GESTIÓN EN SALUD PÚBLICA: Coronavirus and the ethics of home isolation

domingo, 22 de marzo de 2020

Coronavirus and the ethics of home isolation

Coronavirus and the ethics of home isolation

Bioedge

Coronavirus and the ethics of home isolation

by Xavier Symons | 21 Mar 2020 |

Hundreds of millions of people around the globe have been forced to isolate themselves at home in the face of the rapidly escalating coronavirus pandemic. As the grim realities of the global pandemic sink in, ethicists are fielding questions about how people should navigate the challenges of isolation. Here are a selection of questions that have popped up in the media in recent days.

Do I have an obligation to stay at home?

Many countries have already introduced lock-downs in regions that have been hard-hit by the virus. In other places, however, authorities are relying on citizens to voluntarily isolate themselves if they feel they are a risk to others. So do you have an obligation to stay at home?

The obligation for a sick person, or someone who knows they have been have exposed, is clear, according to epidemiologist Jim Thomas (University of North Carolina). “Let’s say you’ve attended a conference where somebody tested positive...I would be seriously considering staying home from other events because I could be infected and not know it”, Thomas told reporters from Quartz.

The obligation for someone healthy, in what he calls a “low-risk” place with relatively few confirmed cases, is a little murkier. Yet even when you are healthy, the risks are significant when you consider the possibility of transmitting the virus to others: “Where could I become infected, I could be a risk to other people. I could be a burden to the healthcare system,” Thomas said. “There are other ways that I could affect society that I should care about.”

Is it okay to send my children to daycare?

In many countries, day care centres remain open as authorities seek to minimise the impact of the virus on the provision of essential services. Yet environments like daycare centres are places where the virus could easily spread and infect both staff and families as well as children.

In a interview with Washingtonian, Georgetown University bioethicist Daniel Sulmasy cautioned against sending children to daycare if you are not involved in the provision of essential services:

“While universities and schools are closed, daycare has remained open in many jurisdictions. In large measure this is because daycare is often needed to enable health professionals and first responders like firefighters and police to do their jobs. Yet we all know that daycare centers are like viral tissue cultures—children playing together often have close contact and spread all kinds of viral illnesses to each other and to their families. The same will doubtless be true for COVID-19. And since older persons are more susceptible to severe disease than are children, toddlers can be asymptomatically infected and pass the disease [to older persons]”.

Is it ethical to order food online in the coronavirus outbreak?

As people seek to adjust to new home isolation requirements, requests for home delivered food have skyrocketed. But is it okay to ‘outsource’ your own risk of infection to a delivery worker?

It depends, says University of Oxford practical ethicist Carissa Veliz. Speaking with The Guardian, Veliz said:

“Society always relies on a minority of people to carry out risky or unpleasant jobs that not everyone is willing to do. To be ethical, ideally, those people should be paid more than others who have more comfortable jobs...Try to do your best. If you order, treat couriers kindly and convey your ethical concerns to companies. Ask if workers’ jobs are being made as safe as possible, and whether they can take sick leave...[If] you order from a family business where they are careful towards their workers and so on, then it’s not clear to me that that it’s unethical at all. On the contrary, one concern is that small businesses will go under during this time, and that will be terrible for the economy as a whole and for families too. So we have to balance it.”

One of the guidelines of the UK’s Nuffield Council on Bioethics about the coronavirus pandemic (see below) is that “Liberty-infringing measures to control disease, such as quarantine and isolation, can be justified if the risk of harm to others can be significantly reduced.”

I agree, but I am still surprised at how few questions have been raised about the draconian restrictions on civil liberties prompted by the crisis. These are sure to lead to recession, soaring unemployment, bankruptcies, and social dislocation. They are the harshest that I have ever experienced in my lifetime – and, with few exceptions, there’s been nary a peep of opposition. In fact, my impression is that op-ed pages segued smoothly from anger at government overreach to anger at government underreach in a month.

How long can lockdowns be sustained? As the Wall Street Journal points out, “no society can safeguard public health for long at the cost of its overall economic health.” I don't think that it is utilitarian to observe that deferring or suppressing discussion of the costs, financial and social, of our response to the coronavirus could backfire. Human dignity is paramount; acting ethically is essential. But good ethics is based on a knowledge of all the facts -- and not just the facts about hand-washing.