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We made a deliberate decision to save money on public services.

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Strip them to the bone. And now we turn around and we expect miracles and people sacrifice their lives.

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And we applaud them. And all of this is just offensive, frankly. Hello, I'm Katrien Devolder.

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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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Working on the frontline of a corona virus pandemic is dangerous.

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In the UK more than 100 care workers have died from COVID-19.

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Some of these deaths could have been prevented. These workers would have access to PPE personal protective equipment.

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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.

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So do they have a moral obligation to keep working?

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I will talk to Udo Schuklenk, professor of philosophy at Queen's University, about this important topic.

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So you think that it's ethically acceptable for care workers who lack PPE to stop working but aren't,

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for example, doctors under a moral obligation to provide care even in times of a crisis?

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I mean, don't they take an oath for that? Well, that's a very good question.

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What we're really asking is whether doctors, health care professionals generally,

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by virtue of being professionals, whether they have a professional obligation to provide care.

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So when you think back about what it means to be a professional, you're right.

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Doctors in particular, you know, they do this modern version of the Hippocratic Oath,

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which is usually modelled on the Declaration of Geneva, a document produced by the Medical Association and   indeed

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I mean, it is a document where they're saying patient comes first. Basically we promise to serve the public good by our actions,

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but of course not to the point of their own actions or the risk that they are taking being super rogatory.

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Extraordinary. The question then, of course, is what constitutes extraordinary or superior rogatory or whatever you want to call it.

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You could approach this different ways, right?

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You could look at traditions of how doctors actually have behaved in comparable or even worse emergencies.

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Think about the Ebola virus outbreak in West Africa in 2014/15.

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I'll go back to the bubonic plague or any number of other of other pandemics,

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basically, and look at what doctors have done in all of these incidences.

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Every single one. That response has been very idiosyncratic, very individualistic.

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Some literally took to the hills and tried to protect themselves and their loved ones and others indeed sacrificed their lives.

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And it has been anything in between.

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So just doctors behaviour in the past does not answer that question that you can look at the issue of what are their values?

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And you will again, of course, have to result in two documents like the Declaration of Geneva.

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And you will find that until. Don't hold me to the mid 1980s or mid 1990s.

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There are they promised without any ifs and buts that in case of emergencies, they would be there for their patients.

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Quietly, they have removed that, the medical association. So. So it isn't there anymore.

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There's nothing that would suggest that doctors as far as they themselves are

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concerned and they themselves understand their values and their traditions, that whatever, that they have these kinds of obligations.

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So then you could look at something more recent in the west and the global north where we are right now.

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And you could probably well, you should, I think, look at what happened with regard to HIV AIDS.

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HIV AIDS for for many years was life threatening.

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Those infected, unless they got access to antiretrovirals and they didn't exist at the beginning for many years, their diet.

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So doctors, nurses, in fact dentists for instance too were super concerned that they might pick something up from patients.

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And many of them questioned were there any obligation to provide care.

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In those days the view was held by professional associations like doctors associations,

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nursing associations and statutory bodies that in fact they had an obligation to provide care.

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And the reason for that was that people at the time looked at the question of whether doctors and nurses could protect themselves.

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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.

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So the view was basically help that if they practise universal precautions, they will be fine.

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They can protect themselves and therefore they have an obligation to provide those professional services.

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And now let's look at this coronavirus thing. There's something very different is happening.

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The risk of death is significantly lower than HIV AIDS. However, it's also much more infectious.

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Way more doctors and nurses have already died all over.

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And you mentioned in the UK more than a

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Hundred. In Italy, it's more than 100 doctors alone in the US.

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Similar numbers. And the numbers are creeping up and up and up and up. What exacerbates this is the lack of protective equipment.

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And this is why I had to view what I could, at least publicly, that health care professionals have no such obligation.

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If personal protective equipment is unavailable to them. Because then they can't protect themselves and then their actions are super rogatory.

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Now you could say, well, fair enough. But you know what?

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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.

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I think that argument actually is mistaken.

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The argument is mistaken because the reason why personal protective equipment is not available to them, it's not a fluke of nature.

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It's not something that wasn't preventable.

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Instead, it was a human made activity, was a direct result of health care systems in neo liberal capitalist societies,

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trying to reduce costs, trying to be lean, trying to be efficient.

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When you think back about all these politicians in the U.K.,

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you had austerity affecting the NHS for God knows how many years, but no policies since Thatcher.

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In fact, the same is true across Europe. Right. And across the United States and Canada where I live.

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I mean, pick any country really in the global north. A little democracy is the same issue.

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What I'm arguing is that. What really led to the lack of personal protective equipment was the decision by

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electorates really to elect governments that would ultimately reduce the taxes,

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put more money into the back pockets, as it were, because campaign more of these kinds of organised of political parties was always,

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we know best what to do with our money, as it were. Well,

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now we have our money and health care professionals have no equipment because that's the direct consequence

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of not resourcing health care systems adequately and running low tax regimes all over the world.

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So to turn that around a society and say, hey,

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you doctors and nurses and cleaners and hospitals who sacrificed their lives for us because we were too stingy to equip you appropriately.

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That seems seems impossible. We made a deliberate decision to save money on public services.

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Strip them to the bone. And now we turn around and we expect miracles.

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And people sacrifice their lives. And we applaud them. And all of this is just offensive, frankly.

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So suppose that the lack of PPE was a result of a natural disaster, say an order of PPE disappeared due to an earthquake,

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then you wouldn't necessarily think that it be acceptable for doctors to just say,

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look, we're not gonna treat patients because we don't have enough protection.

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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.

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I was just wondering what the implications are of your view for people working in other essential sectors.

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I'm just thinking of a bus driver like transport or delivery services and so on.

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So does it follow from your view that it's also acceptable,

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ethically acceptable for these people to stop working if they are not provided with appropriate PPE or actually some sort of protection?

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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,

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if they are not bound by professional codes of conduct, they have no professional obligations to anybody.

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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,

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you don't owe this to anybody.

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There's really a difference with regard to professionals because they have a monopoly in the provision of particular services.

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So the public then really can't go anywhere else.

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And this is why there is a different kind of contract between professionals and society versus other workers.

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And I'm not minimising the importance of the work that they are doing and they should be paid better.

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That's a different argument. What I'm saying is because they're not monopoly providers of these services.

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I couldn't even see why they should have any obligation other than maybe a contractual obligation.

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But the kicker is, of course, because of globalisation, it's a gig economy.

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So the same way that they can get hired and fired, they can also leave if they can afford it.

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And that's always the only caveat, really.

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But beyond that, again, we should be grateful to anybody who does this, but they are under no obligation whatsoever.

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So are you saying they don't have an ethical obligation?

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The doctors, the healthcare workers, the social workers don't have an ethical obligation to keep working.

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But does that also imply that they shouldn't get fired?

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If they stop working. They shouldn't lose their jobs for refusing because none of us would lose their

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jobs if you refuse to basically sacrifice our lives while we do the job.

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It's a bit like saying, hey, you know what,

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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.

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Right. Well, too bad we don't have this, but go in there anyway if you don't make it.

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Well, tough. It's all we could afford. This is not how that works.

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So, of course, they should be protected. I was pleased to see, in fact, that the the what is it called?

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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,

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say their members are under no obligation whatsoever to provide these services.

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And if anybody fires them, they are going to sue over that.

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And then I was pleased to see that, to be honest, because that is an appropriate response, then.

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Yeah, maybe one more question is about further implications of your view.

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So it's one thing to say that it's ethically acceptable to stop working under these circumstances.

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I think that's really important, but it clearly can't be the end of the discussion,

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because even if it's ethically acceptable for them to take that decision to stop working,

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I mean, they still carry an enormous moral burden, I think, because they know that due to their decision.

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I mean, people extra people may die or people will suffer. They also abandon their colleagues in a certain sense.

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So it seems like us saying, look, look, it's ethically acceptable for you to do that.

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It's good, but it's just far from enough. I mean, we should sort of ensure that these

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People never, ever end up in a situation where they have to take that decision.

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I think that I think that's. Do you agree with that, that it's there's more.

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Well. Well, yes, of course. I mean.

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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.

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You can't expect high quality public services and not pay for those.

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And that's sort of the end of it all. And one would hope that when this is all said and done,

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that people understand that there is a direct connexion between low taxes and these kinds of disasters.

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I think we should really reconsider this whole thing and don't get too excited when somebody offers to cut our taxes even more.

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And we should ask, what does it mean either for the most vulnerable in this particular case, really otherwise well-paid health care professionals?

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This is, I think, the lesson that we need to learn from this, that this was a non-starter, this whole thing.

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Why this would happen is a different issue. But that certainly would be my take on it.

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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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