Category Archives: Ethics

What is equitable Distribution of Vaccines?

 

Yesterday Chris and I got the first of our vaccine shots. Hooray! We didn’t ask if this was just or not. It was offered to us and we grabbed it.

 

No one asked whether the current system of vaccine distribution was actually fair or just. Such questions were off-side. This was an emergency. No one had time to think about justice. What an arcane concept. Every official concentrated on getting the medicine out as quickly as possible. Questions could be asked later when the job was done.

Now some interesting information is becoming available. Information is critically important in assessing actions. Good facts make good ethics. And there were some ethical issues.

Here is what Lindsay Glassco said,

“With the reality of our global interdependencies laid bare, the race for mitigation has already begun. A recent study found that equitable vaccine distribution was about more than ensuring all countries have a line of defence against the health impacts of COVID-19 — it is also our best line of defence against economic devastation.

 

In the most extreme scenario, with most wealthy countries vaccinated by the middle of this year and lower-income countries largely excluded, the global economy would suffer losses exceeding US$9 trillion.”

 

Money has a tendency to sharpen judgment. With trillions at stake, where are the ethics? Was the rush to fill arms with vaccines the right approach? Not according to the World Health Organization:

This is why the World Health Organization is advocating for an equitable response through the COVAX global vaccine sharing initiative. While one country’s vaccination strategy may keep its citizens safe temporarily, the heightened risk for virus spread and mutation in unvaccinated countries can continue to grow, eventually crossing borders. Within a few weeks, or even days, we could find ourselves in the same situation we were a year ago — or worse.

 

It is only natural that all of us (except for the sceptics) want the vaccine as soon as possible. We want it for ourselves and our loved ones. That is only natural. And we won’t spend a lot of time thinking about whether anyone should get it before we do, or at the same time. As a result, neither will our governments. The politicians can see by our actions what we want. We want justice for ourselves and families immediately. Once we are all safely inoculated we can discuss what we should do for others. Not now.

Many Canadians have learned what it is like to live in a pandemic coupled with a severe loss of jobs. People are suffering. Either from the disease, or the economic costs of the lockdowns. It is understandable that people want their political leaders to look after these issues and keep their eyes on the ball at all times. This, to most Canadians, is a time for action, not a time for justice. As Lindsay Glassco said,

“As a result of COVID-19, for the first time in many of their lives, Canadians are experiencing some of the hardships that millions of people in other countries face every day — children out of school, economic disruptions, sickness and disease, and scarcity of resources — leading even to hoarding. While these hardships are experienced to varying degrees, their existence is eye-opening and powerful for many.”

 

Yet, at the same, many of us can see, that we are all in this together. None of us want to be seen as hoarders. We mocked hoarders of toilet paper. We felt sadness for hoarders of vaccines. We have deep empathy for “front line workers,” who are putting their lives on the line for the rest of us every hour of every working day. Some of us even feel a modest twinge of guilt. Not enough  to get us to change places with those “essential” front line workers we claim to cherish so deeply.  At least we want to say we feel connected to them, even if none of our actions show that this is true.

Personal interest does not usually sharpen our moral compass. Rather it often dulls it.

Sometimes good ethics is good policy

I admit it I am chomping at the bit to get Coronavirus vaccine. I missed my first appointment, I don’t want to admit my second one coming up soon.

Yet, I also know, no one is safe until we’re all safe. Some of us (not many) are starting to see that rushing the vaccines into as many arms as possible is not the only issue. It is important, but is it overwhelmingly important?

Or is this a time for us to support  the equitable distribution of vaccines and investments to strengthen global health systems. Not just in Manitoba. Not just in Canada. But around the world. Are Canadian seniors really more valuable or important than seniors in Kenya? Or Afghanistan? When you think about it is there really any reason everyone in Canada who wants a vaccine should get one before hardly anyone in poorer countries gets one? No politician can suggest this is an issue. Of course ‘our side’ is more important than every other side.  Any politician who did not solemnly acknowledge this would be committing political suicide.

But not only that. Besides  doing the right thing, the moral thing, what is smart? According to Lindsay Glassco, writing in the Winnipeg Free Press, the smart thing might be to share! What if the smart thing is to do what the Golden rule says we should? Do unto others as we would have them do unto us? Glassco put it this way:

“Emotionally, that can be difficult to do. Many of us want our opportunity to be vaccinated to come up sooner rather than later, but the life we all want to return to – with healthy supply chains, trade and travel – will be out of reach until we get this virus under control globally. A fair, equitable global response is our only answer. Instead of focusing on the vaccination race with other wealthy countries, we need to recognize that we’re all losing until the whole team crosses the finish line.”

 

In fairness to Canada, we have actually done quite a lot to share our good fortune. COVAX is an international program where some countries have agreed to share with less well-off countries. As Glassco said,

“Canada is now one of the largest contributors to COVAX, having recently pledged $75 million to the program on top of what it had already previously committed. To date, the Canadian government has mobilized more than $2 billion in its global COVID-19 response.”

 

I don’t know about you, but I am pretty proud of that. Canada is doing something significant. Maybe it could do even more; I don’t know. But it is doing something good. I suspect my Member of Parliament will criticize the Liberal government for its lavish spending on third world countries. I won’t. I like it.

Lindsay Glassco said it as well as it could be said,

“Canadians’ support of an equitable pandemic response is our defining moment to live our values and build back a better world for generations to come. No one is safe until we are all safe.”

 

Should Canada be a good Samaritan or the Pharisee?

Sometimes good ethics is good policy.

On the Edge of a moral catastrophe: Hoarding Vaccines is not the same as  hoarding toilet paper

 

It is often said that a war brings out the best of people and the worst of people. I think a pandemic works the same way. There have been some genuine heroes. I remember hearing about this nurse who went around the US to help out hospitals in the worst possible circumstances when they were on the verge of being overwhelmed and would not have survived without heroic people like her. She was not able to get health insurance anymore because the insurance companies were smart. They knew she was taking crazy chances by going to hospitals swamped with Covid-19. And then she had to deal with people who did not believe the disease was real, even as they were dying. If the nurses had good sense—like the insurance companies—they would have said sorry I can’t help you. But they went any way.

 

Then there were the people like me from rich countries like Canada complaining that our  government was not getting the vaccines out fast enough.  Every government was criticized. Usually, the governments were all doing the best they could in novel circumstances without a proper playbook.

Yet, there were also people who cheated. Like the rich people who flew to the Yukon to pose as local people who were getting the vaccine faster than the people down south because indigenous people were suffering disproportionately.

Yet we are all in the west benefiting from dubious morality.  This is what The Guardian reported when the global deaths from Covid-19 exceeded 2 million:

“Meanwhile, the head of the World Health Organization has said the world is on the edge of a “catastrophic moral failure” in the distribution of Covid-19 vaccines with just 25 doses administered across all poor countries compared with 39 million in wealthier ones.”

 

Hoarding vaccines is not the same as  hoarding toilet paper.

Why are African Americans suspicious about vaccines?

 

Unfortunately, the colonial past of the USA and Canada means that African American and indigenous people have little trust in their governments.  For good reason they fear they might be taken advantage of because that has happened so often in the past. This is a stark reminder of the legacy of exploitation on the basis of race in both countries. The consequences of that racism are long, sinewy and durable.

In the US one incident stands out. That relates to 40 years of deadly experimentation at Tuskegee by Alabama scientists saturated with the dominant ideology of the time–white supremacy. Those experiments bred suspicion–justifiable suspicion. Those suspicions are now haunting the United States many decades later when it needs the trust of everyone–including African Americans.

It is well-known that historically people of colour have been taken advantage of during health emergencies. The African American men of Tuskegee Alabama were one group that was shamelessly exploited men.

More than 40 years ago scientists got the idea that they would like to “observe the natural history of syphilis.” They wanted to use subjects that were completely unaware that they were involved in an experiment as otherwise the data might be contaminated.  Well, the data was clean; the minds of the experimenters were not.

To keep the minds of the subjects uncompromised, the experimenters thought it would be reasonable to lie to their subjects about what was going on. The subjects thought they were being treated for blood problems. Actually, they had syphilis and were not being treated for blood problems or even for the life-threatening illness they did not know they had.

These experiments were not conducted by some shady medical operatives. They were conducted by the United States Public Health Service (USPHS). It was an offshoot of the government! As Ada McVean explained, “Even after penicillin was discovered as a safe and reliable cure for syphilis, the majority of men did not receive it.”

Here is the really horrific fact. As McVean said,

“Multiple times throughout the experiment researchers actively worked to ensure that their subjects did not receive treatment for syphilis.”

 Actually, the researchers took active steps to prevent participants from getting treatment that could have saved their lives.

Most of us have heard of experiments Nazis conducted on prisoners of war and in the death camps. Those prisoners had no choice. They were the victims of a totalitarian state.  How much better off were the African Americans?

Eventually  there was huge outrage across America. A Class action lawsuit was launched, as it should. In 1974, after I had already been in Law School for nearly 3 years, to put the time into context, Congress passed a law that scientists would be required to obtain informed consent from all subjects, even African Americans.

Yet, as I said, the legacy of exploitation is long and hard. That history is part of the reason that African Americans are reluctant to take vaccines even when their physicians or friends recommend them. And now the United States desperately needs the cooperation of African Americans. If insufficient numbers elect to take the vaccines the United States will not attain herd immunity and then the virus will continue to spread among the unvaccinated communities and, perhaps, even affect those who have been vaccinated, if the virus continues to mutate and evolve to  achieve victory over the vaccines. This poses a real risk to all Americans! Sometimes the effects of historic injustices can be felt through the generations.

McVean summarized the problem this way:

“We know all about evil Nazis who experimented on prisoners. We condemn the scientists in Marvel movies who carry out tests on prisoners of war. But we’d do well to remember that America has also used its own people as lab rats. Yet to this day, no one has been prosecuted for their role in dooming 399 men to syphilis.”

This is why historic injustices require truth and reconciliation. That is a lesson the United States has not learned. Canada claims to have learned, it but I am not sure they have.

 

The Common Good in a time of pandemic

 

In talking about vaccines, there is another significant and extremely interesting issue. I think we in Canada would acknowledge, unlike perhaps our neighbours to the south, that if you live in a society where only people of wealth and privilege have access to the vaccines that is unjust. I think the Americans have come to realize this too.  We and they  really are in this together, and that if everyone, or most people at least, don’t get vaccinated, we  will never achieve herd immunity. I think as a result Americans too have decided to make vaccines freely available to everyone. I guess they would call it “socialism, at least  for vaccines.”

In Canada this was never an issue, and we early on made the decision that the cost of the vaccines will be born collectively. I think we have made, through our elected political leaders, the right decision. Everyone who wants the vaccine should be able to have it at public expense.  Vaccines are a public good. In some countries that is not so clear. Then, I would submit, the case for justifying restrictions only on those who did not “voluntarily” take the vaccinations would be an uneasy one. It would be harder to justify the restrictions in such a society. Thankfully, that is not an issue in Canada. That shows the advantage of doing some things for the common good.

Most of us have come to appreciate that, except for some religious groups like the Church of God Restoration. They don’t appear to believe in the common good. They want to exercise their religious rights whether that is good for everyone or not.

As I said earlier, the government must justify its restrictions and the onus of proving that the restrictions are in fact justified is on the government. If the government is not able to prove the restrictions are justified on the basis I have shown, those restrictions cannot survive a challenge. Some people have argued that because it is estimated that it will take between 6-8 months to vaccinate everyone it is not a good idea to usher in a phased opening up of restrictions for those who have got the vaccine, because this will erode public trust and confidence in the system. People will feel resentful at what they believe is inequity. As a result, social cohesion is being jeopardized by such an approach. Social solidarity is a very valuable common good. That has been amplified demonstrated over and over again during this pandemic. We need social cohesion and trust. Without that we cannot have good government or good social and health policy. We must be careful not to jeopardize this important social good.

This is an argument worth considering. My own view is that this is a risk worth taking.  I recognize that social solidarity is common good that must be included in our weighing and balancing of those goods. I think those of us who are not at the head of the line for vaccines have to learn to suck it up for the common good. Those of us who do that must not be consumed by resentment. For the greater good, we have to learn to accept that. Then, if we do that successfully, we will have achieved greater social solidarity because those who got the advantages will be forced to acknowledge what those who got their benefits later agreed to allow others to go first.

Added to that, we must also consider that opening up the economy on a phased in basis, rather than waiting until everyone is safe, will bring about substantial economic benefits to which we will all have access. Then this would make economic and social sense. That would also be a common good.  The common good is very important.

I hope I am not being a Pollyanna a here. I would like to know what others think.

Difficult Cases make Bad Law and Bad Rules

 

Even with all the facts and good principles, there  usually are some difficult cases in many ethical disputes. There always are difficult cases in ethical disputes. What should be done about people who can’t be vaccinated for good reasons? For example, I understand pregnant women are being advised not to take the vaccines until enough scientific evidence is obtained that confirms it is safe for their fetus. Recently I heard that advice is being moderated by some doctors.

What should be done about people who have underlying medical conditions that make it unwise or unhealthy for them to take vaccines? Perhaps such people might have to wait until enough other people have taken the vaccines that herd immunity has been established. That is unfortunate for them, but is it  not a reasonable restriction to keep them isolated until it is safe for them to do so? Is it too much to ask them to remain at home and if they venture out social distance from others? Perhaps reasonable accommodation can be arranged for such people. If they venture out unprotected, they don’t harm only themselves. They endanger us all and our medial system as well. People should be allowed to do as they please (at least more than now) after they achieve anti-bodies or vaccines. Until it is established that they can’t transmit the virus we have the right to demand they follow health restrictions.

Freedom is an important good, but it is not  an absolute one.

 

Good Facts Make Good Ethics

 

When it comes to Covid-19 the facts are not clear nor free from controversy. It would be nice if we could delay having to make  decisions until all the fact are known, but in a pandemic we don’t have that luxury. Some things must be decided now, on the basis of the best facts available.

We must also admit that the “facts” are constantly changing. Covid-19 is a novel disease. It was unknown to science until a little more than a year ago. When it first became known, the scientists had to give advice based on minimal knowledge. Most of it was on conjecture based on other similar diseases such as SARS and the common flu among others. Now they have a lot more knowledge, but it is still mainly preliminary knowledge. So we don’t really have good facts. And good facts are needed to arrive at good ethics.

Some people were annoyed when scientists at first said, masks were not recommended because they were unlikely to prevent disease spread. They based that on the basis of things they had learned from earlier similar infectious diseases. Later scientific evidence accumulated that the scientists were wrong in their earlier prediction and they quickly changed their advice. As a result some governments made masks mandatory in some situations. Scientists did what they should do. They changed their scientific advice based on better science and more facts. To have done otherwise would have been malfeasance. Only religious leaders can be expected to give infallible advice forever!

In applying the principle of John Stuart Mill I enunciated yesterday, we must acknowledge that imposing restrictions on people as the authorities have done during this pandemic  is a severe curtailment of freedoms people are ordinarily free to exercise. It even amounts to an interference with religious rights guaranteed by our Charter of Rights and Freedoms.  Is such a restriction justified?

First, an infringement on a fundamental freedom is not justified if there is a better way. The impairment of the right must be the most minimal impairment needed to prevent the harm. If I am not at risk of likely spreading the dangerous Coronavirus  the people or the government, they elect are not justified in restricting my freedom of movement. The default position is liberty. I am free to do what I want unless the government proves that my actions will likely create an unreasonable risk of serious harm to others. The onus of proof must be on the government. The government does not have to prove this beyond a reasonable doubt. It is sufficient if it can establish, on a balance of probabilities, that my actions will likely lead to serious harm.

The harm avoided by imposition of restrictions cannot be a trivial one either. The avoidance of trivial harms to not justify interference with fundamental freedoms. For example, such restrictions would not be justified to avoid the common flu. The government must also establish that reasonable alternatives, which would have less effect on my fundamental freedoms are not available. In other words, it must prove that curtailment of my freedom does not exceed the most minimal curtailment that would be sufficient to avoid the harm. If the restrictions are not necessary to achieve the public good, such as freedom from a serious disease, then the governmental restrictions are not justified.

The imposed harm by the government  (e.g compulsory vaccinations) must also be effect at avoiding the harm it is trying to avert (e.g. serious illness). If they are not effective the infringement of freedom is not justified.

Using these principles how do they related to the facts on the ground? First are the vaccines effective at reducing risk of serious harm? There is growing evidence that the vaccines (all of them) are very effective at reducing the risk of serious illness. They are not as effective at stopping minor illness, but we can live with that. We want to avoid the serious illness and death.

To begin with, one must also weigh the harm inflicted on the people who would have chosen not to get vaccinated. The large weight of scientific evidence is that most harms resulting from the vaccination are extremely minor if not non-existent. No more reasonable harm that impairs our freedom less than compulsory vaccinations has been discovered.

Secondly, recent studies have shown that all the vaccines approved so far are about 95% effective at preventing serious illness. Most people who took the vaccines did not become seriously ill and did not die. Even if 1 person in 20 dies after the vaccination, or gets seriously ill any way, the benefits to the majority greatly outweigh the detriments to the minority who would have chosen not to be vaccinated had they been free to do so.

Currently scientific evidence is still in a state of flux as more information becomes available. For example, there have been new variants of the virus that have resulted from mutations. These appear to be more contagious and, in some cases, also more severe. As a result, dealing with this virus demands even more diligence. Some people get annoyed by this. They call it flip flopping. This unfair. This is how science, unlike theology, works.

I will continue this analysis in tomorrow’s blog.

 

An Ethical Approach to Vaccine Passports

 

Would it be fair to opening up society in a time of pandemic only to those with Passports (or other documents) that could satisfy us that allowing people who have had one of the vaccines for Covid-19 or had the “benefit” of having contracted the disease and developed sufficient antibodies? In either case, presumably it is safe to let these people wander around, more of less freely, while we continue to curtail the freedoms of those who don’t have such a passport.

First, it is clear, that current health restrictions in Canada are fundamentally restrictive and a substantial interference with our freedom of movement and freedom to gather as we see fit. Clearly this violates a constitutional right, as I have argued in an earlier blog post. Ordinarily such prohibitions could not be justified in a free and democratic society. But these are special circumstances? Are they special enough to provide the justification?

I think a good place to start my answer to this very interesting question is the classic book On Liberty, by John Stuart Mill. Mill recognized in 1859 that people had the right to fear “the tyranny of the majority” which, he said, “is now generally included among the evils against which society requires to be on its guard.” In other words, Mill argued there are limits on what a majority is entitled to do. As he said,

“There is a limit to the legitimate interference of collective opinion with individual independence: and to find that limit, and maintain it against encroachment, is as indispensable to a good condition of human affairs, as protection against political despotism.”

To Mill as to many lovers of freedom, all that makes life valuable requires there to be reasonable limits or restraints on the actions of other people, either directly or through their elected representatives. Mills posed a clear answer to what he considered those reasonable limits. Mill said that there was one very simple principle that provided an answer to what are the reasonable limits. He elegantly put it this way:

“…the only purpose for which power can be rightfully exercised over any member of a civilised community, against his will, is to prevent harm to others. His own good, either physical or moral, is not sufficient warrant. He cannot rightfully be compelled to do or forebear because it will be better for him to do so, because it will make him happier, because in the opinion of others, to do so would be wise, or even right. These are good reasons for remonstrating with him, or reasoning with him, or persuading him, or entreating him, but not for compelling him, or visiting upon him any evil in case he do otherwise. To justify that, the conduct from which it is desirable to deter him must be calculated to produce evil to some one else. The only part of the conduct of any one for which he is amenable is to society is that which concerns others. In the part which merely concerns himself, his independence is, of right, absolute. Over himself, over his own body and mind, the individual is sovereign.”

This is the fundamental principle of classic  liberalism. The principle is often called the principle of autonomy. In simplified terms, this means that everyone should be free to do whatever he or she wants, without hindrance, unless the exercise of that freedom will harm others.

With some limitations, not relevant to this discussion I accept that principle. How is to be applied to the question at hand. To do that we must look at the facts, as best we can, for as Professor Schafer said, good facts produce good ethics.

In my next blog posting I shall show how this principle applies to the Covid-19 Passport.

Are vaccine passports fair?

 

As part of a project since I retired (more or less), Christiane and I have been attending various activities under the general heading of continuing education or learning for life. We have been taking all kinds of courses at various venues—from the University of Manitoba to McNally Robinson Booksellers. Many of them have been truly amazing. It probably doesn’t show, but Christiane and I have learned a lot.

Recently we latched on to a new venue, the Rose and Max Rady Jewish Community Centre. This is a gem! It has all kinds of programs. Our first venture was a concert of music from 2 of Manitoba’s finest French musicians who played classic French Canadian music, including some wonderful country tunes. Our next venture was a lecture by my guru, Arthur Schafer, a professor of philosophy at the University of Manitoba and director of the Centre for Professional and Applied Ethics at the University of Manitoba. We participated via Zoom in a delightful talk by Professor Schafer on the subject of the ethics of vaccine passports. I is surprising how many ethical issues arise during a pandemic.

Professor Schafer pointed out to us that Israel has recently imposed what it calls a Green Passport. In Israel the rules of confinement imposed by Covid-19 requirements apply to everyone with very exceptions. One of the exceptions is that holders of green passports are entitled to move about freely as they wish, except that in public places they must wear a mask to protect others. The Green passport gives a record of one’s immunizations, including the date taken, and whether or not one has contracted Covid-19 to such an extent that antibodies have been produced in that person. If you have such a passport you can almost go anywhere you like free of encumbrances.

Other countries are now considering the same thing, including Canada. In some places they call it Vaccine Passport in others an immunity certificate, but the effect is always more or less the same. Special privileges are given to those with the Passport. Is this a good idea? Is it fair? Is it just?

Unlike Canada, in Israel 50% of the people have already received vaccinations . So, 50% of the people can do basically what they want, and the rest have to wait until they get their vaccine shot.  But the other 50% have to stay home and suck socks. Is that fair?

In Israel, as in other countries, some people object to vaccinations or are reluctant to take them, on religious or cultural grounds. Advocates for the program in Israel say it encourages people to take the vaccine. Opponents say the program is coercive, unfair, and unreasonable. Does the government have the right to coerce people to take the vaccine? What about people who can’t take the vaccine for medical reasons? Pregnant people are warned against taking the vaccine since there is currently insufficient evidence that the vaccine is healthy for a human fetus.

Now an incentive would be a good thing if the vaccine will protect our health system from being overwhelmed and posing a huge risk to many people and to protect our society and its citizens from devastating harm of the disease itself. These are both significant dangers. So avoiding them or mitigating them are a serious public good.

I ask you, is this reasonable or justified? What do you think? Tomorrow, I will give my views in my next post and I don’t want to influence anyone just yet.

Please give me the benefit of your opinions.