A New York hospital recently told its doctors to “think critically about who you intubate”. For the lay person that means make a decision on who lives and who dies. Yes, a disturbing but important ethical question; but the greater ethical question is: Why has any doctor anywhere been put in the position to make such a choice?
Pandemics have ravaged human history, and while this fact is hardly comforting at this time, the point needs to be made on how ready we were for the current event. As early as 2005 scientist were warning of the potential for a global health pandemic given the outbreaks of SARS, H1N1 (Swine flu), MERS and the potential devastating effects of the H5N1 virus (Avian flu).
In 2005 the World Health Organisation convened a meeting with the Food and Agriculture Organization, the World Organisation for Animal Health, and the World Bank (World Health Organization, 2005) to discuss the potential effects and impact of a mass outbreak of H5N1 and the potential for a global flu pandemic:
“Participants agreed that the threat of a pandemic was of shared and significant concern for all countries, and that actions to prevent a pandemic or mitigate its consequences were likewise a shared responsibility of all countries. Scenarios of events during the first influenza pandemic of the 21st century painted a grim picture for human health the world over, the survival of existing development projects, and the health of the global economy, with losses expected to reach around US$ 800 billion during the first year of a pandemic” (World Health Organization, 2005)
They recommended 7 key strategic action:
- Diagnostic capacity.
- Vigilance for imported cases.
- Investigations of human-to- human transmission
- Vigilance at the family and community level
- Virus and specimen sharing
- Patient management
- Obligations and time-frames for urgent actions (WHO,2005)
The current global pandemic of the coronavirus (Covid 19) shows how ill prepared we are to manage a pandemic, despite the scenario planning for such an event by the WHO. And it is only now that the 7 key strategic actions from the WHO position paper of 2005 are being recognized and implemented with conviction.
However, the radically different responses across countries at a governmental level belie much deeper problems. Nationalistic xenophobia (US President blaming the Chinese), the stupidity and cultural arrogance of the British government’s ‘herd immunity’ approach, and the nationalistic usurpation of democracy by Hungary’s Prime Minster under the guise of ‘fighting Covid 19. These examples among many remind us that the self-aggrandizement of the powerful takes precedence over the rest of us.
Neglected health care systems in the rich and poor countries haven’t had enough funding for decades to be ready and able to cope in a pandemic, despite the earlier warnings from the WHO. The populations of the world’s richest country (The United States of America) and the world’s poorest country (Liberia), and those in between suffer in relative equal measure, because the current global system of predatory capitalism has never prioritized health and well-being of the world’s population. We are ill-prepared in times of a global health pandemic like Covid 19.
So, a more pertinent and relevant ethical question is: Why have people in power been so neglectful of the health and well-being of their populations? The answer is our leaders have treated the rest of us as a simple means to their ends, not as a greater means to a greater end, which of course is the happiness and well-being of their respective populations. Had it been the latter, no doctor would have to make a choice today between who lives and who dies because there aren’t enough ventilators, hospital beds or trained medical personnel to aid the ill and infirm. The world suffers today because of the hubris of a significant number of people within its political and global leadership.
World Health Organization. (2005). WHO strategic action plan for pandemic influenza 2006–2007. Geneva: World Health Organization.