COVID-19: how bioethics can help to make the face of choice heart-rending
Sihem Neila Abtroun
Phd student in bioethics, University of Montreal
Professor of bioethics, University of Montreal
The exceptional situation caused by the pandemic COVID-19 raises challenging ethical issues in medical decision-making, political and social. In the daily, bioéthiciens can help to see things more clearly.
These expert interdisciplinary are trained to analyze the ethical issues specific to the worlds of health care (health care, public health). In these times of crisis, they are called to express themselves on issues related to the allocation of resources or to the quarantine of populations.
They guide and criticize, when necessary, the government’s initiatives. By doing this, they help journalists and the public to better understand the justifications and limitations of various constraints to which we are subject, such as the restriction of our liberties in the name of the common good, and the challenges our societies are facing currently. However, even if the bioethics was more than 50 years in North America, this field of study and professional practice remains little known to the general public.
Experts in applied ethics
The bioéthiciens are experts in applied ethics, which can come from several disciplines (philosophy, social sciences, law, medicine, nursing). Interdisciplinarity is one of the pillars of this area. Although they are often perceived as thinkers feeding on large theories, they may also be led to criticize strongly the practices or decisions which go against the ethics.
However, in most cases, they have roles to support the making of difficult decisions in the health care network for care providers, on issues such as medical assistance to die, or to patients regarding the disclosure of their medical data. They also work in the ethics of research in situations where participants may be more vulnerable.
They work in many organizations, taking on multiple roles. Some are university teachers / researchers : they teach, among other things, medical ethics, professional ethics and research ethics to future professionals and health managers, as well as students of bioethics. The bioethicist professor can comment on current events in the media, sit on advisory committees and groups of experts to clarify complex issues or to help develop guidelines.
Other professionals in the bioethics work in various institutions such as the health network (clinical ethics and organizational ethics), university (ethics research, leads a manager), or the government (e.g. INESSS, INSPQ, NCCHPP). They often work in the shadows, supporting the different stakeholders, health professionals, and managers, when making organizational policies, clinical decision-making or in research.
Sometimes parapet, and sometimes a mediator, sometimes critical, the bioethicist endorse multiple roles of which the common point is to ensure the maintenance of ethical values and principles of our societies such as responsibility, justice, charity, solidarity, transparency, respect for the dignity and autonomy of human…
Lessen the burden on decision-makers
The bioéthiciens play an indispensable role in the current crisis : they must lessen the burden on clinicians and policy makers when making decisions, often difficult and unique. They must be present to support the decision-makers, without substituting for them, ensuring that they can take the best possible decisions in the situations with which they are confronted.
Currently, the bioéthiciens deal with questions of allocation of resources (masks, respirators, beds to the intensive care unit). But they also intervene in the support of managers and caregivers in the context of a crisis in which, for example, must determine how to be more respectful to deal with an overwhelming number of death in the elderly : where to store the body and how to ensure a dignified treatment of the deceased and of the family ?
Balance urgency and ethics
The bioéthiciens must also ensure the protection of participants and the proper conduct of the research as advisors in committees for research ethics. However, with the pandemic of the Covid-19, the emergency comes to be confronted by the usual rules of research. The world needs quickly treatments and a vaccine, but clinical research in this context raises a multitude of ethical issues.
The case of the French professor Didier Raoult and his research related to the use of chloroquine is a good illustration of the ethical debate being publicized. Its therapeutic trials have triggered a great deal of controversy and public debate. Several scientists have expressed reservations about the effectiveness of this treatment and the case has even become a policy issue.
Of course, it is important that the research is advancing quickly. But this requires a rigor and increased monitoring, since any failure would result in not only a loss of time, but also risks serious consequences for the participants. The bioéthiciens, therefore, must ensure the observance of ethical standards and conduct, taking into account also the risk of moving too slowly in a context of health crisis.
The bioethicist academic, meanwhile, can act as a thinker, teacher, and guide to awaken the consciousness, by analyzing and criticizing issues related to the major issues of society. He retains his academic freedom, which allows him to bear a critical eye on the social decisions and policies, for example the lack of transparency of the government on its various scenarios déconfinement, or the use of the applications of smart phones and geo-location to identify and track down individuals, and isolating the individuals carrying it.
In governmental organizations or in the health network, the bioéthiciens – as employees of the State – do not have the same freedom of expression. However, they must answer specific questions and to play the role of guide and guard-crazy in their institutions.
In the current crisis, they have to react quickly and provide decision frameworks relevant (for example, to manage moral distress or the yard) in order to guide and facilitate the implementation of intervention plans that will be both effective and ethical.
The pandemic of COVID-19 has revealed the importance of bioethics, its diversity and its relevance. This profession is a complex mosaic and interdisciplinary. What may seem like barriers are, in fact, of the bridges linking the whole of the profession. In fact, the bioéthiciens play a supporting role and as a catalyst to orient all of the parties with which they interact, while retaining their critical spirit in the service of the company.
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This text first appeared on the website of the franco-canadian of The Conversation. Reproduced with permission.