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Hello, I'm Katrien Devolder. This is thinking out loud conversations with leading philosophers from around the world on topics that concern us all.

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This is a special edition on ethical questions raised by the Corona pandemic.

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In this interview, I talk to philosopher César Palacios-González

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who helped develop Mexico's recently published federal guidelines for deciding who gets to access scarce medical resources like ventilators.

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In the case of COVID-19, developing these guidelines was not a simple task.

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Influential philosophers denied the need for such guidelines, and the presence of widespread corruption and racism in Mexico created extra

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hurdles. To start with it would be good if you could just describe the situation,

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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,

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actually, they declared something that Mexico,

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it's called phase three of the pandemic means that the community transmission of the COVID disease actually starts going up very, very rapidly.

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So they have social distancing measures at the moment, laws many sectors of the economy have it stopped.

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Actually, they are expanding very rapidly or as fast as they can.

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Hospital capacity, already 11 hospitals in Mexico City are completely full.

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There's no more capacity for beds. 10 more hospitals are almost full.

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And then all the other hospitals actually are getting to the same status affecting completely full.

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So that means that actually we're not even close to the peak by far.

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And the situation is already dire in terms of the health care system.

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The death rate in Mexico probably will be very, very high.

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So you helped draught the federal guidelines for a resource allocation,

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but you couldn't just copy existing guidelines because Mexico poses particular challenges.

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So could you tell us a bit more about the particular challenges faced by Mexico and how this affects the draughting of the guidelines?

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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.

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So there could be no mention, at least not explicit mention of age,

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as a criteria for actually discerning between patients and location of research that doctors should not discriminate patients

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according to social or they will think that it's the social value of patients just in general day to day lives.

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It is likely that sometimes there are not enough ventilators, just in a regular hospital in Mexico City.

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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,

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the doctors will say, well, but they have to choose between these two patients.

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And then it seems that actually both of them have the same probability of survival.

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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

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actually he has more social value and then they will allocate their resources to him or her.

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So when we've dropped these guidelines, actually,

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we had to pay a lot of attention to to emphasise that doctors they shouldn't take into account perceived social value.

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So in addition to this perceived social value, that we also have a very entrenched problem of racism in Mexico.

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Actually, how it works there, at least in general, is that people would assign certain value to certain kinds of his skin colour.

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So they will. Oh, yes, of course. White people are they work harder.

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Or actually, they are better educated. They are.

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And then, of course, all those things also enter into deep consideration about resource allocation.

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When we thought about the guidelines, we actually stressed a lot that those types of things shouldn't be taken into account.

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Another thing that, for example, Mexico, Mexico, corruption is widespread.

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We were very worried that people, affluent

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People will actually try to pay their way into ICU for them or for their families.

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They will try to go like to upper management if they know someone there or they will

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resort to actually trying to offer money to someone like that is looking after patients.

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It would be kind of nonsensical just to write don't take bribes,

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so actually what we did there, we tried to justify it in very clear terms why certain way of allocating resources should be followed.

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that we've seen the Mexican context it's understood as actually trying to avoid these type of people actually getting themselves into ICU.

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But of course,

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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.

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So most of them actually have been publishing about, for example, why these are random allocation in this particular set of circumstances is

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a very grave moral mistake.

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So they said if you have someone that actually is in prison and someone did this out of prison, who should you benefit?

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Who should receive that research?

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They were posting it as a serious question, as if being an inmate should rule this person from receiving scarce medical resources,

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even when it is deeply problematic in general terms, in this specific context in Mexico where the legal system simply doesn't work.

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It's even worse. Very important philosophers like like one of the former head of the most important

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research institute actually votes against having any kind of guidelines.

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And then a lot of philosophers, actually scientists,

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philosophers and bioethicists shouldn't publish any kind of guidelines in terms of resource allocation.

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They were worried about philosophy like legitimising certain kinds of research publications.

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And on the other hand, they said like actually philosophy. It shouldn't be involved with these particular matters actually.

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It's just a medical situation, which is very, very, very, very odd.

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I think in stark contrast. Whereas these philosophers actually were saying no philosophers, philosophy,

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bioethics, medical ethics shouldn't be involved with draughting guidelines.

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We have the medical associations actually telling those yes,

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Guidelines would be super helpful.

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That was particularly challenging because at the same time, draughting the guidelines we have to defend in the media.

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And we had to actually present tons of reasons in the public sphere about why the guidelines were important.

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And you have confidence in the fact that most health workers and doctors,

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et cetera, will actually follow the guidelines. Within in every hospital in Mexico

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There is a bioethics group. Those particular groups are in charge of socialising the guidelines within their hospitals.

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And we know that every hospital has one of those. So we would hope that actually the guidelines will be followed.

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So but as I said, it's it's a it's very difficult in Mexico.

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And then it's suddenly for many places, the guidelines will just, don't matter because they're hospitals with no functioning ventilators.

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There are places where there are no hospitals in kilometres.

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And then that means. As I said that we were worried about corruption.

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We were worried about discrimination and then how that affects health care settings where there are these resources.

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But certainly for many other places, there are no resources. So that means that thinking about the pandemic,

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as many other people have said in low and middle income countries, actually presents its particular challenges.

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Thanks for listening to this thinking out loud interview. You can also watch the thinking out loud videos on YouTube.

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On the Practical Ethics Channel. And remain up to date here. The Thinking out loud Facebook page.