We made a deliberate decision to save money on public services.
Strip them to the bone. And now we turn around and we expect miracles and people sacrifice their lives.
And we applaud them. And all of this is just offensive, frankly. 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.
Working on the frontline of a corona virus pandemic is dangerous.
In the UK more than 100 care workers have died from COVID-19.
Some of these deaths could have been prevented. These workers would have access to PPE personal protective equipment.
But there's a shortage. And now doctors and nurses in the U.K. have announced that they will stop working if they are not provided with adequate PPE.
So do they have a moral obligation to keep working?
I will talk to Udo Schuklenk, professor of philosophy at Queen's University, about this important topic.
So you think that it's ethically acceptable for care workers who lack PPE to stop working but aren't,
for example, doctors under a moral obligation to provide care even in times of a crisis?
I mean, don't they take an oath for that? Well, that's a very good question.
What we're really asking is whether doctors, health care professionals generally,
by virtue of being professionals, whether they have a professional obligation to provide care.
So when you think back about what it means to be a professional, you're right.
Doctors in particular, you know, they do this modern version of the Hippocratic Oath,
which is usually modelled on the Declaration of Geneva, a document produced by the Medical Association and indeed
I mean, it is a document where they're saying patient comes first. Basically we promise to serve the public good by our actions,
but of course not to the point of their own actions or the risk that they are taking being super rogatory.
Extraordinary. The question then, of course, is what constitutes extraordinary or superior rogatory or whatever you want to call it.
You could approach this different ways, right?
You could look at traditions of how doctors actually have behaved in comparable or even worse emergencies.
Think about the Ebola virus outbreak in West Africa in 2014/15.
I'll go back to the bubonic plague or any number of other of other pandemics,
basically, and look at what doctors have done in all of these incidences.
Every single one. That response has been very idiosyncratic, very individualistic.
Some literally took to the hills and tried to protect themselves and their loved ones and others indeed sacrificed their lives.
And it has been anything in between.
So just doctors behaviour in the past does not answer that question that you can look at the issue of what are their values?
And you will again, of course, have to result in two documents like the Declaration of Geneva.
And you will find that until. Don't hold me to the mid 1980s or mid 1990s.
There are they promised without any ifs and buts that in case of emergencies, they would be there for their patients.
Quietly, they have removed that, the medical association. So. So it isn't there anymore.
There's nothing that would suggest that doctors as far as they themselves are
concerned and they themselves understand their values and their traditions, that whatever, that they have these kinds of obligations.
So then you could look at something more recent in the west and the global north where we are right now.
And you could probably well, you should, I think, look at what happened with regard to HIV AIDS.
HIV AIDS for for many years was life threatening.
Those infected, unless they got access to antiretrovirals and they didn't exist at the beginning for many years, their diet.
So doctors, nurses, in fact dentists for instance too were super concerned that they might pick something up from patients.
And many of them questioned were there any obligation to provide care.
In those days the view was held by professional associations like doctors associations,
nursing associations and statutory bodies that in fact they had an obligation to provide care.
And the reason for that was that people at the time looked at the question of whether doctors and nurses could protect themselves.
And while this wasn't a terminal illness, it's a life threatening illness. It was also very difficult to transmit or to acquire however you want to look at this.
So the view was basically help that if they practise universal precautions, they will be fine.
They can protect themselves and therefore they have an obligation to provide those professional services.
And now let's look at this coronavirus thing. There's something very different is happening.
The risk of death is significantly lower than HIV AIDS. However, it's also much more infectious.
Way more doctors and nurses have already died all over.
And you mentioned in the UK more than a
Hundred. In Italy, it's more than 100 doctors alone in the US.
Similar numbers. And the numbers are creeping up and up and up and up. What exacerbates this is the lack of protective equipment.
And this is why I had to view what I could, at least publicly, that health care professionals have no such obligation.
If personal protective equipment is unavailable to them. Because then they can't protect themselves and then their actions are super rogatory.
Now you could say, well, fair enough. But you know what?
It's an emergency. Seriously, they cannot just walk out and stay at home like everybody else tries to do as good as we can.
I think that argument actually is mistaken.
The argument is mistaken because the reason why personal protective equipment is not available to them, it's not a fluke of nature.
It's not something that wasn't preventable.
Instead, it was a human made activity, was a direct result of health care systems in neo liberal capitalist societies,
trying to reduce costs, trying to be lean, trying to be efficient.
When you think back about all these politicians in the U.K.,
you had austerity affecting the NHS for God knows how many years, but no policies since Thatcher.
In fact, the same is true across Europe. Right. And across the United States and Canada where I live.
I mean, pick any country really in the global north. A little democracy is the same issue.
What I'm arguing is that. What really led to the lack of personal protective equipment was the decision by
electorates really to elect governments that would ultimately reduce the taxes,
put more money into the back pockets, as it were, because campaign more of these kinds of organised of political parties was always,
we know best what to do with our money, as it were. Well,
now we have our money and health care professionals have no equipment because that's the direct consequence
of not resourcing health care systems adequately and running low tax regimes all over the world.
So to turn that around a society and say, hey,
you doctors and nurses and cleaners and hospitals who sacrificed their lives for us because we were too stingy to equip you appropriately.
That seems seems impossible. We made a deliberate decision to save money on public services.
Strip them to the bone. And now we turn around and we expect miracles.
And people sacrifice their lives. And we applaud them. And all of this is just offensive, frankly.
So suppose that the lack of PPE was a result of a natural disaster, say an order of PPE disappeared due to an earthquake,
then you wouldn't necessarily think that it be acceptable for doctors to just say,
look, we're not gonna treat patients because we don't have enough protection.
What people have argued in the literature that they set up, we can expect a higher degree of risk, but not to the point of self-sacrifice.
I was just wondering what the implications are of your view for people working in other essential sectors.
I'm just thinking of a bus driver like transport or delivery services and so on.
So does it follow from your view that it's also acceptable,
ethically acceptable for these people to stop working if they are not provided with appropriate PPE or actually some sort of protection?
Or do we have to think differently that this. I think there is less of a problem because there nobody's under delusions that these people,
if they are not bound by professional codes of conduct, they have no professional obligations to anybody.
So if you decide not to drive your bus anymore or you stopped delivering pizzas and you kind of felt that that's your decision,
you don't owe this to anybody.
There's really a difference with regard to professionals because they have a monopoly in the provision of particular services.
So the public then really can't go anywhere else.
And this is why there is a different kind of contract between professionals and society versus other workers.
And I'm not minimising the importance of the work that they are doing and they should be paid better.
That's a different argument. What I'm saying is because they're not monopoly providers of these services.
I couldn't even see why they should have any obligation other than maybe a contractual obligation.
But the kicker is, of course, because of globalisation, it's a gig economy.
So the same way that they can get hired and fired, they can also leave if they can afford it.
And that's always the only caveat, really.
But beyond that, again, we should be grateful to anybody who does this, but they are under no obligation whatsoever.
So are you saying they don't have an ethical obligation?
The doctors, the healthcare workers, the social workers don't have an ethical obligation to keep working.
But does that also imply that they shouldn't get fired?
If they stop working. They shouldn't lose their jobs for refusing because none of us would lose their
jobs if you refuse to basically sacrifice our lives while we do the job.
It's a bit like saying, hey, you know what,
you're a firefighter and too bad you have no equipment to protect you like something as basic, like as oxygen, for instance, and masks.
Right. Well, too bad we don't have this, but go in there anyway if you don't make it.
Well, tough. It's all we could afford. This is not how that works.
So, of course, they should be protected. I was pleased to see, in fact, that the the what is it called?
The Royal Nursing Organisation don't hold me to this but the royal contract of nursing or something in the U.K. They came in with a very strong statement,
say their members are under no obligation whatsoever to provide these services.
And if anybody fires them, they are going to sue over that.
And then I was pleased to see that, to be honest, because that is an appropriate response, then.
Yeah, maybe one more question is about further implications of your view.
So it's one thing to say that it's ethically acceptable to stop working under these circumstances.
I think that's really important, but it clearly can't be the end of the discussion,
because even if it's ethically acceptable for them to take that decision to stop working,
I mean, they still carry an enormous moral burden, I think, because they know that due to their decision.
I mean, people extra people may die or people will suffer. They also abandon their colleagues in a certain sense.
So it seems like us saying, look, look, it's ethically acceptable for you to do that.
It's good, but it's just far from enough. I mean, we should sort of ensure that these
People never, ever end up in a situation where they have to take that decision.
I think that I think that's. Do you agree with that, that it's there's more.
Well. Well, yes, of course. I mean.
I mean, you would hope that people understand as far as taxes and services so concerned that you can't have your cake and eat it.
You can't expect high quality public services and not pay for those.
And that's sort of the end of it all. And one would hope that when this is all said and done,
that people understand that there is a direct connexion between low taxes and these kinds of disasters.
I think we should really reconsider this whole thing and don't get too excited when somebody offers to cut our taxes even more.
And we should ask, what does it mean either for the most vulnerable in this particular case, really otherwise well-paid health care professionals?
This is, I think, the lesson that we need to learn from this, that this was a non-starter, this whole thing.
Why this would happen is a different issue. But that certainly would be my take on it.
Thanks for listening to this thinking out loud interview. You can also watch the thinking out loud videos on YouTube,
on the Practical Ethics Channel and remain up to date with the thinking out loud Facebook page.