We have to know when to let go, says bioethicist


Many observers of the unfolding coronavirus crisis have lamented the apparent neglect of the elderly and the disproportionate number of deaths. But, writing in The Hastings Center bioethics forum, 75-year-old bioethicist Larry R. Churchill is more philosophical.

He contends that in a pandemic the elderly have “an obligation for parsimonious use of newly scarce and expensive health care resources”.

My position is grounded in a lifespan approach to ethics. The basic idea is that ethics must be rethought at various stages in life and that what might have counted as virtuous or responsible during one phase might be irrelevant or even counterproductive at a later stage.

For example, autonomy and productivity, which were cardinal virtues in my youth and middle age, are increasingly unimportant. Things I now value highly are convivial friendships, kindness, and humor, and the essential moral tasks are now integrity and bearing a series of inevitable losses with some degree of dignity. Allowing the moral values I earlier prized to remain prominent into my mid-70s would be a sign of arrested moral development.

With that in mind, he says that his obligations are as follows:

  1. To the extent possible, to keep myself well, reducing the burden on the system as a whole;
  2. To think of myself as already infected, and be especially vigilant about hand-washing, social distancing, and eliminating nonessential occasions for exposure;
  3. To refrain from using health care services whenever possible, making sure I am not simply responding anxiously to something I can manage alone or something that can be postponed;
  4. To refrain from being tested, or to allow others to be tested first, even if I have symptoms; others have much more at stake in knowing their status than I do;
  5. If hospitals become overwhelmed, to refrain from being hospitalized, even when that is recommended, except when I become a major hazard to others in my household; here I would hope for a more robust availability of palliative measures in home care;
  6. If I am hospitalized and ventilators remain scarce, to forego ventilation in favor of younger patients;
  7. When a vaccine becomes available, to move near the end of the queue.

Michael Cook is editor of BioEdge




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