The moral issue is based on whether each human should be treated as an end and not a means to an end, in which case the value of each human life, irrespective of age and the use of that human to society, is equal.
by Ruwantissa Abeyratne
writing from Montreal
“We are not going to put a dollar figure on human life”
New York Governor Andrew Cuomo
The moral dilemma presented by the Covid-19 pandemic starts with the disturbing fact that there are just not enough ventilators to go around and eventually the decision will have to be taken in an instance when two patients are in equal need of a ventilator, as to who receives the ventilator and who does not. Should the deprived patient be allowed to suffocate and die? And if so, what would the criteria for selection be? Age? The economic value of the person to society?
For the entirety of 2019, only 77,000 new ventilators were required to meet the market demand of the entire world. For the month of April 2020, New York City alone needed 30,000 additional machines. Healthmanagement.org recorded that: “Italy's experience has already shown that approximately 10 to 25% of hospitalised COVID-19 patients will require ventilation for several weeks. How will this problem be handled as COVID-19 cases across Europe, USA and Canada continue to increase? Based on the estimates from Italy, the number of patients that could possibly need ventilation could range from 1.4 to 31 patients per ventilation. Will it become necessary to ration ventilators? This certainly depends on the pace of the pandemic, but most experts warn that this could be a real possibility…The goal is to save the most lives hence the decision to save which life is usually defined by a patient's likelihood of surviving an acute medical episode. But how does one allocate or ration ventilators? Should patients who have been placed on mechanical ventilation be withdrawn? There was a time when withdrawing a ventilator was akin to killing. Today, withdrawal of ventilatory support often happens in the ICU at the request of a patient or surrogate and is considered a legal and ethical obligation. But withdrawing it without the consent of a patient or surrogate is only allowed in a few regions and only when treatment is determined to be futile. But when its a pandemic like COVID-19, it's not the futility of treatment that is the driving force. It is a shortage of resources”.
It is also recorded that this dilemma has left many healthcare workers crying in the corridors and staircases, filled with remorse, despair and sorrow at the hard choices they are faced with.
The moral issue is based on whether each human should be treated as an end and not a means to an end, in which case the value of each human life, irrespective of age and the use of that human to society, is equal. This is essentially based on human dignity and not on a utilitarian equation of the ultimate happiness of the majority of a community or society.
Suzanne Dovi, in her article Sophie’s Choice: Letting Chance Decide published in Philosophy and Literature, (University of Arizona:2006) argues that genuine moral dilemmas do not carry specific answers and require those who have to take decisions to follow a random selection process when there is clearly no “better” outcome from the range of choices available to the agent; when particular kinds of moral burdens (guilt burdens) can be alleviated by that agent adopting a random decision procedure; and when the alternatives were given to, and not made by, the agent, say by a committee of sages so appointed to establish guidelines.
In such an unbearably emotional situation does one “pick” or does one “choose”. Does one “flip a coin”? Would one try to hitch both patients to the same ventilator to avoid guilt even if both may die of lack of an adequate flow of service from the ventilator?
There are some guidelines from 19th Century philosophy reflected in the theories of Emmanuel Kant (1724-1804) which say that at the centre of human life is dignity - the right of a person to be valued and respected for his own sake - and to be treated ethically. Therefore, how we judge the right thing to do does not depend on consequentialism which is based on the maximum happiness of the maximum number of people. Kanrt’s theory, called the “categorical imperative”, goes against the “pick or choose” criterion of utilitarian positivism and espouses that lives of both patients in need of the ventilator, or of many for that matter, as the case might be, have to be treated as being equal in value. Kant held that human life is centered on dignity which cannot be distinguished or treated by any other characteristics or social needs. Philosophically, the dichotomy would lie on the one hand in Kant’s theory of human dignity and the value of human life and Jeremy Bentham’s utilitarian theory of consequentialism and happiness and the good of the majority, on the other.
Lisa Tessman in her article How to make a difficult decision, when all the options are bad says:” No one should be forced into this position. Not all situations that present these sorts of choices can be prevented — there's always the possibility of bad luck — but at least we shouldn't knowingly bring them about”. Tessman quotes Kant by saying: “for an act to be morally obligatory, it must also be possible: so the impossible cannot be morally required. This principle is typically expressed by moral philosophers with the phrase: "Ought implies can." In other words, you can only be obligated to do something if you're also able to do it”.
Clearly, those faced with this dilemma – the frontline health services providers – should not feel moral inadequacy and remorse, nor should they ascribe guilt and responsibility for their inability to save lives under these circumstances. The moral blame and indeed responsibility should lie on those who can do something about this grave situation. The answer lies in the provision of adequate ventilators to meet the global needs. An article published in The World Economic Forum titled A better answer to the ventilator shortage as the pandemic rages on says the challenge is not impossible, only difficult: “To help all those people, ventilator manufacturers will need the support of a larger, global supply chain. The World Health Organization doesn’t need to commandeer all the ventilation-related manufacturing capacity and transportation, but the world’s most advanced supply chains – UPS, FedEx, DHL, Kuehne + Nagel, Panalpina, Nippon Express, the national post services and even national military procurement arms – should be working together to help ventilator manufacturers and their suppliers meet this single aim. Just as pharmaceutical companies and researchers are working together to produce a vaccine, the world’s top supply chains could pool resources and expertise to make sure these companies get what they need”.
As for those caring health service workers, they should be comforted by the words of the of the scriptures Do Your Best and Let God Do the Rest! (Colossians 3:23-24).
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