re “alone together” across lines of race, gender, and class—was a comforting lie. Chronicling the timeline of media talking points seen over the past few months, I argue that social privilege continues to structure the narratives many people use to process life under (...) the pandemic, even while material conditions are much worse for those not in charge of these narratives. At the same time, however, I argue that the pandemic might be setting the stage for genuinely new collective responses to social inequalities, including the long-overdue uprisings inspired by the Black Lives Matter movement. (shrink)

Debates about effective responses to the COVID-19 pandemic have emphasized the paramount importance of digital tracing technology in suppressing the disease. So far, discussions about the ethics of this technology have focused on privacy concerns, efficacy, and uptake. However, important issues regarding power imbalances and vulnerability also warrant attention. As demonstrated in other forms of digital surveillance, vulnerable subpopulations pay a higher price for surveillance measures. There is reason to worry that some types of COVID-19 technology might lead to (...) the employment of disproportionate profiling, policing, and criminalization of marginalized groups. It is, thus, of crucial importance to interrogate vulnerability in COVID-19 apps and ensure that the development, implementation, and data use of this surveillance technology avoids exacerbating vulnerability and the risk of harm to surveilled subpopulations, while maintaining the benefits of data collection across the whole population. This paper outlines the major challenges and a set of values that should be taken into account when implementing disease surveillance technology in the pandemic response. (shrink)

BackgroundAs a number of commentators have noted, SARS exposed the vulnerabilities of our health care systems and governance structures. Health care professionals (HCPs) and hospital systems that bore the brunt of the SARS outbreak continue to struggle with the aftermath of the crisis. Indeed, HCPs – both in clinical care and in public health – were severely tested by SARS. Unprecedented demands were placed on their skills and expertise, and their personal commitment to their profession was severely tried. Many were (...) exposed to serious risk of morbidity and mortality, as evidenced by the World Health Organization figures showing that approximately 30% of reported cases were among HCPs, some of whom died from the infection. Despite this challenge, professional codes of ethics are silent on the issue of duty to care during communicable disease outbreaks, thus providing no guidance on what is expected of HCPs or how they ought to approach their duty to care in the face of risk.DiscussionIn the aftermath of SARS and with the spectre of a pandemic avian influenza, it is imperative that we (re)consider the obligations of HCPs for patients with severe infectious diseases, particularly diseases that pose risks to those providing care. It is of pressing importance that organizations representing HCPs give clear indication of what standard of care is expected of their members in the event of a pandemic. In this paper, we address the issue of special obligations of HCPs during an infectious disease outbreak. We argue that there is a pressing need to clarify the rights and responsibilities of HCPs in the current context of pandemic flu preparedness, and that these rights and responsibilities ought to be codified in professional codes of ethics. Finally, we present a brief historical accounting of the treatment of the duty to care in professional health care codes of ethics.SummaryAn honest and critical examination of the role of HCPs during communicable disease outbreaks is needed in order to provide guidelines regarding professional rights and responsibilities, as well as ethical duties and obligations. With this paper, we hope to open the social dialogue and advance the public debate on this increasingly urgent issue. (shrink)

In this paper, we critically consider the analogy between “infodemic” and “pandemic”, i.e. the spread of fake news about COVID-19 as a medial virus and the infection with the biological virus itself from the perspective of cultural evolutionary theory (CET). After confronting three major shortcomings of the ‘infodemic’ concept, we use CET as a background framework to analyze this phenomenon. To do so, we summarize which bi-ases are crucial for transmission in terms of cultural selection and how transmission is (...) restricted by filter bubbles or echo chambers acting as TRIMS (transmission isolating mechanisms) post “infection”, which isolate false from trustworthy scientific information in the context of the Corona pandemic. This is followed by a demonstration of the threat to biological fitness posed by the effects of an infection with fake news, which leads to a reduced willingness to vaccinate and follow health measures. We identify fake news on Covid as pseudoscience, trying to immunize itself from external influences. We then address the question of how to combat the infodemic. Since debunking strategies, such as warnings by fact-checking, have proven relatively ineffective in combating fake news, the inoculation theory from psychology might offer an alternative solution. Through its underlying ‘prebunking strategy’, which educates individuals about the risks and tactics of fake news prior to a potential infection, they could be ‘immunized’ in advance, similar to a virological vaccination. Although we recognize that the pandemic/infodemic analogy is in fact far from perfect, we believe that CET could provide a theoretical underpinning in order to give much more semantic depth to the concept ‘infodemic’. (shrink)

Background During the pandemic, social and health care professionals operated in ‘crisis conditions’. Some existing rules/protocols were not operational, many services were closed/curtailed, and new ‘blanket’ rules often seemed inappropriate or unfair. These experiences provide fertile ground for exploring the role of virtues in professional life and considering lessons for professional ethics in the future. Research design and aim This article draws on an international qualitative survey conducted online in May 2020, which aimed to explore the ethical challenges experienced (...) by social workers during Covid-19. Participants and research context 607 social workers responded from 54 countries, giving written online responses. This article first summarises previously published findings from the survey regarding the range of ethical challenges experienced, then develops a new analysis of social workers’ accounts of ethically challenging situations from a virtue ethics perspective. This analysis took a narrative ethics approach, treating respondents’ accounts as stories featuring the tellers as moral agents, with implicit or explicit implications for their professional ethical identity and character. The article is illustrated with accounts from the 41 UK respondents, drawing particularly on two case examples. Ethical considerations Ethical approval was gained from Durham University and anonymity was ensured for participants. Findings/results This article explores the nature of the ethical space created during the pandemic showing how practitioners were able to draw more on ‘inner resources’ and professional discretion than usual, displaying virtues such as professional wisdom, care, respectfulness and courage as they took account of the specific contexts of their work, rather than simply adhering to blanket rules. Conclusion Exploring practice through a virtue ethical lens provides valuable lessons for ‘building back better’ in social and health care professions. (shrink)