Dr. Smadar Bustan, Philosopher

The novelty of the global outbreak of the highly contagious coronavirus disease brought the entire world together as it shared a collective experience, while at the same time, pulled us apart with closed borders, home lockdowns, extreme social distancing and isolation. This coronavirus threat presented a unique set of features: everyone had to be treated as potentially positive as it is possible to be infectious while being asymptomatic. The disease often became a death sentence because there is no treatment or vaccine. Moreover, our contemporary evidence-based medicine was challenged as the notion of knowledge becamein transitu , knocking the solid bottom of the entire healthcare practice. Decisions need to be grounded in science but there was no science to rely upon. Information has been confirmed and refuted on a daily basis: face masks were publicly announced as protective measures but then their viability was debated, medical protocols at hospitals changed continually, confuse the frontline medical staff trying to save lives while feeding substance back to the experiential knowledge of medical care. Nations became indistinguishable by the worry and grief that joined hands: the long lists of hospitalized people shared on social media, the death tolls portrayed by endless lines of military fleet transporting bodies of coronavirus fatalities for burial in North Italy, the mass graves in Latin America or the extent of reported cremations of the Covid-19 victims in China, as well as the alarming cry of healthcare personnel worldwide.
The risk and prevention required to limit the coronavirus spread and rapidly work out the most efficient containment measures, divided the tasks between the political, medical-scientific, public and industrial sectors. Despite their exceptional collaboration, we seem to have turned back to population-oriented medicine after an accomplished era of individualized medicine, looking at the mass instead of the ill human being. In addition, when the whole world seemed to be coping as one, differences emerged in regard to national or even regional anti—Covid-19 management strategies, including sanitary and medical interventions. Since the onset of the outbreak, while keeping people alive has certainly been the immediate and primary imperative, healthcare professionals have been overwhelmed by pressing ethical challenges, having to make hard decisions for which they were accountable and to provide reasons for their actions and omissions. Clearly, clinicians are trained for ethical decision-making, but in view of the pandemic chaos paired with the incredible shortage of medical resources, ethics committees or advisory groups had to help by providing specific guidelines such as those endorsed by the ‘Covid-19 ethical decision-making tool’ (1).
The reality was and still is represented as being constituted in the same fashion as that of decision-making in times of war where the urgency, scarcity of medical supply or critical care beds, rapid spreading of new cases, time sensitive procedures, and fighting the unknown during a public health emergency continue to weigh efficiency (Is it the most effective? What will be the end result?) over the ethical (Is it the right thing to do ?). The dramatic phrasing regarding “the war against Covid-19” announced by politicians and health organization directors-general became integrated into the health care system. It forced challenges that no longer strictly applied to individual patient care (allocation of limited resources such as ventilators, the sharing of patients’ confidential information with relatives or even the media, denying opportunities for families to say goodbye before a death) but also applied to the role of practitioners who found themselves in a newly created chain of command.
The essential service of medical ethics and its decision making process, as I see it, consists in allowing for one part of the decision to lean upon another part of the decision in order to become unambiguous. In this way, each one of the several aspects in which the ethical decision may be considered, assures the values of the right and the good. Obviously, dilemmas put us in a situation of conflict where a difficult choice has to be made between different options. Medical ethics dilemmas create even more conflict than most because they touch upon human lives. The Covid-19 pandemic obliged us all to handle many dilemmas, some of which we took upon ourselves as philosophers, ethicists, doctors and nurses to discuss during the symposiumCovid-19: Ethical Dilemmas in Human Lives held on May 7th 2020 and organized by the Paris Global Center of Columbia University and the Columbia Global Centers. Humbly, we may not provide ready-made solutions, especially as the epidemics storm still rages. This discussion testifies to the ongoing pandemic emergency and its difficult challenges while evaluating whether the ethical principles in the recommendations were able to meet the lived reality. Looking at accountability and consistency in regard to the context of this emergency, it seemed equally important to examine, through an international exchange, whether the contextuality of COVID-19 across countries and cultures affected the ethical decision making processes. The following collection of the symposium’s acts maintains the discussion format whereby each dilemma is addressed by a Covid clinician and then analyzed by a philosopher or an ethicist, who, at times, is also a practicing physician. I organized the discussion around four ethical key dilemmas with leading questions, even though others clearly come up in the various discourses.