ETHICAL AND LEGAL IMPLICATIONS OF NAVIGATING
A PUBLIC HEALTH EMERGENCY IN THE WAKE OF
THE COVID-19 PANDEMIC
DEPARTMENT of EDUCATION, UNESCO CHAIR in BIOETHICS, UNIVERSITY of HAIFA
WEBINAR SUMMARY REPORT
Prepared by Emeritus Professor Des Cahill, RMIT University, Melbourne and Australia Bioethics Unit of the UNESCO Chair in Bioethics, University of Haifa.
This report summarizes a global panel discussion webinar in the wake of COVID-19 held on Sunday night (Melbourne time), 19th April under the sponsorship of the Department of Education’s UNESCO Chair in Bioethics located at the University of Haifa which works to encourage the teaching of bioethics in medical and health sciences and law courses across the world. The two-hour meeting was chaired by the Melbourne-based Professor Russell D’Souza, Chair, Department of Education (International Program) of the UNESCO Chair in Bioethics and was facilitated by Professor Bamran from the University of Manchester, U.K.. Input came from ten specialists in Australia, Germany, India, Israel, Kenya, the UK and the USA. Approximately 420 persons were registered online participants and spectators and asked questions through the chat box which was monitored by Professor Mary Mathew, Head of the Chair’s Indian Program and Col Professor Derek D’Souza of the Education Department in Pune, India.
The webinar began with opening remarks from Professor D’Souza who said that since the March 11th declaration by the World Health Organization the world had entered an unprecedented crisis with major challenges at policy levels and within ethical and legal frameworks. He observed that “equity and public health go hand in hand. We are only as safe as the most vulnerable globally”. A balance needed to be maintained between patient-centered care and public-focused duties. And there were competing sources of moral authority. In his view, health care leaders had three fundamental duties: (1) the duty to plan in managing the uncertainty and responding to the unprecedented challenges, (2) the duty to safeguard, especially in the support and protection of health workers and (3) the duty to guide in continuing and elevating the level of care. Other issues were the balance between public health needs and civil liberties together with the public’s right to know in relation to decision-making of governments which must make very difficult decisions and take measures hard for the public to accept. To what extent can and should a government maintain secrecy about the details behind such decision-making?
He asked the questions: what are the legal rights of health care workers in less than ideal work conditions? And what are the legal implications in insurance and compensation for health care workers? There are clearly very different challenges in the various countries. In the UK, the COVID-19 virus was impacting disproportionately upon minority groups. We need to think about the ethics of the lockdown and the cordon sanitaire.
Professor Ilana Belmaker from the Ben Gurion University of the Negev spoke about the balancing of the number of deaths and the effects and limits of the quarantining of people. She asked whether it was not more appropriate for elderly people to be in lockdown while allowing young people to be free. She referred to the situation of Orthodox Jews with their large families living in poor areas. Israel had adopted the practice of quarantining ‘hot spots’ in towns and cities. Some people were now afraid of going to hospitals for whatever purpose. In Israel police must explain the reasons for lockdown before issuing a penalty.
Professor Marion Mutugi, Vice-Chancellor of the Amref International University in Nairobi spoke of the disconnect between knowledge, attitude and practice. Human nature has poor compliance unless there is a motivation or a sanction. She mentioned that one of the earliest recorded epidemics was the Justinian plague in 541 CE that resulted in 30-50 million deaths in Europe, North Africa and Arabia. Constantinople was completely decimated. She compared the two Italian cities of Bergamo and Lodi. Bergamo took the route of half-way measures whereas Lodi had enforced lockdown – Lodi has had half the number of positive cases. She drew attention to the matter of culture, particularly in regard to funerals where mourning and closure were very important in African culture. But death is also a taboo subject. She also mentioned that long-distant truck drivers and other transportation workers were major conduits as they had been during the AIDS crisis.
Some African countries are worse than others, led by Egypt, South Africa and Morocco. There was in most countries little or no capacity or infrastructure to test and there was some stigmatization. Decisions about resource allocation need to be made within an ethical framework – in prioritizing ventilators: a patient or a health worker? Lastly, she drew attention to the ethics of health journalism and the use of statistics and fake news.
Several participants drew attention to the situation in India. Professor Abhay Gaidhane of the Datta Meghe University of Medical Sciences at Wardha in the north-east Indian state of Maharashtra and Professor Abhay Banerjee from the DY Patil University in Mumbai drew attention to urban slums where social distancing was very difficult with people living in such close quarters with each other, using the same open toilet etc.. India has a large percentage of young people so India could have taken a different strategy to lockdown. There is an extra complication. Each day 1,400 people die from TB in India and so should health experts have recommended the strategy when so many die from TB and child mortality? “We never had a curve to flatten”, noted Professor Banerjee. He also commented later in the webinar that the WHO and Indian government responses to the masks issue had been ‘terrible’.
In Germany, according to Professor Gerard Fortwengel from the University of Hanover, the situation was under control following the implementation of various measures such as domestic isolation and contact ban. The German Medical Protection Act, in place for a long time, had proved very useful. The German health insurance treats everyone equally. The government had communicated appropriately, and was trying to minimize the side effects. But how long can a population follow the recommended restrictions? Some shops were expected to open the following day (April 20th) but regular businesses would not resume until May. Schools and universities are closed so now there are digital classes. The country had been running out of masks but the government had solved this problem. And there were now 10,000 free hospital beds in ICUs. People are very appreciative of and relaxed about the government’s actions.
Professor D’Souza spoke of how Australia was doing well, certainly on a per capita figures collected by the John Hopkins University in Baltimore. Seventy persons had died. The death rate was 0.24 deaths per 100,000 population, compared to Belgium (45.20 deaths), Italy (37.64), Spain (42.81), the United Kingdom (21.97) and the US (11.24). The Australian government had moved fairly quickly in closing the borders, closing down non-essential business and introducing social distancing. Many employees were working from home accompanied by many online meetings. Very crucial has been the successful formation of a national cabinet composed of the prime minister and State/Territory premiers with health experts, the first time since World War II. University classes were now online as were school classes. A major problem has been cruise ship passengers, and a police investigation is being conducted about how passengers were let off the Ruby Princess in Sydney without proper testing. Hundreds of thousands of people have lost their jobs, and governments have been offering job payment schemes at very great cost to offset the economic impact.
Professor Joe Fontaine spoke of the US situation. Covid-19 had highlighted the country’s weaknesses and there were major disagreements about the allocation of resources in balancing the various demands on care. As well, decisions are being made politically. New York has been heavily impacted whereas rural regions had more options. There was a need for good science on which to base good decisions. There will be social disruption until November. Vivienne Harpwood, Professor of Healthcare Law at the University of Cardiff, spoke of how quickly the Coronavirus Act had been passed by Parliament though there was some pushback by those who wanted to protect personal autonomy. She worried about vulnerable groups: the homeless, cancer patients and people with mental illnesses. There was also the issue of very expensive treatments. She finally concluded, “We will have to reflect on the inadequacies when it is all finished”.
Reported by Emeritus Professor Desmond Cahill
Deputy Moderator of ACRP
Chair of RfP Australia.