As the world faces the unprecedented effects of the COVID-19 coronavirus pandemic, thorny moral questions are arising.
From every level and sector of society, people are asking: What is the right thing to do?
From mundane issues such as how much toilet paper is too much toilet paper, to the life-and-death decisions being made in hospitals in northern Italy, ethical dilemmas abound.
Joseph Meaney is the president of the Philadelphia-based National Catholic Bioethics Center, and he told Crux that the Catholic moral framework is “centered on willingness to make sacrifices for others.”
What follows are excerpts of his conversation with Crux.
Crux: First of all, this is probably the most drastic international event since World War II – with huge sacrifices being asked of people. Are these sacrifices justified?
In a word yes. The Catholic moral framework is centered on willingness to make sacrifices for others. There are many people whose lives can be saved by taking extraordinary measures. These strong measures are justified and even necessitated by the real potential for overburdening the health sector, especially intensive care capacities, in various countries.
It has to be said, however, that effectively shutting down huge sections of modern economies comes at a tremendous cost. The ethical analysis of what we should do as societies needs to take into account the potential for more deaths resulting from the loss of employment and the economic hardships and potential civil disorder that will result from an extended disruption of the normal activities of nations.
One of the problems associated with the COVID-19 pandemic is the large number of hospitalizations which – as we see in Italy – can overwhelm healthcare systems. This leads to major ethical questions, primarily: Who gets help? What must be taken into consideration when making these decisions.
There is a medical-moral duty to deliver care, so no one should be refused medical help. The agonizing problem that is currently confronting Italy, and potentially other countries soon, is that certain very intensive therapies cannot be given to more than a certain number of patients at a time. There are only so many ventilators available, for instance. A just form of triage may need to be put in place. The medical term “triage” refers to sorting patients on the basis of their immediate treatment needs while keeping in mind their chances of benefiting from available therapies.
Succinctly speaking, objective criteria must be used to give the most limited intensive therapies to those most in need who can still benefit from them. It is tragic when a patient has so many organ system failures that they are extremely unlikely to survive, and it would also be wrong to prioritize these patients for the limited number of ventilators over other seriously ill patients who would likely survive if given this chance. Similarly, it would be unacceptable to place a patient on a ventilator when they could clearly survive without one and when others are at grave risk of death if they cannot receive this medical care.
I add that everything must be done to increase the quantities of scarce medical equipment that is needed at this time. Also, compassionate care, including pain medication, must be provided to all patients, even if they cannot receive all the therapies we would wish to provide.
COVID-19 disproportionately affects the elderly. The median age of fatal cases in Italy is 79.5. However, there are still a large number of younger people needing ventilation in the hospital as they recover. This has led to some proposals to refuse ventilators for people over a certain age. Given the limit of resources, and the relative expectation of recovery based on age, can that be ethical?
No. It would not be ethical to triage a person out simply on the basis of their age, disability, sex, etc. It is true that some elderly patients may not meet objective criteria for ventilator access in a crisis situation because they are dying and it is impossible to save them, but that can also be true of younger patients. We have to be very mindful of not discriminating. The slippery slope goes downhill very rapidly once one starts on that road.
Another issue we have seen is the empty supermarket shelves. Can you comment on how to draw the line between preparedness and hoarding?
It is a big problem in some locations. It goes from the objectively silly — people buying a year’s supply of toilet paper — to a dangerous anti-social activity, where people snap up all the medical facemasks that are most needed for emergency workers.
We should prepare in a reasonable way for our family’s needs, but it is clear that “panic buying” is a threat to the common good. Governmental and other institutions have a duty to prevent people from hoarding by limiting the quantities that can be purchased of certain items.
Very fortunately, in most places there is no real structural shortage of basic goods, only a temporary disruption caused by the selfishness and panic of individuals acting in a rather irrational way. Catholics , in particular, need to ask themselves: Do I really need this, or this much? I wrote an essay on this topic posted on the NCBC website: Our Better Angels.
What about on an international level? China, for example, has been reluctant to ship masks. If a country develops a vaccine, are they allowed to prioritize their own citizens, even if another country might be more in need?
It is true that “charity begins at home.” We have a greater moral obligation to help our close family members than strangers who are further removed from us. On the other hand, that which can be beneficial to all of humanity, like a new effective vaccine, should not be hoarded either. Finding the right balance can be tricky. It would be wonderful if humanitarian actions triumphed over selfishness or greed. Also, people will remember which countries and institutions displayed generosity in times of need and which did not.
This has been especially difficult for those wanting the Sacraments. What pointers should Church leaders keep in mind during this period?
Our Catholic faith is very clear on a fundamental point. Our eternal destiny is much more important than our physical lives. The martyrs chose to suffer death rather than violating their religious beliefs and consciences.
There is no greater charity or religious duty than to help a dying person with the last rites. Some institutions have made it extraordinarily difficult for priests to access those who are dying. That is a very grave violation of religious liberty. Safety precautions should be taken, but there is no more important caregiver to a believer at the end of their earthly journey than a priest.
Creative solutions need to be found. Yes, it can be dangerous to have a large crowd gathered together in a restricted space for a Mass. Can more Masses be said with a limited number of people admitted? Poland is trying this. One American priest in Oklahoma celebrated a Mass outside with loudspeakers and the faithful staying in their cars and following along from the parking lot. Along similar lines, drive-by confessions were being celebrated by one priest.
It is clear that people need more spirituality, not less, in times of pestilence. We have to place as high a priority on access to the sacraments as we do with other vital life-sustaining institutions, like grocery stores. After all, man does not live by bread alone…
Many internet initiatives are beautiful. We have the opportunity to “attend” Mass online and to make a spiritual communion if we cannot go in person.
I was very moved by the news coverage of priests going out with monstances and blessing cities with the Blessed Sacrament. One priest was even taken up in an airplane and blessed his whole country from the air!
Finally, what can history teach us? Many similar issues happened during the Spanish Flu pandemic a century ago – church closures, quarantines, etc. – and even present-day Ebola outbreaks have affected life in Africa, especially.
Yes, it is astonishing how little cultural memory there is of the Great Flu of 1918–-1919 that killed far more people than World War I. It is a fact that the cities that put into place strong preventive measures had far lower mortality rates than those where the authorities allowed parades and ordinary life to continue while the virus was spreading.
We must heed the lessons of history. Sometimes people are their own worst enemies when they do not act rationally. In those circumstances, the common good must be defended by governmental and other authorities. We unfortunately live in a particularly individualistic and hedonistic age.
There is an added problem. Many people rebel at the notion of having some of their liberties curtailed or not being able to indulge certain pleasures, even if there are objective reasons for the restrictions. It may be more than a simple coincidence that what public health authorities are telling us to do is falling during the liturgical season of Lent when we are called to do penance and make sacrifices.
Follow Charles Collins on Twitter: @CharlesinRome
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