An Institute for Civil Services

#01

IAS Mains 2020

Mentorship

COVID – 19
&
Ethical Issues
1. ETHICAL ISSUES INVOLVED IN 5. Role of Corporate Organizations in
COVID 19 fighting against COVID-19
2. Ethical Dilemmas 6. Civil Servant’s role in period of
3. Foundational Values of Health COVID-19 in their Line of Duty
Administrators, Doctors 7. Lessons to Learn from COVID-19
4. Utility of Emotional Intelligence in Crisis
dealing with COVID -19 8. Stoicism

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COVID – 19
&
Ethical Issues

This pandemic, COVID-19 has literally opened a Pandora’s box on ethical and moral issues. We see grave compromise
of ethics in several aspects of actions taken by countries across the globe. From the actions of Italy to China and from
Papua New Guinea to Ecuador. Nonetheless we have never felt the necessity of including this subject in the curriculum
of studies across schools, colleges as strongly as we feel today.

ETHICAL ISSUES INVOLVED IN COVID 19

Triage Policy
 Triage is the name of the system that is used for world patients seeking emergency health treatment. Rather than
operating on a ‘first come, first served’ system like you would expect at a restaurant, emergency departments
in hospitals use the triage system to sort patients into categories, so that they can attend to patient who need
urgent help first. In this manner limited resources are most efficiently utilized.
 The triage system exists because, while all patients at hospital emergency departments may be experiencing
serious illness or injury, those with life-threatening and severe conditions must be treated first.
 Qs : For example, in a hypothetical case if there are 5 critical patients (a 70-year-old, a pregnant lady, a 16-year-
old cancer patient, a 25-year-old young man and a 90- year-old lady which is on death bed) require a ventilator
at the same time, and there is, in fact, a singular ventilator, who gets it?

The Protagoras Paradox

 Think about this - Should we continue lockdown for a long time and wipe out our economies or let a thousand
and lakhs of people die and keep the economies going? This dilemma will be answered by The Protagoras
Paradox.
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 According to Protagoras Paradox; whichever ways you look both have equally convincing arguments. This
Paradox is again reflecting in our current Lockdown situation. The issue is Recently Donald Trump tweeted,
‘hope the cure is not worse than the disease’. In our global attempt to flatten the COVID curve, one hopes
that we do not flatten the global economy curve.
 The dilemma is that ‘total lockdown’ to break the transmission chain, based on evidence from China, they
managed to control the spread of the virus by ruthless lock down and 3 months later they are showing that
disease is controlled in Wuhan. On the other hand, the other school of thought recommends graded isolation &
protection of elderly and very young and those with comorbidities, let it spread amongst the young and healthy,
after all the disease ultimately will be controlled when we achieve ‘herd immunity’. The medical community is
divided in these two groups. To enforce complete lockdown or Graded isolation?
 If we don’t do a complete lockdown, then according to an estimate from Many million people can be infected
and may die. Economists argue that if the lockdown continues then our medical resources will be overwhelmed,
Agriculture will suffer, food shortages will occur, production will come to a standstill. There will be an economic
crisis of proportions that the world. has not seen ever. So, they exhort to discontinue the lockdown.
 Unfortunately, the costs in either case will be huge, both lives and money. Situation is Protagoras Paradox
which has not been resolved till date.

Disaster and Medical Ethics

 Disaster ethics deals with situations in which a crisis has led to a large number of people needing medical help.
In the case of disasters, decisions must be made on who should receive services until more can arrive. Due to
COVID-19 many a times’ medical and other food material becomes scarce for the large no. of people wanting
them. Hence Ethical Principles are required for equitable distribution of resources.
 The other question crops up whether scarce medical supplies available at the time of pandemics should be
made available to front line medical doctors or to critical patients?
 Medical ethics is a system of moral principles that apply values to the practice of clinical medicine and in
scientific research. Medical ethics is based on a set of values that professionals can refer to in the case of any
confusion or conflict. These values include the respect for autonomy, non-maleficence, beneficence, and justice.
Such tenets may allow doctors, care providers, and families to create a treatment plan and work towards the
same common goal. It is important to note that these values are not ranked in order of importance or relevance
and that they all encompass values pertaining to medical ethics. However, a conflict may arise leading to the
need for hierarchy in an ethical system, such that some moral elements overrule others with the purpose of
applying the best moral judgement to a difficult medical situation.

“Human challenge Trials”

 The Human Challenge Trials (HCT) is the method of developing a vaccine for a disease. This involves intentionally
infecting volunteers with the novel coronavirus, and is being promoted in order to speed up the process of
preparing a vaccine.
 Issue of informed consent: Many times, in the past informed consent is not obtained from the volunteers
who are participating in trials. It is essential that challenge studies be conducted within an ethical framework in
which truly informed consent is given. When conducted, human challenge studies should be undertaken with
abundant forethought, caution, and oversight. The value of the information to be gained should clearly justify
the risks to human subjects. HCT appears to be in conflict with the guiding principle in modern medicine to
do no harm to humans.

Business Ethics
 Massive 145% profiteering exposed in coronavirus rapid test kits sold to ICMR. Many ethical questions have
been raised by this news.
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 At the time of such a pandemic situation what is the responsibility of corporate organizations towards society?
 Should corporate organizations charge such high Profit from sale of drugs?
 What ethical regulations should be put upon this profit-oriented organizations, so that they act in the welfare of
people?
 Answers to all these ethical questions lie in Gandhi’s Trusteeship Principle. The resources of society which are
being used by corporate organizations to earn profit belong to society. These organizations are just using them
and are trustees to such resources.
 Hence this philosophical understanding needs to be inculcated in the corporate ethical framework of these
companies. Moreover, the decision to earn 145 percent profit is morally unjustifiable according to Utilitarian
Principle (because charging high profit will lead to suffering for a large section of people resulting in their
unhappiness).

Ethical issues in state handling of migration:

 Whose responsibility is to take care of migrant laborers?
 Shouldn’t be states where laborers are working be held responsible to arrange for their welfare?
 Many laborers were plying on the roads without any means. They don’t have any food to eat. What is the ethical
responsibility of the citizen and society in helping them?
 What is the role of Emotional Intelligence & persuasion in persuading the migrant workers not to go to their
home states and rest in camps?
 Ethical issues in government handling diaspora in times of pandemic.
 Indian citizens are being charged a fee in retrieving them from Gulf States during COVID-19. Is this justified?
Also tell the ethical viewpoint of charging a fee?
 There are many Indians who are stranded in other countries where not good treatment is given to them. So,
should India use its resources to bring them back or firstly provide medical services to Indian residents?

Coronavirus Pandemic Has Become an Invitation to Autocracy

 In the name of fighting COVID, leaders at states and countries level try to usurp draconian powers, often not
related to COVID.
 The other political developments are as follows: Hungary has extended the state of emergency indefinitely
with its Prime Minister, Viktor Orban, allowing himself to rule by decree. Serbia’s President Aleksandar Vu6e has
announced an open-ended state of emergency, sidelining Parliament and enforcing some of Europe’s strictest
measures.
 The declaration of emergency is not problematic, per se — the prevailing situation demands such extreme
measures. The worrisome aspect is the unchecked power it bestows on the head of government, which allows
her/him to push forward a repressive agenda against dissenting voices and erode democratic processes that
aim to hold them accountable. The biggest casualty of this concentration of power is human rights: citizens
overnight are converted into “subjects” and compelled to surrender their rights in the name of larger public
good.

Racial Discrimination in USA in getting medical treatment:

 An example, Chicago’s African-American Black population constitutes 3o% of its total population but when it
comes to fatality rate due to COVID-19, Black African-American constitutes 7o% of total fatality (COVID-19).
This pattern is not limited to Chicago, but it is being witnessed in other states of the USA also. Such as, in New
York City, black and Latino people die at about twice the rate of the total population.
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 All these evidences point that there may be some racial discrimination in the treatment being allocated to the
COVID-19 patients. Either the poverty level or the negligence of the state administration for curing and aiding
the minority populations is unethical and against Constitutional Morality. This also puts important questions
upon Medical Ethics of the doctors and health administrators.

Is China ethically responsible for spreading the COVID-19 across

the globe?
 Why the Initial whistleblowing about the COVID was muzzled?
 Withholding of news about COVID-19 after being cognizant about the potential of the virus is Unethical and
immoral on the part of Chinese government.

What will be the ethical basis upon which the vaccine will be distributed among the
people or nations, once it is developed?
 Vaccine development is important, but, once vaccines are available, the distribution of a vaccine is also an
important ethical question. These days the distribution of masks, gloves and diagnostic kits are determined
by who pays the highest amount. This shows that the supply and demand curve cannot solve the distribution
problem. If vaccines are also distributed in a similar way, poorer countries will unfortunately get the vaccines
last.
 Some richer countries are likely to preempt and stock up on vaccines for the protection of their own citizens.
They’re able to do so because there is no regulatory force that mandates countries that develop vaccines to
share those vaccines with other countries. That’s why Bill Gates argued recently for a worldwide approach to
fighting the disease, and that the vaccine should be a “global public good”.

Ethical Dilemmas

Note:
 To answers of ethical dilemmas always priorities choices and rule one apply to solve issues and students
should try to analyses their standpoint with respect to different Ethical schools such as Utilitarianism,
Gandhian Ethics, Deontology, Constitutional Morality for ethical reasoning, etc.

The Toughest Triage — Allocating Ventilators in a Pandemic

Question: Dilemma Suppose you are a doctor in COVID designated hospital. And at the same
time, an 85-year-old lady, a 75 years old man, a 20-year-old college student, a 45
years old couple and a 30 years old foreign tourist arrive for the same disease with
prime facial similar symptoms.
(a) What would be the priority of your order of treatment?
(b) On which criteria’s, would you base your answer considering as a doctor you have
very limited time to make additional tests?

COVID-19 and Competition — The Ethical Dilemma

 Once the vaccine will be developed, who will be first to get access to it. Should the Front-Line doctors (people
of high social utility) who are fighting the battle or the critical patients be given the first shot of the vaccine?
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Question: There is only one ventilator in the hospital. The doctor has given the ventilator
to one old person whose chances of survival are poor. In the meantime, another
young man with COVID-19 symptoms comes and he also needs a ventilator. His
chances of survival are high. Should the doctor remove the ventilator from the old
man and give it to the young man?

Question: India Is Forcing People to mandatorily use Its Covid App, Unlike Any Other
Democracy. How can such a step be ethically and morally justified. What are the
ethical issues and legal issues involved?

Foundational Values of Health Administrators, Doctors

 Compassion for the patients seeking the treatment
 Maintaining rationality in providing health services to the patients so that no discrimination on basis of race,
caste, religion, class, sex can take place. Practicing Emotional Intelligence in taking tough decisions during the
time of crisis. For example, selecting one patient out of many in administering the ventilator to treat COVID.
 Observing Professional Integrity in the discharging the academic and doctoral responsibilities.
 Need for Moral courage to support the right administered
 Maintaining Intellectual Integrity in advising the politicians, so that EFFECTIVE policy can be framed to fight
COVID-19. For example, many allege that ICMR did not correctly state the community spread of COVID.

Utility of Emotional Intelligence in dealing with COVID -19

 The current COVID-19 pandemic is proving to be one of the greatest tests of emotional intelligence in a
generation. Indian civil servsants, doctors, police personnel’s, scientists, etc. all have been utilizing E.I. in their
daily lives and performing their work with highest efficiency.
 It is further seen that teams of doctors and administrators that function for COVID-19 well amidst high stress
exhibit the four foundational dimensions of Emotional Intelligence:
!! Self-awareness
!! Self-management
!! Social awareness and motivating others
!! Social skills
!! Handling relationship

Role of Corporate Organizations in fighting against COVID-19

 Selling the products at minimized profit so that large section of society is benefited. (Utilitarian and Gandhian
ethics).
 Providing technology and products which directly or indirectly help the people. Try to protect the jobs because
the same employees have worked in uplifting the company.
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Civil Servant’s role in period of COVID-19 in their Line of Duty

 There were many instances in the last few months which proves that Indian Civil servants handled COVID-19
fight with sensitivity, professionalism and integrity. Handling of COVID crisis has reassured that the steel frame
of our country, the civil service, is intact and has even strengthened over time.

Note:
!! Try to think of the associated values of public servants being shown in these acts which are
mentioned below.

Some examples
 Policeman walks for 450 km from Kanpur to Jabalpur to join duty (Organizational commitment, Moral courage,
Integrity, loyalty, moral conscience, etc.)
 Sub-inspector Mamata Mishra despite being eight months pregnant worked at Betnoti police station in Odisha
to perform her duty at the time of crisis.
 Meghalaya IAS officer, Swapnil Tembre is ensuring that no daily wage worker, migraine worker goes to sleep
hungry in his district. He is taking help of Community, NGO, SHG
 Narendra Kumar Singh, a commandant at (CRPF) at Maoist-affected Rayagada district called 200 poor villagers
lived around the camp and gave Rs 500 each. There are scores of such stories. The main issue is to appreciate
their commitment to duty and their values.
 In Italy, a 72-year old Italian priest gave up his ventilator so that the same may be used to save the life of a
younger patient, while in Belgium, 92-year-old Suzanne Hoylaerts refused to take a ventilator, asking instead
that the same be used for a younger patient.

Lessons to Learn from COVID-19 Crisis

 Due to human led destruction of forests and wildlife resulting in as we have intruded into the wild ecosystem
and we disturbed the Flora Fauna balance. The result of this intrusion is Zoonotic diseases like corona
 Regulation of the Animal wet markets especially in the places where animal’s blood is being mixed with.
 As Churchill famously said, ‘Never let a good crisis goes to waste’. India needs to learn lessons from COVID-19
regarding maintaining hygiene etiquettes, maintaining personal health based behavioral regulation in social
perspective, etc.
 India needs a Pandemic response that combines both ethics and economics as tools.
 Need for framing pragmatic and holistic Triage policy for treating patients during times of pandemics.
 Evolving an Ethical and Rational policy for distribution of societal and medical resources during any pandemic
emergency.

Stoicism
In challenging times like today, one can adopt Stoic Principle of tranquility; i.e. not to allow one’s inner
peace to be disrupted by outside events. It involves: -
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 Negative visualization: This involves imagining what life would be like without the people or things we love,
to help us appreciate what we have more. Instead of being upset about the current pandemic situation. We find
small gifts in it. Eg. More family time, time to work on a hobby etc.
 Focus on what we can control: It helps us to accept and adapt when things go out of our control.
 We have very little control over the death rate and the spread of the virus. But we can control and influence
over what we do, contribute to the problem or become part of the solution.
 The hidden joy in abstinence: It means to abstain from things that we enjoy or indulge in so that we appreciate
them more when we do get to enjoy them.
 We can reflect on what we enjoy most about things we are not allowed to partake in right now, and keep a list
of things that you will appreciate about each once you get to do them again. Like going for a coffee, hanging
out with friends etc.
 Fellowship and the purpose of life: Strong relationships are critical to a good life.
 Social isolation is teaching us how much we need other people and that we can be service in the simplest of
ways
 Sense of Humour: Break the tension in a serious argument by refocusing on what is funny about the situation.
Learn not to take things personally
 Being in close proximity to our family members can be challenging at times. It is important to use humour to
our advantage.
 Path to happiness: Only sure path to happiness is not living a life of self-indulgence but rather a life of self-
discipline.
We must reflect on what matters most to us and who you want to become as a result of the current
challenges. We must spend our time wisely by pursuing those things that align with our ultimate goal
or most important values in life.

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