Hello, I'm Katrien Devolder. This is thinking out loud conversations with leading philosophers from around the world on topics that concern us all.
This is a special edition on ethical questions raised by the Corona pandemic.
In this interview, I talk to philosopher César Palacios-González
who helped develop Mexico's recently published federal guidelines for deciding who gets to access scarce medical resources like ventilators.
In the case of COVID-19, developing these guidelines was not a simple task.
Influential philosophers denied the need for such guidelines, and the presence of widespread corruption and racism in Mexico created extra
hurdles. To start with it would be good if you could just describe the situation,
the current situation in Mexico. Mexico actually had its first confirmed case of coronavirus on the 28th of February and then on the 21st of April,
actually, they declared something that Mexico,
it's called phase three of the pandemic means that the community transmission of the COVID disease actually starts going up very, very rapidly.
So they have social distancing measures at the moment, laws many sectors of the economy have it stopped.
Actually, they are expanding very rapidly or as fast as they can.
Hospital capacity, already 11 hospitals in Mexico City are completely full.
There's no more capacity for beds. 10 more hospitals are almost full.
And then all the other hospitals actually are getting to the same status affecting completely full.
So that means that actually we're not even close to the peak by far.
And the situation is already dire in terms of the health care system.
The death rate in Mexico probably will be very, very high.
So you helped draught the federal guidelines for a resource allocation,
but you couldn't just copy existing guidelines because Mexico poses particular challenges.
So could you tell us a bit more about the particular challenges faced by Mexico and how this affects the draughting of the guidelines?
One of the things that makes the Mexico case interesting is that any kind of guidelines actually should not run afoul of Mexico's human rights law.
So there could be no mention, at least not explicit mention of age,
as a criteria for actually discerning between patients and location of research that doctors should not discriminate patients
according to social or they will think that it's the social value of patients just in general day to day lives.
It is likely that sometimes there are not enough ventilators, just in a regular hospital in Mexico City.
And then when doctors are faced with these, I know from experience because I used to work as a paramedic in Mexico for a long time,
the doctors will say, well, but they have to choose between these two patients.
And then it seems that actually both of them have the same probability of survival.
And then they will say, OK, let's I think actually this patient has family or actually it's more productive or it looks that
actually he has more social value and then they will allocate their resources to him or her.
So when we've dropped these guidelines, actually,
we had to pay a lot of attention to to emphasise that doctors they shouldn't take into account perceived social value.
So in addition to this perceived social value, that we also have a very entrenched problem of racism in Mexico.
Actually, how it works there, at least in general, is that people would assign certain value to certain kinds of his skin colour.
So they will. Oh, yes, of course. White people are they work harder.
Or actually, they are better educated. They are.
And then, of course, all those things also enter into deep consideration about resource allocation.
When we thought about the guidelines, we actually stressed a lot that those types of things shouldn't be taken into account.
Another thing that, for example, Mexico, Mexico, corruption is widespread.
We were very worried that people, affluent
People will actually try to pay their way into ICU for them or for their families.
They will try to go like to upper management if they know someone there or they will
resort to actually trying to offer money to someone like that is looking after patients.
It would be kind of nonsensical just to write don't take bribes,
so actually what we did there, we tried to justify it in very clear terms why certain way of allocating resources should be followed.
that we've seen the Mexican context it's understood as actually trying to avoid these type of people actually getting themselves into ICU.
But of course,
I mean, I'm not sure it happens here in the U.K., but in Mexico, a lot of professionals philosophers actually have weekly columns in newspapers.
So most of them actually have been publishing about, for example, why these are random allocation in this particular set of circumstances is
a very grave moral mistake.
So they said if you have someone that actually is in prison and someone did this out of prison, who should you benefit?
Who should receive that research?
They were posting it as a serious question, as if being an inmate should rule this person from receiving scarce medical resources,
even when it is deeply problematic in general terms, in this specific context in Mexico where the legal system simply doesn't work.
It's even worse. Very important philosophers like like one of the former head of the most important
research institute actually votes against having any kind of guidelines.
And then a lot of philosophers, actually scientists,
philosophers and bioethicists shouldn't publish any kind of guidelines in terms of resource allocation.
They were worried about philosophy like legitimising certain kinds of research publications.
And on the other hand, they said like actually philosophy. It shouldn't be involved with these particular matters actually.
It's just a medical situation, which is very, very, very, very odd.
I think in stark contrast. Whereas these philosophers actually were saying no philosophers, philosophy,
bioethics, medical ethics shouldn't be involved with draughting guidelines.
We have the medical associations actually telling those yes,
Guidelines would be super helpful.
That was particularly challenging because at the same time, draughting the guidelines we have to defend in the media.
And we had to actually present tons of reasons in the public sphere about why the guidelines were important.
And you have confidence in the fact that most health workers and doctors,
et cetera, will actually follow the guidelines. Within in every hospital in Mexico
There is a bioethics group. Those particular groups are in charge of socialising the guidelines within their hospitals.
And we know that every hospital has one of those. So we would hope that actually the guidelines will be followed.
So but as I said, it's it's a it's very difficult in Mexico.
And then it's suddenly for many places, the guidelines will just, don't matter because they're hospitals with no functioning ventilators.
There are places where there are no hospitals in kilometres.
And then that means. As I said that we were worried about corruption.
We were worried about discrimination and then how that affects health care settings where there are these resources.
But certainly for many other places, there are no resources. So that means that thinking about the pandemic,
as many other people have said in low and middle income countries, actually presents its particular challenges.
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