What ought one do? COVID-19 a quandary of ethical decision-making

By Kristy Muir

Wednesday April 8, 2020

Choice is everywhere. Adobe

Like many people, my husband and I have started shopping for five of our older neighbours who shouldn’t be leaving their homes. This one was an easy decision. Is it safer for us to shop or them? Us. There wasn’t really a debate for us to consider. Between Jamie and I both doing trips to the supermarket we can (usually) get what all four households need within the supermarket limits.

A trip to the supermarket is (almost) a happy outing to get out of the house, but it also feels a little like running the gauntlet. Did I remember to pack some wipes in my pocket (the hand sanitiser ran out long ago; and I’m not sure what we’ll improvise with next when the wipes are gone)? Who has touched this item? How do I avoid picking something up and putting it back down so someone else doesn’t have to touch something I’ve touched? How do I stay far enough away from the people at the check-out to keep them safe? Do we really need this product, could we wait another week, or should we leave it for someone else who is more desperate?

The supermarkets have now put in place screens to protect their workers. It’s a good initiative, but many I notice are still not wearing gloves and they’ve got to touch all the products that we’ve touched, and some are still touching and packing the bags we bring from home. Should the supermarket be supplying and requiring gloves and face masks for their staff?

One of my teenage nieces works for Woolworths and has therefore suddenly become one of the “essential” workers we rely on. My twin sister is in a predicament: Does she pull her teenage daughter from the job because of increased potential exposure of COVID to the rest of the family? Or does she let her daughter keep the job she loves, that society needs, that gets her out of the house and gives her some sense of normality, while everything else — her school, friends, sport and social life has been significantly disrupted? What ought she do? And, does it change the answer if I add that my twin sister has a pituitary tumour and has had brain surgery twice before and that she and my nephew and niece are all asthmatics?

This week I also had my six-monthly check-up appointment with my retinal ophthalmologist. Do I go? Don’t I go? Will I be risking my eyesight and end up being a more significant burden on the health system if I put this off? Which option will subject me and others to the least risk? After a phone call to the clinic to ask them about their practices to keep staff and patients as safe as possible and as someone who almost lost their sight in my left eye two-years ago, who is a ‘ticking time bomb’ as far as my right eye is concerned and who at risk of glaucoma, I decide I should go to the appointment.

Going home, I was grateful for a stable outcome for my eyes, for the health workers who were exposing themselves for my and other’s benefits, grateful that the public transport system was still operating for those who needed it, grateful that many workers had been told to stay home and so it was easy to be socially distanced on the train. I was aware that they were all working for the common good and at some moment they had to make a decision about whether to go to work, even if it might put them and their family’s health at risk.

It struck me that we are faced with ethical dilemmas almost daily now. Many situations we find ourselves in leave us with the question asked by Greek philosopher Socrates: “What ought one to do?”

In this climate of COVID-19, it feels like there has never been a time where we’ve been so collectively asked to make ethical decisions on almost every aspect of our lives. How do we make these decisions when there aren’t always black and white/right or wrong answers?

While many of us have learned about and discussed some of the biggest and most alarming ethical dilemmas (Philippa Foot’s the trolley experiment is the classic example: who lives and who dies?), we now seem to be facing ethical dilemmas on a daily basis.

We cannot underestimate the enormity of the ethical decisions being made by health professionals during COVID-19. They are grappling with some of these philosophical questions in a very real, raw and practical sense: Who lives? Who dies? Do I go to work to protect the sick, while potentially compromising myself and my family?

But this isn’t just a health system dilemma.

With COVID-19, every day we face significant ethical decisions in going about our lives. What we do and how we do it can have life or death implications for ourselves, our families, our neighbours and our communities.

The ethics of the decisions we make confronts all of us in so many aspects of our lives. We know that employees are making decisions around whether they go in to work or not; boards and senior executives are making decisions around the survival of their business, pay cuts and who does and does not keep jobs; and our politicians are faced with the unenviable task of making decisions that will significantly affect the health, economic and social outcomes of the population now and into the future.

As individuals, the questions and decisions are endless: Who do we and don’t we visit? Who does and doesn’t provide care and for who? Where is that care best provided? When does caring for mental health override physical health concerns? Do we pick up the extra pack of toilet paper because it’s there, or do we leave it for those who need it because we still have some spare at home? Is it ok to go and get takeaway? Are we spreading infection or supporting local businesses? Where do we exercise and who with?

The daily decisions we have to make may feel paralysing. A simple trip to the shops for bread and milk could be a minefield of ethical dilemmas.

What ought one to do?

The challenge with ethics, as Aristotle pointed out, is that ethical decisions are not a precise science. As Vanessa Pigrum, CEO of the Cranlana Centre for Ethical Leadership, reflected: “it’s impossible for any list of rules to dictate the ‘right’ thing to do in every situation. Instead, he [Aristotle] proposes we focus on identifying the larger good that we are trying to achieve. Keeping that goal clearly in view helps us to determine the right course of action in difference circumstances.”

Aristotle was a proponent of virtue ethics (generosity, moderation, courage, kindness, justice, friendship), but there are other ethical frameworks we can draw upon to help us make decisions about our actions and the approaches we take. We can combine the five universal ethical approaches to derive key questions worth considering as we navigate options and decisions in our work lives, caring responsibilities, family dynamics, keeping fit and trips to the supermarket.

  1. Purpose: What’s the greater purpose we are trying to achieve? What option is best for the most people and harms the least number of people? [Utilitarian approach1]
  2. Consider people’s rights: What are the moral rights of the people who might be affected by each option? How can I best uphold other people’s rights? How do I do this with dignity and respect for others? [Moral rights approach2]
  3. Consider fairness: Am I treating people fairly? Am I showing favouritism or discrimination to one group over another? Which option treats everyone the same? Where this is not possible, can I morally justify the decision? [Fairness/Justice approach3] 
  4. Consider social responsibility: Which option will be best for the common good? Is this beneficial for me and my family alone, or will this be a good outcome for others in the community and society? [Common good approach4]
  5. Consider morals and values: Which option best aligns to my morals, principles and values? [Virtue approach5]
  6. Look for blind spots: What are the potential moral hazards of my decision-making? What blind spots might be (unconsciously) convincing me that option A (that supports me personally) is better than option B that is the ‘right’ thing to do (or avoids putting others at risk)? Are there people we are forgetting in this situation? [Moral Hazard6]

This isn’t easy. Because what happens when one of these areas contradicts another, how do we balance the best possible option by looking at these holistically? It may require tweaks to the options, decisions or approaches we take?6 For example, if my twin sister and my niece decide that she continues to work, what are the approaches they and the supermarket take to keep her and everyone as safe as possible?

We’re not always going to get it right, but when we find ourselves asking, “What ought one do?”, we can apply this framework to help navigate the decisions we make and the approaches we take.

Having an ethical framework may assist us with deeper reflection about our decisions. And it may just make me (and hopefully others) rest a little easier that we are making the best decisions we can with the information we’ve got for the greater good and for the people we love and care about.

There is much to be lost in COVID-19, but there is also much to be gained (or regained) in how we live our purpose, our values and demonstrate our humanity to not just our loved ones, but also strangers.

References

  1. Peter Singer (1993), Practical Ethics 3rd edition, Cambridge University Press, Cambridge; Markkula Center for Applied Ethics (2014), Calculating Consequences: The Utilitarian Approach to Ethics, Santa Clara University
  2. Kenneth E. Aupperle. K.E. (2008), Moral Decision Making: Searching for the Highest Expected Moral Value, International Journal of Organizational Theory and Behaviour, 11(1), 1-11.
  3. Waheed Hussain, W. (2018), The Common Good, Stanford Encyclopedia of Philosophy, Stanford University.
  4. Walker, R.L. and Ivanhoe, P.J., Ed.s (2007), Working Virtue: Virtue Ethics and Contemporary Moral Problems, Oxford University Press, Oxford; and The Ethics Centre (2016), Ethics Explainer: Virtue Ethics.
  5. Matthew Beard (2020), It’s easy to avoid the people we can’t see.
  6. Velasquez, M., Moberg, D., Meyer, M., Shanks, T., McLean, M., DeCosse, D., André, C. and Hanson, K. (2009), A Framework for Ethical Decision Making.

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