What Happened to Ethics During the Pandemic?

The aims of the UK COVID-19 Inquiry are far-reaching. They include:

preparedness and resilience;
how decisions were made, communicated, recorded, and implemented;
decision-making between the Governments of the U.K.

However, the Inquiry does not specifically intend to address two fundamental questions: Why was the Government’s action plan and the detailed planning document on which it was based disregarded? And why were ethical considerations not factored in when decisions of fundamental social importance were being made?

The policy documents are clear enough. For example:

There is similarity between COVID-19 and influenza (both are respiratory infections), but also some important differences. Consequently, contingency plans developed for pandemic influenza, and lessons learned from previous outbreaks, provide a useful starting point for the development of an effective response plan to COVID-19.

The U.K. Influenza Preparedness Strategy 2011 includes 14 references to ethics, yet ethics was never mentioned in any Government briefing by its expert advisers.

Section 3.3 of the Preparedness Strategy states that pandemic preparedness and response will “continue to be based on both evidence and ethical principles”. Section 3.19 says:

People are more likely to understand and accept the need for, and the consequences of, difficult decisions if these have been made in an open, transparent and inclusive way. National and local preparations for an influenza pandemic should therefore be based on widely held ethical values, and the choices that may become necessary should be discussed openly as plans are developed, so that they reflect what most people will accept as proportionate and fair.

This recommendation was itself based on a Department of Health ‘ethical framework’ drawn up in 2007. One section of this document says:

Those making decisions will:

involve people to the greatest extent possible in aspects of planning that affect them

take into account all relevant views expressed

try to ensure that particular groups are not excluded from becoming involved. Some people may find it harder to access communications or services than others, and decision-makers need to think about how to ensure that they can express their views and have a fair opportunity to get their needs for treatment or care met

take into account any disproportionate impact of the decision on particular groups of people.

Section 4.3 is ethically explicit:

During a pandemic, the Government will need to make final decisions and issue advice on the application of specific measures in the light of emerging scientific evidence and data. In doing so, the ethical framework and in particular the principles of precaution (which assists in ensuring that harm is minimised), proportionality and flexibility will apply throughout. No additional restrictions, such as restrictions to public events will be placed on the public unless it is absolutely necessary to protect the health of the public and then only for so long as it is appropriate.

Yet the measures taken during the pandemic – two national lockdowns, allowing spectator sport only behind closed doors if at all, confining students to Halls of Residence, closing leisure facilities for months, banning all but ‘essential travel’, severely restricting attendance at funerals, prohibiting visits to dying relatives in care homes, closing schools and mandating the use of ineffective masks – did not by any stretch reflect “widely held ethical values”, or support the “continuation of everyday activities”. Nor were the measures “proportionate”, “fair”, “inclusive”, “transparent” or egalitarian under any reasonable understanding of these terms.

The reasons for such an extraordinary overreaction have been considered at length in this and similar publications. But perhaps at bottom it is disturbingly simple. Annexe B of the action plan offers a possible insight:

The U.K. health departments’ preparations and response are developed with expert advice, ensuring that staff, patients and the wider public can be confident that our plans are developed and implemented using the best available evidence. These groups include:

the Scientific Advisory Group for Emergencies (SAGE) – chaired by the Government Chief Scientific Adviser and co-chaired by the CMO for England – provides scientific and technical advice to support government decision makers during emergencies, ensuring that timely and coordinated scientific advice is made available to decision makers to support U.K. cross-Government decisions in the U.K. Cabinet Office Briefing Room

the New and Emerging Respiratory Virus Threats Advisory Group (NERVTAG) is an expert committee of DHSC and advises the CMOs and, through the CMOs, ministers, DHSC and other Government departments, and the devolved administrations. It provides scientific risk assessment and mitigation advice on the threat posed by new and emerging respiratory virus threats and on options for their management.

The annexe continues in a similar vein, listing the Advisory Committee on Dangerous Pathogens (ACDP), the Scientific Pandemic Influenza Group on Modelling (SPI-M), the Joint Committee on Vaccination and Immunisation (JCVI), FCO Travel Advice and tellingly concludes with: “The actions we are taking to tackle the COVID-19 outbreak are being informed by the advice of these committees.”

But not by anyone experienced in ethics, or indeed any non-quantitative form of decision-making. Perhaps the cause of the massively disproportionate response to a mostly harmless virus was simply that few if any of the key decision makers understood the nature and importance of ethics, human rights and the moral basis of liberal society.

If so, then it is of paramount importance that the Inquiry makes balanced recommendations in this regard and insists on a far wider focus in future.

Dr. David Seedhouse is Honorary Professor of Deliberative Practice at Aston University and the creator of Our Decision Too, a free website of participatory democracy which welcomes new members.