Coronavirus ethics begins with a recognition of our limitations
The Covid-19 pandemic gives us, in the Judeo-Christian tradition, an opportunity to remember that we are finite creatures. The United States has a “can do” culture that brought us to the moon, but we can be impatient and expect things to happen instantly. The coronavirus brings us face to face with the reality that we have limitations. We have a limited number of hospital beds. Our health care personnel are limited, and our knowledge is limited.
Our ability to face reality will be tested on the frontlines, where heroic health care workers face their own health risks while they deal with supply shortages and long work hours. Americans do not like to talk about limits; it goes against our national mythology. But we have always limited health care by excluding people from the system. Before the Affordable Care Act was passed, over 44 million Americans were without health insurance; even now that number is over 25 million.
Americans do not like to talk about limits; it goes against our national mythology. But we have always limited health care by excluding people from the system.
In confronting the coronavirus, we must recognize another kind of limitation: We do not have an unlimited supply of the ventilators that assist the most seriously ill to breathe. As The New York Times reports, medical leaders in Washington State, which had the earliest wave of Covid-19 diagnoses, “have quietly begun preparing a bleak triage strategy...[that] will assess factors such as age, health and likelihood of survival in determining who will get access to full care and who will merely be provided comfort care, with the expectation that they will die.”
“Rationing” is a frightening word, but we will need clear ethical guidelines about how medical resources are allocated. Every accredited hospital in the United States must have a formalized way of addressing the ethical questions that arise when there is a shortage of resources or staff, but their guidelines may need to be updated to take into account the particular challenges of the coronavirus pandemic.
Should care be given first to the sickest people or to those with the best prospects of recovery? Should they go to the highest bidders? Can we take resources, like a ventilator, away from one patient to help another?
As we debate those questions, we would also do well to follow a tradition that allows patients to refuse medical treatments they find inappropriate. A distinction between ordinary and extraordinary means is based on choices by patients about the ways they would want to live. So a patient can refuse the most basic elements of human life, such as feeding or hydration. The wisdom of that tradition ought not disappear in a time of pandemic.
These are not easy questions to answer, but we need to be clear about the guidelines we use to help first responders do their jobs. We ought not to make these decisions on the fly. We need to be clear, in a public way, about our guidelines, and those guidelines should be set by those health professionals on the frontlines.
This pandemic also reminds us that we do not live alone. We are human beings, and we live in communities with one another. As a nation, we should have a concern for the common good. Too often, we think of health care as if it were like any other consumer product that we buy, when, in fact, health care is built on a model of knowledge supported by public investment and infrastructure.
We should have a concern for the common good. Too often, we think of health care as if it were like any other consumer product.
Thomas Daschle, former U.S. senator from South Dakota, William Frist, former U.S. senator from Tennessee, and Andrew von Eschenbach, former commissioner of the Food and Drug Administration, developed a statement, recently published in Roll Call, that highlights the communal dimension of health care in an argument for greater investment in the U.S. public health infrastructure. “It has been estimated that we need an additional $4.5 billion a year to close the gap between what we currently spend on public health and what we would need to ensure that all communities across our nation are served by a strong public health system,” they write.
This pandemic reminds us that health is not simply about the individual patient; it is about community. The United States has not been facing this reality. Our health care system should reflect communal solidarity and deeply held Christian ethical values.
In this pandemic, we have seen examples of the extremes of human behavior in society. There have been stories of people hoarding cleaning products and fighting over groceries. At the same time, we have seen heroic examples of doctors, nurses and health care workers, along with the staff of nursing homes and assisted living facilities, risking their lives in caring for some of our most vulnerable. Both reveal contrary tendencies within the human heart.
We are witnessing both human selfishness and grace in our society, revealing our finitude and our limits. This pandemic confronts us with the limits of our physical health, our resources and our knowledge. It can also remind us of what is possible through the grace and love of others and especially of God. Throughout all of this, we are reminded once again that Good Friday is not the end of the human story, but a theological prelude to Easter Sunday and Resurrection.