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“We Cannot Abandon Anyone”

The coronavirus crisis has posed previously unheard of challenges for our society and at the same time confronted it with wide-ranging ethical conflicts. On the one hand, there is the matter of tackling and containing the pandemic. On the other hand, the social and economic consequences, including restrictions on freedom and compulsory closures, have to be observed and constantly reassessed. Last but not least, there is the pressing question of who receives access to intensive care in a crisis and who doesn’t. In order to provide guidelines for making these difficult decisions, the German Ethics Council has published an ad hoc recommendation paper titled “Solidarity and Responsibility during the Coronavirus Crisis”. Renowned brain researcher Prof. Katrin Amunts of Jülich’s Institute of Neuroscience and Medicine is Vice-Chair of the German Ethics Council and explains the recommendation’s key points in the following interview.

Prof. Katrin AmuntsProf. Katrin Amunts, Direktorin am Institut für Neurowissenschaften und Medizin (INM-1) des Forschungszentrums Jülich und des C. und O. Vogt-Instituts für Hirnforschung des Universitätsklinikums Düsseldorf. Katrin Amunts ist zudem wissenschaftliche Leiterin des Human Brain Project (HBP).
Copyright: Forschungszentrum Jülich / Sascha Kreklau

Where does the Ethics Council see the main ethical conflict in the coronavirus crisis?

For one thing, there is the need to avoid the danger of overloading the healthcare system, and for another, we have to prevent or mitigate what you could call the serious side-effects of the containment measures on the general public and society. This means that we have to carefully evaluate the steps taken and not lose track of the fundamental principles of solidarity and responsibility. We are faced with the question of how long and to what extent a society can cope with the restrictions that we are currently under. At the moment, most people are being patient and acting in solidarity. But we also need to make sure that they aren’t placed under excessive strain or indeed that individual groups, such as the disabled, aren’t left behind or disadvantaged.

What do politicians need to be doing, and what about scientists?

The purpose of the Ethics Council’s paper is to raise awareness among politicians and the public of the fact that every member of society has a duty to help in tackling the pandemic and its consequences and to bring the normative problems that we are faced with into focus. Scientists’ role is to provide data, facts, and advice – based on lessons learned from epidemiology, virology, and medicine, but also from mathematics, economics, law, ethics, and sociology. Ultimately, however, political decisions must be taken by those who were elected to do so. They are the ones who are responsible.

What answers to potential crisis situations in medical care does the paper provide?

The measures that have been recommended are aimed at preventing what are called triage situations in the coronavirus crisis, something which can occur in emergency medical care. In these cases, doctors have to decide which patient is treated first when there is a lack of capacity. If it is ever the case that there are not enough ventilators, a key issue is that the state is not permitted to dictate who is saved and who is not in such an extreme crisis. The responsibility for this decision rests with the medical practitioners themselves, in line with the general code of medical ethics and law. In response to the coronavirus crisis, recommendations by medical associations were adopted on 25 March that provide important guidance for doctors.

One point that we emphasized in the paper is that even in such a situation, a doctor is not permitted to decide to disconnect someone who is already on a ventilator, even if someone else would potentially have a better chance of survival with that ventilator. Such a decision would not be justified either ethically or legally.

The pandemic and its impact are constantly changing. What accompanying measures does the Ethics Council recommend?

The first priority at the moment is to substantially slow the spread of the coronavirus. However, in parallel with this, we also have to constantly review whether the preventive measures restricting our freedom are effective and whether they are still necessary and appropriate. We also have to define criteria for deciding when and how we can return to something approaching a normal social and private life. Along with these major priorities, the end of the paper contains a list of individual recommendations, including the expansion of test capacities, research on vaccines and therapeutics as well as on the psychological consequences of the pandemic, further development of models for assessing the effects in different areas and scenarios, and protection and isolation strategies for risk groups. The goal is to keep the damage caused by the crisis to a minimum in all areas.

Link to the full ad hoc recommendation: Solidarity and Responsibility during the Coronavirus Crisis