The restrictions and lockdown measures related to curbing the spread of the novel coronavirus have raised ethical questions, which, in my opinion, have not been studied in sufficient depth.
There are four universally accepted ‘pillars’ of medical ethics. These are, in no particular order; non-maleficence, beneficence, autonomy and justice. The original Hippocratic Oath taken by physicians requires the physician to swear ‘primum non nocere’, meaning “first, do no harm” or non-maleficence. In short, beneficence means acting in the best interests of the patient, which includes honesty. The moral ideal is to maximise medical benefit with minimal harm i.e. beneficence with non-maleficence (Gillon, 1994). Autonomy is the freedom a person has to make a decision about their own life. Finally, justice is a multi-faceted concept but broadly refers to the concept of fairness, and has equality at its heart (Gillon, 1994). Gillon conceptulalised justice into three sub-categories; rights-based justice (respect for human rights), distributive justice (just sharing of scarce resources) and legal justice (respect for morally acceptable laws).
The human rights of individuals in society are upheld in constitutional law as well as in the Universal Declaration of Human Rights (1948). They include the inviolable rights to life, liberty, privacy, family life, freedom of thought, conscience and religion (including public worship), right to peaceful assembly, right to work, right to education, and right to participate in the cultural life of the community, to name some. Article 3 (Everyone has the right to life, liberty and the security of person) expressly states the inextricable link between life and liberty- one cannot be in the shadow of the other. The emergence of new legislation affecting right-based justice is a source of moral and ethical concern.
As a person of religious faith, I am particularly concerned about my loss of freedom to practice my religion in public worship, as are many other people of different religions.
Having discussed rights-based justice in terms of human and constitutional rights, I will now discuss distributive justice. Private consultants in the Republic of Ireland have been left frustrated since the Irish Government agreed a deal to take over private hospitals in Ireland for a three-month period during this crisis. Private consultants were offered a new contract whereby they could exclusively see public patients to the detriment of their new and existing private patients, the latter of whom often have chronic illness requiring regular follow-up and treatment. The takeover deal comes with a huge financial burden to society but is it the best use of the healthcare budget available for public benefit? Implementation of social distancing in society, and all of its facets, comes with an enormous financial cost. This is where ethical questions are raised in terms of distributive justice.
Are available resources including staff, equipment and hospital beds, being distributed justly for societal benefit? Important services like outpatient clinic appointments and cancer screening services have been cancelled, which will undoubtedly lead to morbidity and mortality. Has this been weighed up against the burden of the novel coronavirus and is it just to deprive people of health services which are available for their beneficence?
Thirdly, there is legal justice. The legislation which has been adopted seeks to act in the collective public interest. This places more importance on collective rights than individual rights, which poses a huge ethical question about whether the legislation is morally acceptable to society and therefore just to begin with.
Lockdown is having an enormous impact on mental wellbeing. People are experiencing anxiety and depression from loss of education, employment, financial strain, relationship difficulties, domestic violence, lack of routine, loss of religious freedom, loneliness, and lack of fresh air and physical exercise; the latter of which we know is important for mental wellbeing. Visitors to the acute psychiatric unit have been stopped for a number of weeks and patients are finding this extremely difficult and detrimental to their recovery, where support from loved ones plays a huge role.
It is possible to count numbers of deaths, but how do we measure pain, anxiety, depression, loss of employment and education, loss of religious freedom etc. and weigh these important factors related to quality of life against death from COVID19?
Reassuringly, ~84% of people in Ireland who have been diagnosed with COVID-19 have recovered. Perhaps basic measures like increased frequency of handwashing and asking those with symptoms to self-isolate for 7-14 days were just as effective at reducing spread and much less damaging than asking the healthy population to also stay at home.
In summary, I have highlighted some concerns pertaining to current social restrictions and lockdown measures in terms of ethico-legal considerations. It is apparent that, in writing this article, I have been left with more questions than answers.
Dr Bernadette Kevin studied medicine at Queen’s University Belfast from 2010-16. She obtained a First Class Honours degree in Medical Science from Queen’s University Belfast in 2014. This intercalated degree involved a research project with the Centre for Infection and Immunity (QUB) and a thesis on the pathogenesis of opportunistic bacteria in cystic fibrosis. She is passionate about human rights and humanitarian work in Africa.